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 ActiveSaver MSA (MSA) | $0.00 | n/a | No Rx Coverage | H9788 -003 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 ActiveSaver MSA (MSA) | $0.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 UnitedHealthcare MedicareComplete Choice (Regional PPO) | $0.00 | $4,900 | $0 | No additional gap coverage, only the Donut Hole Discount | R5342 -001 -0 | $3.00 | $6.00 | $45.00 | $45.00 | 3,614 2012 Formulary | ||
2013 UnitedHealthcare MedicareComplete Choice (Regional PPO) | $0.00 | $4,900 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $6.00 | $45.00 | $45.00 | 3,825 2013 Formulary | |||
2012 UnitedHealthcare MedicareComplete Choice Essential (Regional PPO) | $0.00 | $3,900 | No Rx Coverage | R5342 -002 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 UnitedHealthcare MedicareComplete Choice Essential (Regional PPO) | $0.00 | $3,900 | 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 -- |
H9859 -001 -0 | |||||||||||
2013 Preferred Gold (HMO-POS) | $13.20 | $4,500 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2012 -- |
H3388 -001 -0 | |||||||||||
2013 CDPHP Choice (HMO) | $25.00 | $2,500 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Today's Options Premier 400 (PFFS) | $30.00 | $6,700 | No Rx Coverage | H2816 -009 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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2013 Today's Options Premier 600 (PFFS) | $30.00 | n/a | 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 -- |
H9615 -007 -0 | |||||||||||
2013 GoldAnywhere Rx Option 2 (PPO) | $33.80 | $4,000 | $0 | Few Generics | $10.00 | $35.00 | $90.00 | $90.00 | 3,714 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H3388 -004 -0 | |||||||||||
2013 CDPHP Value Rx (HMO) | $34.00 | $3,300 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $9.00 | $45.00 | $45.00 | 3,003 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H9859 -013 -0 | |||||||||||
2013 GoldValue Rx (HMO-POS) | $41.80 | $6,000 | $0 | Few Generics | $10.00 | $35.00 | $90.00 | $90.00 | 3,714 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 Today's Options Premier 100 (PFFS) | $70.00 | $3,400 | No Rx Coverage | H2816 -025 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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2013 Today's Options Premier 200 (PFFS) | $70.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Today's Options Premier Plus 450H (PFFS) | $66.00 | $6,700 | $100 | No additional gap coverage, only the Donut Hole Discount | H2816 -021 -0 | n/a | ||||||
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2013 Today's Options Premier Plus 650B (PFFS) | $71.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $12.00 | $45.00 | $45.00 | 4,885 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H3388 -002 -0 | |||||||||||
2013 CDPHP Choice Rx (HMO) | $79.00 | $2,500 | $0 | Many Generics, Few Brands | $0.00 | $8.00 | $40.00 | $40.00 | 3,003 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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-- This plan not offered in 2012 -- |
H9859 -002 -0 | |||||||||||
2013 Preferred Gold Rx (HMO-POS) | $98.30 | $4,500 | $0 | Few Generics | $10.00 | $35.00 | $90.00 | $90.00 | 3,714 2013 Formulary | |||
2012 CDPHP Classic (PPO) | $95.00 | $2,500 | No Rx Coverage | H5042 -004 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 CDPHP Classic (PPO) | $100.00 | $2,500 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Medicare Blue PPO Plan FOUR (PPO) | $100.00 | $4,000 | No Rx Coverage | H3335 -044 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Medicare BlueBasic PPO (PPO) | $100.00 | $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 |
||||||
2012 Today's Options Premier Plus 150A (PFFS) | $102.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H2816 -027 -0 | n/a | ||||||
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2013 Today's Options Premier Plus 250A (PFFS) | $107.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $7.00 | $40.00 | $40.00 | 4,885 2013 Formulary | |||
2012 CDPHP Core Rx (PPO) | $99.00 | $3,300 | $0 | No additional gap coverage, only the Donut Hole Discount | H5042 -005 -0 | $0.00 | $9.00 | $45.00 | $45.00 | 3,064 2012 Formulary | ||
2013 CDPHP Core Rx (PPO) | $113.00 | $3,300 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $9.00 | $45.00 | $45.00 | 3,003 2013 Formulary | |||
2012 Medicare Blue PPO Plan SIX (PPO) | $140.00 | $3,500 | $160 | No additional gap coverage, only the Donut Hole Discount | H3335 -018 -0 | $8.00 | $45.00 | $95.00 | $95.00 | 4,804 2012 Formulary | ||
2013 Medicare BluePlus PPO (PPO) | $143.00 | $3,500 | $210 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $45.00 | $95.00 | $95.00 | 4,989 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 CDPHP Classic Rx (PPO) | $145.00 | $2,500 | $0 | Many Generics | H5042 -001 -0 | $0.00 | $8.00 | $40.00 | $40.00 | 3,064 2012 Formulary | ||
2013 CDPHP Classic Rx (PPO) | $159.00 | $2,500 | $0 | Many Generics, Few Brands | $0.00 | $8.00 | $40.00 | $40.00 | 3,003 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H9615 -002 -0 | |||||||||||
2013 GoldAnywhere Rx Option 1 (PPO) | $192.00 | $2,000 | $0 | Few Generics | $8.00 | $35.00 | $90.00 | $90.00 | 3,714 2013 Formulary | |||
2012 CDPHP Prime Rx (PPO) | $199.00 | $2,000 | $0 | Many Generics | H5042 -007 -0 | $0.00 | $5.00 | $40.00 | $40.00 | 3,064 2012 Formulary | ||
2013 CDPHP Prime Rx (PPO) | $228.00 | $2,000 | $0 | Many Generics, Few Brands | $0.00 | $5.00 | $40.00 | $40.00 | 3,003 2013 Formulary | |||
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