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 Empire MediBlue Essential (HMO) | $0.00 | $3,400 | No Rx Coverage | H3370 -019 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Empire MediBlue Essential (HMO) | $0.00 | $4,000 | 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 | |||
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 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. | ||||||||
2012 Empire MediBlue Select (HMO) | $36.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H3370 -002 -0 | $7.00 | $35.00 | $80.00 | $80.00 | 4,453 2012 Formulary | ||
2013 Empire MediBlue Select (HMO) | $41.00 | $4,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $10.00 | $45.00 | $45.00 | 4,173 2013 Formulary | |||
2012 Today's Options Premier 400 (PFFS) | $59.00 | $6,700 | No Rx Coverage | H2816 -010 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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2013 Today's Options Premier 600 (PFFS) | $59.00 | 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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2012 Empire MediBlue Freedom II (PPO) | $47.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H3342 -014 -0 | $8.00 | $45.00 | $85.00 | $85.00 | 4,453 2012 Formulary | ||
2013 Empire MediBlue Freedom II (PPO) | $66.00 | $3,900 | $75 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $10.00 | $45.00 | $45.00 | 4,173 2013 Formulary | |||
2012 Today's Options Premier Plus 450G (PFFS) | $95.00 | $6,700 | $90 | No additional gap coverage, only the Donut Hole Discount | H2816 -022 -0 | n/a | ||||||
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2013 Today's Options Premier Plus 650F (PFFS) | $100.00 | n/a | $100 | 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 Premier 100 (PFFS) | $110.00 | $3,400 | No Rx Coverage | H2816 -026 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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2013 Today's Options Premier 200 (PFFS) | $110.00 | 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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2012 Today's Options Premier Plus 150A (PFFS) | $152.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H2816 -028 -0 | n/a | ||||||
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2013 Today's Options Premier Plus 250A (PFFS) | $157.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $7.00 | $40.00 | $40.00 | 4,885 2013 Formulary | |||
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