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 Geisinger Gold Reserve (MSA) | $0.00 | n/a | No Rx Coverage | H8468 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Geisinger Gold Reserve (MSA) | $0.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 FreedomBlue PPO HD Rx (PPO) | $0.00 | $2,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H3916 -025 -0 | $10.00 | $45.00 | $95.00 | $95.00 | 4,948 2012 Formulary | ||
2013 Freedom Blue PPO HD Rx (PPO) | $0.00 | $5,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $45.00 | $95.00 | $95.00 | 5,246 2013 Formulary | |||
2012 Humana Gold Choice H8145-055 (PFFS) | $0.00 | $6,700 | No Rx Coverage | H8145 -055 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Humana Gold Choice H8145-055 (PFFS) | $0.00 | 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 HumanaChoice R5826-062 (Regional PPO) | $0.00 | $3,400 | No Rx Coverage | R5826 -062 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 HumanaChoice R5826-062 (Regional PPO) | $0.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 SeniorBlue - Option 3 (HMO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H3962 -007 -0 | $7.00 | $36.00 | 33% | 2,676 2012 Formulary | |||
2013 SeniorBlue - Option 3 (HMO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $20.00 | $38.00 | $38.00 | 3,021 2013 Formulary | |||
2012 Today's Options Premier 400 (PFFS) | $0.00 | $6,700 | No Rx Coverage | H2816 -008 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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2013 Today's Options Premier 500 (PFFS) | $0.00 | 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 450B (PFFS) | $35.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H2816 -020 -0 | n/a | ||||||
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2013 Today's Options Premier Plus 550B (PFFS) | $40.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $12.00 | $45.00 | $45.00 | 4,885 2013 Formulary | |||
2012 Today's Options Premier 100 (PFFS) | $47.00 | $3,400 | No Rx Coverage | H2816 -002 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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2013 Today's Options Premier 100 (PFFS) | $47.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Humana Gold Choice H8145-052 (PFFS) | $49.00 | $5,900 | $0 | Few Generics, Few Brands |
H8145 -052 -0 | $7.00 | $42.00 | $84.00 | $84.00 | 3,798 2012 Formulary | ||
2013 Humana Gold Choice H8145-052 (PFFS) | $56.00 | n/a | $0 | Few Generics, Few Brands | $6.00 | $15.00 | $45.00 | $45.00 | 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 FreedomBlue PPO Basic Rx (PPO) | $39.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H3916 -018 -0 | $10.00 | $45.00 | $95.00 | $95.00 | 4,948 2012 Formulary | ||
2013 Freedom Blue PPO ValueRx (PPO) | $60.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $45.00 | $95.00 | $95.00 | 5,246 2013 Formulary | |||
2012 SeniorBlue - Option 2 (PPO) | $42.10 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H3923 -013 -0 | $7.00 | $40.00 | $89.00 | $89.00 | 4,575 2012 Formulary | ||
2013 SeniorBlue - Option 2 (PPO) | $63.70 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $20.00 | $44.00 | $44.00 | 4,995 2013 Formulary | |||
2012 HumanaChoice R5826-081 (Regional PPO) | $58.00 | $6,700 | $320 | No additional gap coverage, only the Donut Hole Discount | R5826 -081 -0 | 25% | 25% | 25% | 25% | 3,798 2012 Formulary | ||
2013 HumanaChoice R5826-081 (Regional PPO) | $75.00 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 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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2012 FreedomBlue PPO Value (PPO) | $61.00 | $3,400 | No Rx Coverage | H3916 -012 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Freedom Blue PPO Value (PPO) | $81.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 HumanaChoice R5826-002 (Regional PPO) | $79.00 | $5,000 | $0 | Few Generics, Few Brands |
R5826 -002 -0 | $8.00 | $44.00 | $85.00 | $85.00 | 3,798 2012 Formulary | ||
2013 HumanaChoice R5826-002 (Regional PPO) | $85.00 | $5,300 | $0 | Few Generics, Few Brands | $6.00 | $15.00 | $45.00 | $45.00 | 3,906 2013 Formulary | |||
2012 Today's Options Premier Plus 150A (PFFS) | $100.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H2816 -014 -0 | n/a | ||||||
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2013 Today's Options Premier Plus 150A (PFFS) | $105.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $7.00 | $40.00 | $40.00 | 4,885 2013 Formulary | |||
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 SeniorBlue - Option 2 (HMO) | $107.40 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H3962 -004 -0 | $7.00 | $36.00 | $89.00 | $89.00 | 4,575 2012 Formulary | ||
2013 SeniorBlue - Option 2 (HMO) | $120.40 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $38.00 | $38.00 | 4,995 2013 Formulary | |||
2012 FreedomBlue PPO Standard (PPO) | $132.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H3916 -015 -0 | $8.00 | $45.00 | $90.00 | $90.00 | 4,948 2012 Formulary | ||
2013 Freedom Blue PPO Standard (PPO) | $165.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $45.00 | $90.00 | $90.00 | 5,246 2013 Formulary | |||
2012 SeniorBlue - Option 1 (HMO) | $156.80 | $3,400 | $0 | Many Generics | H3962 -001 -0 | $5.00 | $36.00 | $89.00 | $89.00 | 4,575 2012 Formulary | ||
2013 SeniorBlue - Option 1 (HMO) | $169.30 | $3,400 | $0 | Many Generics | $4.00 | $12.00 | $38.00 | $38.00 | 4,995 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 SeniorBlue - Option 1 (PPO) | $162.70 | $3,400 | $0 | Many Generics | H3923 -017 -0 | $6.00 | $38.00 | $89.00 | $89.00 | 4,575 2012 Formulary | ||
2013 SeniorBlue - Option 1 (PPO) | $180.70 | $3,400 | $0 | Many Generics | $5.00 | $15.00 | $44.00 | $44.00 | 4,995 2013 Formulary | |||
2012 FreedomBlue PPO Deluxe (PPO) | $167.00 | $3,400 | $0 | Many Generics | H3916 -005 -0 | $8.00 | $42.00 | $90.00 | $90.00 | 4,948 2012 Formulary | ||
2013 Freedom Blue PPO Deluxe (PPO) | $208.00 | $3,400 | $0 | Many Generics | $8.00 | $42.00 | $90.00 | $90.00 | 5,246 2013 Formulary | |||
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