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 -- |
H6609 -070 -0 | |||||||||||
2013 Humana Prime Choice H6609-070 (PPO) | $0.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Regence MedAdvantage Basic (PPO) | $35.00 | $3,400 | No Rx Coverage | H3817 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Regence MedAdvantage Basic (PPO) | $35.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2012 -- |
H3811 -003 -0 | |||||||||||
2013 Samaritan Advantage Special Needs Plan (HMO SNP) | $37.40 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,833 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 Regence MedAdvantage + Rx Classic (PPO) | $67.00 | $3,400 | $160 | No additional gap coverage, only the Donut Hole Discount | H3817 -002 -0 | $7.50 | $33.00 | $45.00 | $45.00 | 4,317 2012 Formulary | ||
2013 Regence MedAdvantage + Rx Classic (PPO) | $53.00 | $3,400 | $165 | No additional gap coverage, only the Donut Hole Discount | $7.50 | $33.00 | $45.00 | $45.00 | 3,733 2013 Formulary | |||
2012 ODS Advantage PPO (PPO) | $40.60 | $3,400 | No Rx Coverage | H3813 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 ODS Advantage PPO (PPO) | $57.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2012 -- |
H6609 -068 -0 | |||||||||||
2013 Humana Prime Choice H6609-068 (PPO) | $62.00 | $4,500 | $0 | Few Generics, Few Brands | $6.00 | $40.00 | $80.00 | $80.00 | 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 |
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-- This plan not offered in 2012 -- |
H3813 -006 -0 | |||||||||||
2013 ODS Advantage PPORX (PPO) | $68.00 | $3,400 | $120 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $33.00 | $41.00 | $41.00 | 3,458 2013 Formulary | |||
2012 Samaritan Advantage Conventional Plan (HMO) | $67.00 | $3,400 | No Rx Coverage | H3811 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Samaritan Advantage Conventional Plan (HMO) | $72.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Samaritan Advantage Premier Plan (HMO) | $99.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H3811 -002 -0 | $0.00 | $9.00 | $40.00 | $40.00 | 3,216 2012 Formulary | ||
2013 Samaritan Advantage Premier Plan (HMO) | $105.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $9.00 | $40.00 | $40.00 | 3,833 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 Samaritan Advantage Premier Plan Plus (HMO) | $121.00 | $3,400 | $0 | Many Generics | H3811 -009 -0 | $0.00 | $9.00 | $40.00 | $40.00 | 3,216 2012 Formulary | ||
2013 Samaritan Advantage Premier Plan Plus (HMO) | $135.00 | $3,400 | $0 | All Generics | $0.00 | $9.00 | $40.00 | $40.00 | 3,833 2013 Formulary | |||
2012 ODS Advantage PPORX Select (PPO) | $128.30 | $3,400 | $120 | No additional gap coverage, only the Donut Hole Discount | H3813 -003 -0 | $5.00 | $33.00 | $40.00 | $40.00 | 3,377 2012 Formulary | ||
2013 ODS Advantage PPORX Select (PPO) | $139.00 | $3,400 | $120 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $33.00 | $41.00 | $41.00 | 3,458 2013 Formulary | |||
2012 Regence MedAdvantage + Rx Enhanced (PPO) | $135.00 | $2,500 | $0 | Many Generics | H3817 -003 -0 | $5.00 | $33.00 | $45.00 | $45.00 | 4,317 2012 Formulary | ||
2013 Regence MedAdvantage + Rx Enhanced (PPO) | $143.00 | $2,500 | $0 | Many Generics | $5.00 | $33.00 | $45.00 | $45.00 | 3,733 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 -- |
H6609 -073 -0 | |||||||||||
2013 Humana Prime Choice H6609-073 (PPO) | $202.00 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,906 2013 Formulary | |||
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