2012 / 2013 Medicare Advantage Plan Information Click here to jump to the Chart Legend | ||||||||||||
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Plan Name | Monthly Premium |
Part A&B Maximum Out-Of |
Part D Deduct- ible |
(Donut Hole) Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Formulary Drugs | |||||
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
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-- This plan not offered in 2012 -- |
H0084 -050 -0 | |||||||||||
2013 Care Improvement Plus Copper RX (PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H0084 -048 -0 | |||||||||||
2013 Care Improvement Plus Gold Rx (PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H0084 -052 -0 | |||||||||||
2013 Care Improvement Plus Medicare Advantage (PPO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | |||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
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2012 Advantra Platinum (PPO) | $0.00 | $4,500 | $0 | No additional gap coverage, only the Donut Hole Discount | H8393 -001 -0 | $5.00 | $40.00 | $80.00 | $80.00 | 3,171 2012 Formulary | ||
2013 Coventry Advantra Platinum (PPO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $9.00 | $45.00 | $45.00 | 3,224 2013 Formulary | |||
2012 Advantra Silver (HMO) | $0.00 | $4,500 | $0 | No additional gap coverage, only the Donut Hole Discount | H7149 -001 -0 | $5.00 | $40.00 | $80.00 | $80.00 | 3,171 2012 Formulary | ||
2013 Coventry Advantra Silver (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $9.00 | $45.00 | $45.00 | 3,224 2013 Formulary | |||
2012 HumanaChoice H6609-004 (PPO) | $0.00 | $4,000 | No Rx Coverage | H6609 -004 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 HumanaChoice H6609-004 (PPO) | $0.00 | $4,000 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
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-- This plan not offered in 2012 -- |
H2012 -021 -0 | |||||||||||
2013 Humana Gold Plus H2012-021 (HMO) | $21.00 | $3,400 | $0 | Few Generics, Few Brands | $5.00 | $10.00 | $45.00 | $45.00 | 3,906 2013 Formulary | |||
2012 UnitedHealthcare Dual Complete (HMO-POS SNP) | $33.40 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H2803 -010 -0 | 15% | 15% | 3,614 2012 Formulary | ||||
2013 UnitedHealthcare Dual Complete (HMO-POS SNP) | $34.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,825 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H0084 -049 -0 | |||||||||||
2013 Care Improvement Plus Chrome RX (PPO SNP) | $34.60 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | |||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
-- This plan not offered in 2012 -- |
H0084 -051 -0 | |||||||||||
2013 Care Improvement Plus Dual Advantage (PPO SNP) | $34.60 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H0084 -047 -0 | |||||||||||
2013 Care Improvement Plus Silver Rx (PPO SNP) | $34.60 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | |||
2012 HumanaChoice H6609-003 (PPO) | $71.00 | $4,000 | $0 | Few Generics, Few Brands |
H6609 -003 -0 | $6.00 | $40.00 | $80.00 | $80.00 | 3,798 2012 Formulary | ||
2013 HumanaChoice H6609-003 (PPO) | $81.00 | $4,000 | $0 | Few Generics, Few Brands | $6.00 | $12.00 | $45.00 | $45.00 | 3,906 2013 Formulary | |||
Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
2012 Today's Options Advantage Plus 450F (PPO) | $82.00 | $6,700 | $75 | No additional gap coverage, only the Donut Hole Discount | H5378 -194 -0 | n/a | ||||||
2013 Today's Options Advantage Plus 650E (PPO) | $87.00 | $6,700 | $90 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $12.00 | $45.00 | $45.00 | 4,885 2013 Formulary | |||
2012 Today's Options Advantage Plus 250A (PPO) | $127.00 | $3,250 | $0 | No additional gap coverage, only the Donut Hole Discount | H5378 -188 -0 | n/a | ||||||
2013 Today's Options Advantage Plus 350A (PPO) | $132.00 | $3,250 | $0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $7.00 | $40.00 | $40.00 | 4,885 2013 Formulary | |||
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