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 Advantra Elite (PPO) | $0.00 | $6,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H5522 -008 -0 | $5.00 | $24.00 | $37.00 | $37.00 | 3,230 2012 Formulary | ||
2013 Advantra Elite (PPO) | $0.00 | $6,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $24.00 | $37.00 | $37.00 | 3,281 2013 Formulary | |||
2012 Advantra Silver (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H3959 -011 -0 | $6.00 | $24.00 | $35.00 | $35.00 | 3,230 2012 Formulary | ||
2013 Advantra Silver (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $24.00 | $35.00 | $35.00 | 3,281 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 Advantra Silver (PPO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H5522 -004 -0 | $6.00 | $25.00 | $35.00 | $35.00 | 3,230 2012 Formulary | ||
2013 Advantra Silver (PPO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $25.00 | $35.00 | $35.00 | 3,281 2013 Formulary | |||
2012 Aetna Medicare Basic Plan (HMO) | $0.00 | $6,700 | No Rx Coverage | H3931 -054 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Aetna Medicare Basic Plan (HMO) | $0.00 | $6,700 | 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 | |||
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 -- |
H5932 -007 -0 | |||||||||||
2013 Gateway Health Plan Medicare Assured Select (HMO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $45.00 | $45.00 | 2,470 2013 Formulary | |||
2012 Geisinger Gold Classic 3 (HMO) | $0.00 | $1,500 | No Rx Coverage | H3954 -098 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Geisinger Gold Classic 3 (HMO) | $0.00 | $2,000 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
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 |
||||||
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 Today's Options Premier 300 (PFFS) | $0.00 | $4,400 | No Rx Coverage | H2816 -007 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- | ||||||||||||
2013 Today's Options Premier 400 (PFFS) | $0.00 | $4,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Geisinger Gold Preferred 2 (PPO) | $10.00 | $3,000 | No Rx Coverage | H3924 -045 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Geisinger Gold Preferred 2 (PPO) | $20.00 | $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 Today's Options Premier 100 (PFFS) | $20.00 | $3,400 | No Rx Coverage | H2816 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- | ||||||||||||
2013 Today's Options Premier 100 (PFFS) | $20.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 HumanaChoice H6900-004 (PPO) | $19.00 | $6,700 | $0 | Few Generics, Few Brands |
H6900 -004 -0 | $6.00 | $43.00 | $86.00 | $86.00 | 3,798 2012 Formulary | ||
2013 HumanaChoice H6900-004 (PPO) | $26.00 | $6,700 | $0 | Few Generics, Few Brands | $6.00 | $15.00 | $45.00 | $45.00 | 3,906 2013 Formulary | |||
2012 Today's Options Premier Plus 350B (PFFS) | $21.00 | $4,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H2816 -019 -0 | n/a | ||||||
-- | ||||||||||||
2013 Today's Options Premier Plus 450B (PFFS) | $26.00 | $4,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $12.00 | $45.00 | $45.00 | 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 |
||||||
2012 Geisinger Gold Preferred 1 (PPO) | $28.00 | $2,550 | No Rx Coverage | H3924 -021 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Geisinger Gold Preferred 1 (PPO) | $33.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Aetna Medicare Standard Plan (HMO) | $36.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H3931 -070 -0 | $6.00 | $33.00 | $45.00 | $45.00 | 3,158 2012 Formulary | ||
2013 Aetna Medicare Standard Plan (HMO) | $36.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $33.00 | $45.00 | $45.00 | 3,323 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H5932 -009 -0 | |||||||||||
2013 Gateway Health Plan Medicare Assured 3 (HMO SNP) | $36.50 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 2,470 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 Gateway Health Plan Medicare Assured (HMO SNP) | $34.00 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H5932 -001 -0 | 0% | 0% | 2,304 2012 Formulary | ||||
2013 Gateway Health Plan Medicare Assured (HMO SNP) | $36.50 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 2,470 2013 Formulary | ||||||
2012 Geisinger Gold Secure 1 (HMO SNP) | $34.30 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H3954 -097 -0 | 15% | 15% | 3,010 2012 Formulary | ||||
2013 Geisinger Gold Secure 1 (HMO SNP) | $38.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 3,253 2013 Formulary | ||||||
-- This plan not offered in 2012 -- |
H3959 -036 -0 | |||||||||||
