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 SecureHorizons (HMO) | $0.00 | $3,900 | $0 | Some Generics | H4590 -010 -0 | $5.00 | $33.00 | $42.00 | $42.00 | 3,617 2012 Formulary | ||
2013 AARP MedicareComplete SecureHorizons (HMO) | $0.00 | $3,400 | $0 | Some Generics | $5.00 | $33.00 | $45.00 | $45.00 | 3,833 2013 Formulary | |||
2012 AARP MedicareComplete SecureHorizons Essential (HMO) | $0.00 | $3,900 | No Rx Coverage | H4590 -029 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 AARP MedicareComplete SecureHorizons Essential (HMO) | $0.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Advantra Total Care (PPO) | $0.00 | $3,200 | $0 | No additional gap coverage, only the Donut Hole Discount | H7306 -003 -0 | $6.00 | $35.00 | $70.00 | $70.00 | 3,238 2012 Formulary | ||
2013 Advantra Total Care (PPO) | $0.00 | $3,200 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $35.00 | $70.00 | $70.00 | 3,224 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 Aetna Medicare Premier Plan (HMO) | $0.00 | $3,400 | $0 | Many Generics | H4523 -001 -0 | $4.00 | $33.00 | $45.00 | $45.00 | 3,158 2012 Formulary | ||
2013 Aetna Medicare Premier Plan (HMO) | $0.00 | $3,200 | $0 | Some Generics | $7.00 | $33.00 | $45.00 | $45.00 | 3,323 2013 Formulary | |||
2012 Amerivantage Classic Choice + Rx (HMO-POS) | $0.00 | $6,700 | $0 | Some Generics | H5817 -010 -0 | $0.00 | $0.00 | $30.00 | $30.00 | 3,055 2012 Formulary | ||
2013 Amerivantage Classic+ Rx (HMO) | $0.00 | $6,700 | $0 | Some Generics | $0.00 | $4.00 | $40.00 | $40.00 | 2,941 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H0084 -027 -0 | |||||||||||
2013 Care Improvement Plus Copper RX (PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $45.00 | $95.00 | $95.00 | 3,401 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 -- |
R6801 -022 -0 | |||||||||||
2013 Care Improvement Plus Copper RX (Regional PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | |||
2012 Care Improvement Plus Gold Rx (PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H0084 -004 -0 | $8.00 | $45.00 | $95.00 | $95.00 | 3,159 2012 Formulary | ||
2013 Care Improvement Plus Gold Rx (PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | |||
2012 Care Improvement Plus Gold Rx (Regional PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | R6801 -009 -0 | $8.00 | $45.00 | $95.00 | $95.00 | 3,159 2012 Formulary | ||
2013 Care Improvement Plus Gold Rx (Regional PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $45.00 | $95.00 | $95.00 | 3,401 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 Care Improvement Plus Medicare Advantage (PPO) | $15.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H0084 -001 -0 | $10.00 | $43.00 | $95.00 | $95.00 | 3,159 2012 Formulary | ||
2013 Care Improvement Plus Medicare Advantage (PPO) | $0.00 | $6,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | |||
2012 Care Improvement Plus Medicare Advantage (Regional PPO) | $59.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | R6801 -012 -0 | $9.00 | $45.00 | $95.00 | $95.00 | 3,159 2012 Formulary | ||
2013 Care Improvement Plus Medicare Advantage (Regional PPO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | |||
2012 Bravo Achieve (HMO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H4528 -014 -0 | $3.00 | $8.00 | $35.00 | $35.00 | 2,990 2012 Formulary | ||
2013 HealthSpring Achieve (HMO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $8.00 | $35.00 | $35.00 | 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 |
||||||
-- This plan not offered in 2012 -- |
H4528 -016 -0 | |||||||||||
2013 HealthSpring Advantage (HMO) | $0.00 | $6,700 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Bravo Classic Plus (HMO-POS) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H4528 -001 -0 | $3.00 | $8.00 | $35.00 | $35.00 | 2,990 2012 Formulary | ||
2013 HealthSpring Preferred (HMO) | $0.00 | $3,400 | $0 | Many Generics | $0.00 | $4.00 | $35.00 | $35.00 | 3,056 2013 Formulary | |||
2012 Humana Gold Plus H4510-015 (HMO) | $0.00 | $4,000 | $0 | Some Generics, Few Brands |
H4510 -015 -0 | $0.00 | $20.00 | $60.00 | $60.00 | 3,798 2012 Formulary | ||
2013 Humana Gold Plus H4510-015 (HMO) | $0.00 | $4,000 | $0 | Some Generics, Few Brands | $0.00 | $20.00 | $60.00 | $60.00 | 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 -- |
H4510 -030 -0 | |||||||||||
2013 Humana Gold Plus SNP-CHF/DM H4510-030 (HMO SNP) | $0.00 | n/a | $0 | Some Generics, Few Brands | $6.00 | $40.00 | $80.00 | $80.00 | 3,906 2013 Formulary | |||
