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 AARP MedicareComplete Choice (PPO) | $0.00 | $4,500 | $0 | No additional gap coverage, only the Donut Hole Discount | H3812 -001 -0 | $3.00 | $6.00 | $44.00 | $44.00 | 3,614 2012 Formulary | ||
2013 AARP MedicareComplete Choice (PPO) | $0.00 | $4,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $6.00 | $45.00 | $45.00 | 3,825 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H3805 -012 -0 | |||||||||||
2013 AARP MedicareComplete Plan 2 (HMO) | $0.00 | $3,900 | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $7.00 | $45.00 | $45.00 | 3,825 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H6815 -002 -0 | |||||||||||
-- | -- | -- | ||||||||||
2013 Health Net Jade (HMO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $38.00 | $38.00 | 4,263 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 Health Net Violet Option 2 (PPO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H5520 -005 -0 | n/a | ||||||
2013 Health Net Violet Option 2 (PPO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $20.00 | $45.00 | $45.00 | 4,263 2013 Formulary | |||
2012 Humana Gold Choice H8145-097 (PFFS) | $0.00 | $4,500 | No Rx Coverage | H8145 -097 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Humana Gold Choice H8145-097 (PFFS) | $0.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Humana Gold Plus H1036-153 (HMO) | $0.00 | $3,200 | $0 | Few Generics, Few Brands |
H1036 -153 -0 | $6.00 | $40.00 | $80.00 | $80.00 | 3,798 2012 Formulary | ||
2013 Humana Gold Plus H1036-153 (HMO) | $0.00 | $3,200 | $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 -- |
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 Providence Medicare Choice (HMO-POS) | $40.00 | $3,400 | No Rx Coverage | H9047 -035 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Providence Medicare Choice (HMO-POS) | $20.00 | $3,000 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Health Net Ruby (HMO) | $59.00 | $2,500 | $0 | No additional gap coverage, only the Donut Hole Discount | H6815 -001 -0 | n/a | ||||||
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2013 Health Net Ruby (HMO) | $23.00 | $2,250 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $38.00 | $38.00 | 4,263 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 Humana Gold Plus H1036-149 (HMO-POS) | $25.00 | $3,700 | $0 | Few Generics, Few Brands |
H1036 -149 -0 | $6.00 | $40.00 | $80.00 | $80.00 | 3,798 2012 Formulary | ||
2013 Humana Gold Plus H1036-149 (HMO-POS) | $28.00 | $3,900 | $0 | Few Generics, Few Brands | $6.00 | $40.00 | $80.00 | $80.00 | 3,906 2013 Formulary | |||
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. | ||||||||
2012 CareOregon Advantage Plus (HMO-POS SNP) | $36.40 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H5859 -001 -0 | 15% | 15% | 2,620 2012 Formulary | ||||
2013 CareOregon Advantage Plus (HMO-POS SNP) | $37.50 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 2,727 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 CareOregon Advantage Star (HMO-POS) | $36.40 | $6,700 | $320 | No additional gap coverage, only the Donut Hole Discount | H5859 -003 -0 | $5.00 | 25% | 2,620 2012 Formulary | ||||
2013 CareOregon Advantage Star (HMO-POS) | $37.50 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | $5.00 | 25% | 2,727 2013 Formulary | |||||
2012 PremierCare Plus (HMO SNP) | $36.50 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H3818 -002 -0 | 15% | 15% | 2,669 2012 Formulary | ||||
2013 MyPlan C (HMO SNP) | $37.50 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 2,721 2013 Formulary | |||
2012 UnitedHealthcare Nursing Home Plan (PPO SNP) | $35.20 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H3812 -005 -0 | 25% | 25% | 25% | 25% | 3,614 2012 Formulary | ||
2013 UnitedHealthcare Nursing Home Plan (PPO SNP) | $37.50 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 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 Kaiser Permanente Senior Advantage Basic (HMO) | $39.00 | $3,400 | $0 | All Generics, Few Brands |
H9003 -006 -0 | n/a | ||||||
2013 Kaiser Permanente Senior Advantage Basic (HMO) | $39.00 | $3,400 | $0 | All Generics, Few Brands | $6.00 | $10.00 | $45.00 | $45.00 | 5,250 2013 Formulary | |||
2012 Health Net Aqua (PPO) | $45.00 | $2,500 | No Rx Coverage | H5520 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Health Net Aqua (PPO) | $45.00 | $2,500 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Providence Medicare Choice + RX (HMO-POS) | $76.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H9047 -024 -0 | $7.00 | $50.00 | 33% | 2,718 2012 Formulary | |||
