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 Soundpath Health Alpine (HMO) | $49.00 | $2,250 | No Rx Coverage | H9302 -004 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Soundpath Health Alpine (HMO) | $24.00 | $2,250 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Soundpath Health Pinnacle + Rx (HMO) | $21.00 | $3,400 | $320 | No additional gap coverage, only the Donut Hole Discount | H9302 -010 -0 | $6.00 | $18.00 | $36.00 | $36.00 | 3,125 2012 Formulary | ||
2013 Soundpath Health Pinnacle + Rx (HMO) | $28.00 | $3,400 | $325 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $18.00 | $36.00 | $36.00 | 3,285 2013 Formulary | |||
2012 Community HealthFirst MA Special Needs Plan (HMO SNP) | $36.50 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H5826 -005 -0 | 15% | 15% | 2,910 2012 Formulary | ||||
2013 Community HealthFirst MA Special Needs Plan (HMO SNP) | $37.40 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 3,102 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 Soundpath Health Charter + Rx (HMO) | $94.00 | $2,250 | $0 | Many Generics | H9302 -003 -0 | $6.00 | $18.00 | $36.00 | $36.00 | 3,125 2012 Formulary | ||
2013 Soundpath Health Charter + Rx (HMO) | $104.00 | $2,250 | $0 | Many Generics | $6.00 | $18.00 | $36.00 | $36.00 | 3,285 2013 Formulary | |||
2012 Soundpath Health Apex + Rx (HMO) | $169.00 | $1,400 | $0 | Many Generics | H9302 -001 -0 | $6.00 | $18.00 | $36.00 | $36.00 | 3,125 2012 Formulary | ||
2013 Soundpath Health Apex + Rx (HMO) | $201.00 | $1,400 | $0 | Many Generics | $6.00 | $18.00 | $36.00 | $36.00 | 3,285 2013 Formulary | |||
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