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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-- 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 (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 | |||
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 | |||
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 R5826-026 (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 SeniorCare Sr Select-Medical Only (Cost) | $40.00 | $3,400 | No Rx Coverage | H4564 -012 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 SeniorCare Sr Select-Medical Only (Cost) | $0.00 | $6,700 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
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. | ||||||||
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 -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 (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 (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 SeniorCare Sr Select - Basic Rx (Cost) | $77.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H4564 -003 -0 | $7.00 | $35.00 | $64.00 | $64.00 | 2,671 2012 Formulary | ||
2013 SeniorCare Sr Select - Basic Rx (Cost) | $44.50 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $35.00 | $64.00 | $64.00 | 2,880 2013 Formulary | |||
2012 SeniorCare Sr Select - Value Rx (Cost) | $70.60 | $3,400 | $320 | No additional gap coverage, only the Donut Hole Discount | H4564 -015 -0 | 25% | 25% | 25% | 25% | 2,671 2012 Formulary | ||
2013 SeniorCare Sr Select - Value Rx (Cost) | $46.80 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 2,880 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 | |||
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 R5826-012 (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 | |||
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 SeniorCare Sr Preferred-Medical Only (Cost) | $87.00 | $3,400 | No Rx Coverage | H4564 -011 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 SeniorCare Sr Preferred-Medical Only (Cost) | $87.00 | $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 SeniorCare Sr Select - Enhanced Rx (Cost) | $133.10 | $3,400 | $0 | Many Generics | H4564 -006 -0 | $0.00 | $35.00 | $65.00 | $65.00 | 2,671 2012 Formulary | ||
2013 SeniorCare Sr Select - Enhanced Rx (Cost) | $98.00 | $6,700 | $0 | Many Generics | $2.00 | $35.00 | $65.00 | $65.00 | 2,880 2013 Formulary | |||
2012 SeniorCare Sr Preferred - Basic Rx (Cost) | $124.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H4564 -002 -0 | $7.00 | $35.00 | $64.00 | $64.00 | 2,671 2012 Formulary | ||
2013 SeniorCare Sr Preferred - Basic Rx (Cost) | $131.60 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $35.00 | $64.00 | $64.00 | 2,880 2013 Formulary | |||
2012 SeniorCare Sr Preferred - Value Rx (Cost) | $117.60 | $3,400 | $320 | No additional gap coverage, only the Donut Hole Discount | H4564 -014 -0 | 25% | 25% | 25% | 25% | 2,671 2012 Formulary | ||
2013 SeniorCare Sr Preferred - Value Rx (Cost) | $133.90 | $3,400 | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 2,880 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 SeniorCare Sr VIP - Medical Only (Cost) | $125.00 | $3,400 | No Rx Coverage | H4564 -016 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 SeniorCare Sr VIP - Medical Only (Cost) | $147.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 SeniorCare Sr MedOption - Medical Only (Cost) | $148.00 | $3,400 | No Rx Coverage | H4564 -020 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 SeniorCare Sr MedOption - Medical Only (Cost) | $167.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 SeniorCare Sr Preferred - Enhanced Rx (Cost) | $180.10 | $3,400 | $0 | Many Generics | H4564 -005 -0 | $0.00 | $35.00 | $65.00 | $65.00 | 2,671 2012 Formulary | ||
2013 SeniorCare Sr Preferred - Enhanced Rx (Cost) | $185.00 | $3,400 | $0 | Many Generics | $2.00 | $35.00 | $65.00 | $65.00 | 2,880 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 SeniorCare Sr Premium-Medical Only (Cost) | $167.00 | $3,400 | No Rx Coverage | H4564 -010 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 SeniorCare Sr Premium-Medical Only (Cost) | $187.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 SeniorCare Sr VIP - Basic Rx (Cost) | $162.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H4564 -017 -0 | $7.00 | $35.00 | $64.00 | $64.00 | 2,671 2012 Formulary | ||
2013 SeniorCare Sr VIP - Basic Rx (Cost) | $191.60 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $35.00 | $64.00 | $64.00 | 2,880 2013 Formulary | |||
2012 SeniorCare Sr VIP - Value Rx (Cost) | $155.60 | $3,400 | $320 | No additional gap coverage, only the Donut Hole Discount | H4564 -019 -0 | 25% | 25% | 25% | 25% | 2,671 2012 Formulary | ||
2013 SeniorCare Sr VIP - Value Rx (Cost) | $193.90 | $3,400 | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 2,880 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 SeniorCare Sr MedOption - Basic Rx (Cost) | $185.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H4564 -021 -0 | $7.00 | $35.00 | $64.00 | $64.00 | 2,671 2012 Formulary | ||
2013 SeniorCare Sr MedOption - Basic Rx (Cost) | $211.50 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $35.00 | $64.00 | $64.00 | 2,880 2013 Formulary | |||
2012 SeniorCare Sr MedOption - Value Rx (Cost) | $178.60 | $3,400 | $320 | No additional gap coverage, only the Donut Hole Discount | H4564 -023 -0 | 25% | 25% | 25% | 25% | 2,671 2012 Formulary | ||
2013 SeniorCare Sr MedOption - Value Rx (Cost) | $213.90 | $3,400 | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 2,880 2013 Formulary | |||
2012 SeniorCare Sr Premium - Basic Rx (Cost) | $204.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H4564 -001 -0 | $7.00 | $35.00 | $64.00 | $64.00 | 2,671 2012 Formulary | ||
2013 SeniorCare Sr Premium - Basic Rx (Cost) | $231.50 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $35.00 | $64.00 | $64.00 | 2,880 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 SeniorCare Sr Premium - Value Rx (Cost) | $197.60 | $3,400 | $320 | No additional gap coverage, only the Donut Hole Discount | H4564 -013 -0 | 25% | 25% | 25% | 25% | 2,671 2012 Formulary | ||
2013 SeniorCare Sr Premium - Value Rx (Cost) | $233.80 | $3,400 | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 2,880 2013 Formulary | |||
2012 SeniorCare Sr VIP - Enhanced Rx (Cost) | $218.10 | $3,400 | $0 | Many Generics | H4564 -018 -0 | $0.00 | $35.00 | $65.00 | $65.00 | 2,671 2012 Formulary | ||
2013 SeniorCare Sr VIP - Enhanced Rx (Cost) | $244.90 | $3,400 | $0 | Many Generics | $2.00 | $35.00 | $65.00 | $65.00 | 2,880 2013 Formulary | |||
2012 SeniorCare Sr MedOption - Enhanced Rx (Cost) | $241.10 | $3,400 | $0 | Many Generics | H4564 -022 -0 | $0.00 | $35.00 | $65.00 | $65.00 | 2,671 2012 Formulary | ||
2013 SeniorCare Sr MedOption - Enhanced Rx (Cost) | $264.90 | $3,400 | $0 | Many Generics | $2.00 | $35.00 | $65.00 | $65.00 | 2,880 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 SeniorCare Sr Premium - Enhanced Rx (Cost) | $260.10 | $3,400 | $0 | Many Generics | H4564 -004 -0 | $0.00 | $35.00 | $65.00 | $65.00 | 2,671 2012 Formulary | ||
2013 SeniorCare Sr Premium - Enhanced Rx (Cost) | $284.90 | $3,400 | $0 | Many Generics | $2.00 | $35.00 | $65.00 | $65.00 | 2,880 2013 Formulary | |||
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