2012 HumanaChoice R5826-026 (Regional PPO) | $0.00 | $3,400 | No Rx Coverage | R5826 -026 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 HumanaChoice R5826-026 (Regional PPO) | $0.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Today's Options Premier 400 (PFFS) | $0.00 | $6,700 | No Rx Coverage | H6169 -011 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- | ||||||||||||
2013 Today's Options Premier 600 (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 UnitedHealthcare Chronic Complete (HMO SNP) | $0.00 | n/a | $0 | Some Generics | H4590 -037 -0 | $5.00 | $32.00 | $42.00 | $42.00 | 3,617 2012 Formulary | ||
2013 UnitedHealthcare Chronic Complete (HMO SNP) | $0.00 | n/a | $0 | Some Generics | $5.00 | $32.00 | $45.00 | $45.00 | 3,833 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H1264 -008 -0 | |||||||||||
2013 WellCare Dividend (HMO) | $0.00 | $6,700 | $0 | All Generics | $3.00 | $30.00 | $60.00 | $60.00 | 2,835 2013 Formulary | |||
2012 WellCare Value (HMO-POS) | $0.00 | $5,500 | $0 | No additional gap coverage, only the Donut Hole Discount | H1264 -004 -0 | $3.00 | $30.00 | $60.00 | $60.00 | 2,506 2012 Formulary | ||
2013 WellCare Value (HMO-POS) | $0.00 | $6,700 | $0 | All Generics | $3.00 | $30.00 | $60.00 | $60.00 | 2,835 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 Choice H8145-126 (PFFS) | $0.00 | $5,000 | No Rx Coverage | H8145 -126 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Humana Gold Choice H8145-126 (PFFS) | $10.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 UnitedHealthcare Dual Complete (HMO SNP) | $10.40 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H4590 -022 -0 | 15% | 15% | 3,614 2012 Formulary | ||||
2013 UnitedHealthcare Dual Complete (HMO SNP) | $11.50 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,825 2013 Formulary | |||
2012 WellCare Access (HMO SNP) | $28.60 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H1264 -007 -0 | $0.00 | $45.00 | $95.00 | $95.00 | 2,506 2012 Formulary | ||
2013 WellCare Access (HMO SNP) | $18.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $45.00 | $95.00 | $95.00 | 2,835 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 200 (PFFS) | $20.00 | $3,250 | No Rx Coverage | H6169 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- | ||||||||||||
2013 Today's Options Premier 300 (PFFS) | $20.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 UnitedHealthcare Nursing Home Plan (HMO SNP) | $28.50 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H4590 -039 -0 | 25% | 25% | 25% | 25% | 3,614 2012 Formulary | ||
2013 UnitedHealthcare Nursing Home Plan (HMO SNP) | $29.20 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,825 2013 Formulary | |||
2012 Advantage by Superior HealthPlan (HMO SNP) | $5.10 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H5294 -001 -0 | n/a | ||||||
2013 Advantage by Superior HealthPlan (HMO SNP) | $30.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $45.00 | $95.00 | $95.00 | 3,010 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 SNP-DE H4510-024 (HMO SNP) | $27.60 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H4510 -024 -0 | 0% | 0% | 3,798 2012 Formulary | ||||
2013 Humana Gold Plus SNP-DE H4510-024 (HMO SNP) | $30.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,906 2013 Formulary | |||
2012 Molina Medicare Options Plus (HMO SNP) | $0.70 | n/a | $320 | Many Generics | H7678 -001 -0 | $0.00 | $45.00 | $95.00 | $95.00 | 2,837 2012 Formulary | ||
-- | ||||||||||||
2013 Molina Medicare Options Plus (HMO SNP) | $30.90 | n/a | $325 | Many Generics, Few Brands | $0.00 | $45.00 | $95.00 | $95.00 | 2,941 2013 Formulary | |||
2012 Amerivantage Specialty + Rx (HMO SNP) | $29.90 | n/a | $320 | Many Generics | H5817 -009 -0 | $0.00 | $0.00 | 25% | 25% | 3,055 2012 Formulary | ||
2013 Amerivantage Specialty + Rx (HMO SNP) | $31.80 | n/a | $325 | Many Generics, Few Brands | $0.00 | $0.00 | 25% | 25% | 2,941 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 -- |
H0084 -026 -0 | |||||||||||
2013 Care Improvement Plus Chrome RX (PPO SNP) | $31.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | |||
-- This plan not offered in 2012 -- |
R6801 -021 -0 | |||||||||||
2013 Care Improvement Plus Chrome RX (Regional PPO SNP) | $31.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | |||
2012 Care Improvement Plus Dual Advantage (PPO SNP) | $30.00 | n/a | $195 | No additional gap coverage, only the Donut Hole Discount | H0084 -005 -0 | $10.00 | $45.00 | $95.00 | $95.00 | 3,159 2012 Formulary | ||
