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 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 | ||||||
2012 Group Health Cooperative Clear Care Vital (HMO) | $19.00 | $3,200 | $320 | No additional gap coverage, only the Donut Hole Discount | H5050 -013 -0 | $2.00 | $10.00 | $11.00 | $11.00 | 4,918 2012 Formulary | ||
2013 Group Health Cooperative Clear Care Vital (HMO) | $43.00 | $3,200 | $325 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $9.00 | $13.00 | $13.00 | 5,235 2013 Formulary | |||
2012 Group Health Cooperative Clear Care Basic (HMO) | $35.00 | $2,500 | No Rx Coverage | H5050 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Group Health Cooperative Clear Care Basic (HMO) | $59.00 | $2,500 | 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 Community HealthFirst MA Pharmacy Plan (HMO) | $49.00 | $2,800 | $0 | No additional gap coverage, only the Donut Hole Discount | H5826 -009 -0 | $10.00 | $45.00 | 33% | 2,910 2012 Formulary | |||
2013 Community HealthFirst MA Pharmacy Plan (HMO) | $61.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $50.00 | 33% | 3,102 2013 Formulary | ||||
2012 Group Health Cooperative Clear Care Essential (HMO) | $118.00 | $2,500 | $320 | No additional gap coverage, only the Donut Hole Discount | H5050 -009 -0 | $2.00 | $11.00 | $12.00 | $12.00 | 4,918 2012 Formulary | ||
2013 Group Health Cooperative Clear Care Essential (HMO) | $153.00 | $2,500 | $250 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $18.00 | $20.00 | $20.00 | 5,235 2013 Formulary | |||
2012 Group Health Cooperative Clear Care Optimal (HMO) | $212.00 | $1,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H5050 -004 -0 | $4.00 | $20.00 | $25.00 | $25.00 | 4,918 2012 Formulary | ||
2013 Group Health Cooperative Clear Care Optimal (HMO) | $254.00 | $1,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $20.00 | $25.00 | $25.00 | 5,235 2013 Formulary | |||
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