2013 Providence Medicare Choice + RX (HMO-POS) | $52.00 | $3,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $11.00 | $35.00 | $35.00 | 2,945 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 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 AARP MedicareComplete (HMO) | $65.00 | $4,900 | $0 | No additional gap coverage, only the Donut Hole Discount | H3805 -001 -0 | $3.00 | $6.00 | $44.00 | $44.00 | 3,614 2012 Formulary | ||
2013 AARP MedicareComplete Plan 1 (HMO) | $55.00 | $3,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $6.00 | $44.00 | $44.00 | 3,825 2013 Formulary | |||
2012 PremierCare Choice (HMO) | $49.00 | $3,400 | No Rx Coverage | H3818 -004 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 MyPlan R (HMO) | $55.00 | $3,400 | 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 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 -- |
H9047 -013 -0 | |||||||||||
2013 Providence Medicare Extra Part B Only + RX (HMO) | $59.60 | n/a | $0 | n/a | $6.00 | $11.00 | $35.00 | $35.00 | 2,945 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H6609 -067 -0 | |||||||||||
2013 Humana Prime Choice H6609-067 (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 |
||||||
-- This plan not offered in 2012 -- |
H3813 -005 -0 | |||||||||||
2013 Legacy Health Medicare, powered by ODS (PPO) | $63.00 | $2,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $33.00 | $40.00 | $40.00 | 3,458 2013 Formulary | |||
-- 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 Humana Gold Choice H8145-093 (PFFS) | $67.00 | $3,400 | $0 | Few Generics, Few Brands |
H8145 -093 -0 | $6.00 | $40.00 | $80.00 | $80.00 | 3,798 2012 Formulary | ||
2013 Humana Gold Choice H8145-093 (PFFS) | $70.00 | n/a | $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 |
||||||
2012 PremierCare Choice Rx (HMO) | $74.00 | $3,400 | $190 | No additional gap coverage, only the Donut Hole Discount | H3818 -003 -0 | $7.00 | $30.00 | $65.00 | $65.00 | 2,669 2012 Formulary | ||
2013 MyPlan A (HMO) | $74.00 | $3,400 | $190 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $30.00 | $70.00 | $70.00 | 2,721 2013 Formulary | |||
2012 Providence Medicare Extra (HMO) | $87.00 | $2,500 | No Rx Coverage | H9047 -033 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Providence Medicare Extra (HMO) | $87.00 | $2,500 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Health Net Violet Option 1 (PPO) | $99.00 | $2,500 | $0 | No additional gap coverage, only the Donut Hole Discount | H5520 -002 -0 | n/a | ||||||
2013 Health Net Violet Option 1 (PPO) | $99.00 | $2,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $15.00 | $42.00 | $42.00 | 4,263 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 Kaiser Permanente Senior Advantage (HMO) | $99.00 | $2,500 | $0 | All Generics, Few Brands |
H9003 -001 -0 | n/a | ||||||
2013 Kaiser Permanente Senior Advantage (HMO) | $99.00 | $2,500 | $0 | All Generics, Few Brands | $6.00 | $10.00 | $45.00 | $45.00 | 5,250 2013 Formulary | |||
2012 Providence Medicare Extra + RX (HMO) | $130.00 | $2,500 | $0 | No additional gap coverage, only the Donut Hole Discount | H9047 -001 -0 | $7.00 | $50.00 | 33% | 2,718 2012 Formulary | |||
2013 Providence Medicare Extra + RX (HMO) | $133.00 | $2,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $11.00 | $35.00 | $35.00 | 2,945 2013 Formulary | |||
2012 Providence Medicare Open (PPO) | $103.00 | $2,500 | No Rx Coverage | H5016 -002 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- | ||||||||||||
2013 Providence Medicare Open (PPO) | $133.00 | $2,500 | 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 PremierCare Value Rx (HMO) | $125.00 | $3,400 | $100 | No additional gap coverage, only the Donut Hole Discount | H3818 -014 -0 | $7.00 | $30.00 | $70.00 | $70.00 | 2,669 2012 Formulary | ||
2013 MyPlan E (HMO) | $136.00 | $3,400 | $100 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $30.00 | $70.00 | $70.00 | 2,721 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 |
||||||
2012 Health Net Healthy Heart (PPO) | $149.00 | $1,750 | $0 | No additional gap coverage, only the Donut Hole Discount | H5520 -009 -0 | n/a | ||||||
2013 Health Net Healthy Heart (PPO) | $159.00 | $2,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $10.00 | $35.00 | $35.00 | 4,263 2013 Formulary | |||
2012 Providence Medicare Open + RX (PPO) | $155.00 | $2,500 | $0 | No additional gap coverage, only the Donut Hole Discount | H5016 -001 -0 | $7.00 | $50.00 | 33% | 2,718 2012 Formulary | |||
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2013 Providence Medicare Open + RX (PPO) | $188.00 | $2,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $11.00 | $35.00 | $35.00 | 2,945 2013 Formulary | |||
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