2013 Care Improvement Plus Dual Advantage (PPO SNP) | $31.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,401 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 Care Improvement Plus Dual Advantage (Regional PPO SNP) | $30.00 | n/a | $215 | No additional gap coverage, only the Donut Hole Discount | R6801 -011 -0 | $10.00 | $45.00 | $95.00 | $95.00 | 3,159 2012 Formulary | ||
2013 Care Improvement Plus Dual Advantage (Regional PPO SNP) | $31.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | |||
2012 Care Improvement Plus Silver Rx (PPO SNP) | $30.00 | n/a | $210 | No additional gap coverage, only the Donut Hole Discount | H0084 -003 -0 | $10.00 | $45.00 | $95.00 | $95.00 | 3,159 2012 Formulary | ||
2013 Care Improvement Plus Silver Rx (PPO SNP) | $31.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | |||
2012 Care Improvement Plus Silver Rx (Regional PPO SNP) | $30.00 | n/a | $165 | No additional gap coverage, only the Donut Hole Discount | R6801 -008 -0 | $10.00 | $45.00 | $95.00 | $95.00 | 3,159 2012 Formulary | ||
2013 Care Improvement Plus Silver Rx (Regional PPO SNP) | $31.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,401 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 Select (HMO SNP) | $30.00 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H4528 -002 -0 | 15% | 15% | 2,990 2012 Formulary | ||||
2013 HealthSpring TotalCare (HMO SNP) | $31.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 3,025 2013 Formulary | ||||||
2012 Aetna Medicare Value Plan (PPO) | $19.00 | $5,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H4524 -001 -0 | $7.00 | $33.00 | $45.00 | $45.00 | 3,158 2012 Formulary | ||
2013 Aetna Medicare Value Plan (PPO) | $32.00 | $5,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $33.00 | $45.00 | $45.00 | 3,323 2013 Formulary | |||
2012 Today's Options Advantage Plus 650B (PPO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H5378 -190 -0 | n/a | ||||||
2013 Today's Options Advantage Plus 650B (PPO) | $32.00 | $6,700 | $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 Today's Options Premier Plus 450B (PFFS) | $27.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H6169 -031 -0 | n/a | ||||||
-- | ||||||||||||
2013 Today's Options Premier Plus 650B (PFFS) | $32.00 | 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 HumanaChoice H4520-006 (PPO) | $49.00 | $3,400 | $0 | Few Generics, Few Brands |
H4520 -006 -0 | $7.00 | $40.00 | $80.00 | $80.00 | 3,798 2012 Formulary | ||
2013 Humana Prime Choice H4520-006 (PPO) | $57.00 | $4,500 | $0 | Few Generics, Few Brands | $7.00 | $12.00 | $42.00 | $42.00 | 3,906 2013 Formulary | |||
2012 HumanaChoice R5826-012 (Regional PPO) | $54.00 | $5,000 | $0 | Few Generics, Few Brands |
R5826 -012 -0 | $7.00 | $42.00 | $82.00 | $82.00 | 3,798 2012 Formulary | ||
2013 HumanaChoice R5826-012 (Regional PPO) | $59.00 | $6,700 | $125 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $12.00 | $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 250A (PFFS) | $72.00 | $3,250 | $0 | No additional gap coverage, only the Donut Hole Discount | H6169 -021 -0 | n/a | ||||||
-- | ||||||||||||
2013 Today's Options Premier Plus 350A (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 Humana Gold Choice H8145-084 (PFFS) | $79.00 | $5,000 | $0 | Few Generics, Few Brands |
H8145 -084 -0 | $6.00 | $38.00 | $80.00 | $80.00 | 3,798 2012 Formulary | ||
2013 Humana Gold Choice H8145-084 (PFFS) | $87.00 | n/a | $0 | Few Generics, Few Brands | $6.00 | $12.00 | $39.00 | $39.00 | 3,906 2013 Formulary | |||
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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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 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 -- |
||||||||||||
2012 Texas Hassle-Free (HMO-POS) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H6642 -001 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,152 2012 Formulary | ||
-- This plan not offered in 2013 -- |
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2012 Texas Hassle-Free C-SNP (HMO-POS SNP) | $0.00 | n/a | $0 | Many Generics | H6642 -007 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,152 2012 Formulary | ||
-- This plan not offered in 2013 -- |
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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 Texas Hassle-Free D-SNP (HMO-POS SNP) | $29.90 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H6642 -008 -0 | 15% | 15% | 3,152 2012 Formulary | ||||
-- This plan not offered in 2013 -- |
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