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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2012 Presbyterian MediCare PPO Plan 1 (PPO) | $49.00 | $3,000 | No Rx Coverage | H3206 -003 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Presbyterian MediCare PPO Plan 1 (PPO) | $52.00 | $3,000 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Presbyterian MediCare PPO Plan 2 with Rx (PPO) | $86.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H3206 -001 -0 | $5.00 | $40.00 | $75.00 | $75.00 | 2,561 2012 Formulary | ||
2013 Presbyterian MediCare PPO Plan 2 with Rx (PPO) | $90.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $40.00 | $40.00 | 2,664 2013 Formulary | |||
2012 Presbyterian MediCare PPO Plan 3 with Rx (PPO) | $107.00 | $3,000 | $0 | Many Generics | H3206 -002 -0 | $5.00 | $40.00 | $75.00 | $75.00 | 2,561 2012 Formulary | ||
2013 Presbyterian MediCare PPO Plan 3 with Rx (PPO) | $118.00 | $3,000 | $0 | Many Generics | $2.00 | $8.00 | $40.00 | $40.00 | 2,664 2013 Formulary | |||
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