2013 Advantra Cares (HMO SNP) | $38.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 3,113 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 Geisinger Gold Classic 3 $0 Deductible Rx (HMO) | $36.00 | $1,500 | $0 | No additional gap coverage, only the Donut Hole Discount | H3954 -100 -0 | $3.00 | $7.00 | $39.00 | $39.00 | 3,010 2012 Formulary | ||
2013 Geisinger Gold Classic 3 $0 Deductible Rx (HMO) | $41.00 | $2,000 | $0 | Few Generics | $3.00 | $7.00 | $39.00 | $39.00 | 3,253 2013 Formulary | |||
2012 Advantra Silver Plus (PPO) | $39.00 | $4,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H5522 -013 -0 | $6.00 | $25.00 | $35.00 | $35.00 | 3,230 2012 Formulary | ||
2013 Advantra Silver Plus (PPO) | $43.00 | $4,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $25.00 | $35.00 | $35.00 | 3,281 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H5932 -008 -0 | |||||||||||
2013 Gateway Health Plan Medicare Assured Select Plus (HMO SNP) | $44.50 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $45.00 | $45.00 | 2,470 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 Geisinger Gold Preferred 2 $0 Deductible Rx (PPO) | $40.00 | $3,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H3924 -046 -0 | $3.00 | $7.00 | $39.00 | $39.00 | 3,010 2012 Formulary | ||
2013 Geisinger Gold Preferred 2 $0 Deductible Rx (PPO) | $55.00 | $3,400 | $0 | Few Generics | $3.00 | $7.00 | $39.00 | $39.00 | 3,253 2013 Formulary | |||
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 | |||
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 | |||
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 -- |
H3954 -150 -0 | |||||||||||
2013 Geisinger Gold Classic Plus (HMO-POS) | $60.00 | $6,700 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
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 Geisinger Gold Preferred 1 $0 Deductible Rx (PPO) | $64.00 | $2,550 | $0 | No additional gap coverage, only the Donut Hole Discount | H3924 -023 -0 | $3.00 | $7.00 | $39.00 | $39.00 | 3,010 2012 Formulary | ||
2013 Geisinger Gold Preferred 1 $0 Deductible Rx (PPO) | $74.00 | $3,400 | $0 | Few Generics | $3.00 | $7.00 | $39.00 | $39.00 | 3,253 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 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 | |||
2012 Today's Options Premier Plus 150A (PFFS) | $72.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H2816 -013 -0 | n/a | ||||||
-- | ||||||||||||
2013 Today's Options Premier Plus 150A (PFFS) | $77.00 | 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 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. | ||||||||
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 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 Advantra Gold (PPO) | $89.00 | $4,300 | $0 | Some Generics | H5522 -002 -0 | $2.00 | $23.00 | $40.00 | $40.00 | 3,230 2012 Formulary | ||
2013 Advantra Gold (PPO) | $93.00 | $4,300 | $0 | Some Generics | $2.00 | $23.00 | $40.00 | $40.00 | 3,281 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H3954 -151 -0 | |||||||||||
2013 Geisinger Gold Classic Plus $0 Deductible Rx (HMO-POS) | $100.00 | $6,700 | $0 | Few Generics | $3.00 | $7.00 | $39.00 | $39.00 | 3,253 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 Geisinger Gold Classic 1 (HMO) | $112.00 | $2,800 | No Rx Coverage | H3954 -007 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Geisinger Gold Classic 1 (HMO) | $112.00 | $2,800 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Aetna Medicare Premier Plan (PPO) | $120.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H5521 -012 -0 | $6.00 | $33.00 | $45.00 | $45.00 | 3,158 2012 Formulary | ||
2013 Aetna Medicare Premier Plan (PPO) | $120.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $33.00 | $45.00 | $45.00 | 3,323 2013 Formulary | |||
2012 Geisinger Gold Secure 3 (HMO SNP) | $118.00 | n/a | $0 | Few Generics | H3954 -135 -0 | $3.00 | $7.00 | $39.00 | $39.00 | 3,010 2012 Formulary | ||
2013 Geisinger Gold Secure 3 (HMO SNP) | $123.00 | n/a | $0 | Few Generics | $3.00 | $7.00 | $39.00 | $39.00 | 3,253 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 Geisinger Gold Classic 1 $0 Deductible Rx (HMO) | $137.00 | $2,800 | $0 | No additional gap coverage, only the Donut Hole Discount | H3954 -033 -0 | $3.00 | $7.00 | $39.00 | $39.00 | 3,010 2012 Formulary | ||
2013 Geisinger Gold Classic 1 $0 Deductible Rx (HMO) | $142.00 | $2,800 | $0 | Few Generics | $3.00 | $7.00 | $39.00 | $39.00 | 3,253 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 (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 | |||
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 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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