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. | ||||||||
-- This plan not offered in 2012 -- |
H3959 -033 -0 | |||||||||||
2013 Advantra Silver (HMO) | $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 Bravo Achieve (HMO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H3949 -024 -0 | $4.00 | $10.00 | $40.00 | $40.00 | 2,990 2012 Formulary | ||
2013 Bravo-HealthSpring Achieve (HMO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $40.00 | $40.00 | 3,057 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 Bravo Classic (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H3949 -002 -0 | $4.00 | $10.00 | $40.00 | $40.00 | 2,990 2012 Formulary | ||
2013 Bravo-HealthSpring Classic (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $40.00 | $40.00 | 3,056 2013 Formulary | |||
2012 Bravo Gold (HMO) | $0.00 | $6,700 | No Rx Coverage | H3964 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Bravo-HealthSpring Gold (HMO) | $0.00 | $6,700 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- 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 | |||
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 Keystone 65 Select Medical Only (HMO) | $30.00 | $6,700 | No Rx Coverage | H3952 -050 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Keystone 65 Select Medical Only (HMO) | $0.00 | $6,700 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Aetna Medicare Basic Plan (HMO) | $49.00 | $6,700 | No Rx Coverage | H3931 -055 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Aetna Medicare Basic Plan (HMO) | $25.00 | $6,700 | 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 Bravo Gold Rx (HMO-POS) | $28.00 | $6,700 | $185 | No additional gap coverage, only the Donut Hole Discount | H3964 -003 -0 | $8.00 | $11.00 | $40.00 | $40.00 | 2,990 2012 Formulary | ||
2013 Bravo-HealthSpring Gold Rx (HMO-POS) | $32.00 | $6,700 | $180 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $10.00 | $40.00 | $40.00 | 3,056 2013 Formulary | |||
2012 UnitedHealthcare Nursing Home Plan (PPO SNP) | $32.70 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H3912 -001 -0 | 25% | 25% | 25% | 25% | 3,614 2012 Formulary | ||
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2013 UnitedHealthcare Nursing Home Plan (PPO SNP) | $33.70 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,825 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 |
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-- This plan not offered in 2012 -- |
H5932 -001 -0 | |||||||||||
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 | ||||||
-- This plan not offered in 2012 -- |
H4227 -001 -0 | |||||||||||
new | new | new | ||||||||||
2013 Keystone VIP Choice (HMO SNP) | $36.50 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,884 2013 Formulary | |||
2012 Bravo Select (HMO SNP) | $34.30 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H3949 -009 -0 | 15% | 15% | 2,990 2012 Formulary | ||||
2013 Bravo-HealthSpring Select (HMO SNP) | $36.60 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 3,025 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 Bravo Silver (HMO SNP) | $34.30 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H3964 -002 -0 | 15% | 15% | 2,990 2012 Formulary | ||||
2013 Bravo-HealthSpring Silver (HMO SNP) | $36.60 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 3,025 2013 Formulary | ||||||
2012 Bravo Traditions (HMO SNP) | $34.30 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H3949 -016 -0 | 25% | 25% | 2,990 2012 Formulary | ||||
2013 Bravo-HealthSpring Traditions (HMO SNP) | $36.60 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 3,025 2013 Formulary | ||||||
-- This plan not offered in 2012 -- |
H3959 -035 -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 |
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-- 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 | |||
2012 Today's Options Advantage 400 (PPO) | $45.00 | $6,700 | No Rx Coverage | H2775 -097 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Today's Options Advantage 600 (PPO) | $45.00 | $6,700 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Keystone 65 Select Rx (HMO) | $57.10 | $6,700 | $280 | No additional gap coverage, only the Donut Hole Discount | H3952 -051 -0 | $4.00 | $40.00 | $80.00 | $80.00 | 3,624 2012 Formulary | ||
2013 Keystone 65 Select Rx (HMO) | $46.50 | $6,700 | $280 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $40.00 | $80.00 | $80.00 | 3,921 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 -- |
H5522 -015 -0 | |||||||||||
2013 Advantra Gold (PPO) | $48.00 | $5,900 | $0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $25.00 | $38.00 | $38.00 | 3,281 2013 Formulary | |||
2012 Aetna Medicare Standard Plan (HMO) | $90.00 | $6,700 | $320 | No additional gap coverage, only the Donut Hole Discount | H3931 -064 -0 | $4.00 | $25.00 | $30.00 | $30.00 | 3,158 2012 Formulary | ||
2013 Aetna Medicare Standard Plan (HMO) | $57.00 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $30.00 | $40.00 | $40.00 | 3,323 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 |
||||||
2012 Today's Options Advantage Plus 450I (PPO) | $65.00 | $6,700 | $120 | No additional gap coverage, only the Donut Hole Discount | H2775 -091 -0 | n/a | ||||||
2013 Today's Options Advantage Plus 650F (PPO) | $70.00 | $6,700 | $100 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $12.00 | $45.00 | $45.00 | 4,885 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 | |||
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 | |||
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 Plus 450G (PFFS) | $95.00 | $6,700 | $90 | No additional gap coverage, only the Donut Hole Discount | H2816 -022 -0 | n/a | ||||||
-- | ||||||||||||
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 Bravo Premier (HMO) | $89.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H3949 -013 -0 | $0.00 | $0.00 | $35.00 | $35.00 | 2,990 2012 Formulary | ||
2013 Bravo-HealthSpring Premier (HMO) | $104.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $35.00 | $35.00 | 3,056 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. | |||||||
-- | ||||||||||||
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 |
||||||
2012 Aetna Medicare Premier Plan (HMO) | $145.00 | $6,700 | $0 | Many Generics | H3931 -004 -0 | $4.00 | $31.00 | $45.00 | $45.00 | 3,158 2012 Formulary | ||
2013 Aetna Medicare Premier Plan (HMO) | $149.00 | $6,700 | $0 | Some Generics | $6.00 | $33.00 | $45.00 | $45.00 | 3,323 2013 Formulary | |||
2012 Today's Options Advantage Plus 150A (PPO) | $146.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H2775 -085 -0 | n/a | ||||||
2013 Today's Options Advantage Plus 250A (PPO) | $151.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $7.00 | $40.00 | $40.00 | 4,885 2013 Formulary | |||
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 | ||||||
-- | ||||||||||||
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 | |||
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 Keystone 65 Preferred Medical Only (HMO) | $184.80 | $6,700 | No Rx Coverage | H3952 -044 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Keystone 65 Preferred Medical Only (HMO) | $184.80 | $6,700 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2012 -- |
H8145 -053 -0 | |||||||||||
2013 Humana Gold Choice H8145-053 (PFFS) | $194.00 | n/a | $0 | Few Generics, Few Brands | $6.00 | $15.00 | $45.00 | $45.00 | 3,906 2013 Formulary | |||
2012 Keystone 65 Preferred Rx (HMO) | $226.20 | $6,700 | $100 | Many Generics | H3952 -045 -0 | $5.00 | $40.00 | $80.00 | $80.00 | 4,945 2012 Formulary | ||
2013 Keystone 65 Preferred Rx (HMO) | $248.50 | $6,700 | $100 | Many Generics | $5.00 | $40.00 | $80.00 | $80.00 | 5,233 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 Any, Any, Any Gold (PFFS) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H8098 -001 -0 | $6.00 | $15.00 | $45.00 | $45.00 | 3,148 2012 Formulary | ||
-- This plan not offered in 2013 -- |
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2012 Any, Any, Any Gold MA Only (PFFS) | $0.00 | $6,700 | No Rx Coverage | H8098 -003 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- This plan not offered in 2013 -- |
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