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 Essential (HMO) | $0.00 | $4,250 | No Rx Coverage | H4102 -025 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 AARP MedicareComplete Essential (HMO) | $0.00 | $4,700 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 AARP MedicareComplete Plus (HMO-POS) | $0.00 | $4,750 | $0 | No additional gap coverage, only the Donut Hole Discount | H4102 -001 -0 | $3.00 | $6.00 | $45.00 | $45.00 | 3,614 2012 Formulary | ||
2013 AARP MedicareComplete Plus (HMO-POS) | $0.00 | $5,200 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $6.00 | $45.00 | $45.00 | 3,825 2013 Formulary | |||
2012 BlueCHiP for Medicare Core (HMO) | $35.00 | $3,350 | No Rx Coverage | H4152 -004 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 BlueCHiP for Medicare Core (HMO) | $0.00 | $4,250 | 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 BlueCHiP for Medicare Value (HMO-POS) | $0.00 | $4,800 | $0 | No additional gap coverage, only the Donut Hole Discount | H4152 -016 -0 | $7.00 | $17.00 | $45.00 | $45.00 | 3,055 2012 Formulary | ||
2013 BlueCHiP for Medicare Value (HMO-POS) | $0.00 | $4,950 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $45.00 | $45.00 | 3,911 2013 Formulary | |||
2012 AARP MedicareComplete Choice (Regional PPO) | $20.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | R7444 -001 -0 | $5.00 | $8.00 | $45.00 | $45.00 | 3,614 2012 Formulary | ||
2013 AARP MedicareComplete Choice (Regional PPO) | $20.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $8.00 | $45.00 | $45.00 | 3,825 2013 Formulary | |||
2012 UnitedHealthcare Nursing Home Plan (PPO SNP) | $32.00 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H2228 -002 -0 | 25% | 25% | 25% | 25% | 3,614 2012 Formulary | ||
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2013 UnitedHealthcare Nursing Home Plan (PPO SNP) | $30.40 | 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 BlueCHiP for Medicare Standard with Drugs (HMO) | $46.00 | $3,350 | $0 | No additional gap coverage, only the Donut Hole Discount | H4152 -013 -0 | $6.00 | $12.00 | $40.00 | $40.00 | 3,055 2012 Formulary | ||
2013 BlueCHiP for Medicare Standard with Drugs (HMO) | $48.00 | $4,250 | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $12.00 | $45.00 | $45.00 | 3,911 2013 Formulary | |||
2012 BlueCHiP for Medicare Plus (HMO) | $157.00 | $2,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H4152 -005 -0 | $4.00 | $10.00 | $35.00 | $35.00 | 3,055 2012 Formulary | ||
2013 BlueCHiP for Medicare Plus (HMO) | $161.00 | $2,950 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $10.00 | $45.00 | $45.00 | 3,911 2013 Formulary | |||
2012 BlueCHiP for Medicare Preferred (HMO-POS) | $279.00 | $1,750 | $0 | Many Generics | H4152 -007 -0 | $4.00 | $10.00 | $35.00 | $35.00 | 3,055 2012 Formulary | ||
2013 BlueCHiP for Medicare Preferred (HMO-POS) | $283.00 | $2,250 | $0 | All Generics | $3.00 | $10.00 | $45.00 | $45.00 | 3,911 2013 Formulary | |||
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