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 Extra Plan (HMO) | $0.00 | $3,400 | $0 | Many Generics | H5826 -010 -0 | $10.00 | $45.00 | 33% | 2,910 2012 Formulary | |||
2013 Community HealthFirst MA Extra Plan (HMO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $50.00 | 33% | 3,102 2013 Formulary | ||||
2012 Community HealthFirst MA Plan (HMO) | $0.00 | $2,800 | No Rx Coverage | H5826 -006 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Community HealthFirst MA Plan (HMO) | $0.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Community HealthFirst MA Pharmacy Plan (HMO) | $33.60 | $2,800 | $0 | No additional gap coverage, only the Donut Hole Discount | H5826 -008 -0 | $7.00 | $45.00 | 33% | 2,910 2012 Formulary | |||
2013 Community HealthFirst MA Pharmacy Plan (HMO) | $37.30 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $50.00 | 33% | 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 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 Regence MedAdvantage Basic (PPO) | $79.00 | $3,400 | No Rx Coverage | H5009 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Regence MedAdvantage Basic (PPO) | $79.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2012 -- |
H6609 -072 -0 | |||||||||||
2013 Humana Prime Choice H6609-072 (PPO) | $92.00 | $4,500 | $0 | Few Generics, Few Brands | $6.00 | $40.00 | $80.00 | $80.00 | 3,906 2013 Formulary | |||
2012 Regence MedAdvantage + Rx Classic (PPO) | $119.00 | $3,400 | $200 | No additional gap coverage, only the Donut Hole Discount | H5009 -002 -0 | $7.50 | $33.00 | $45.00 | $45.00 | 4,317 2012 Formulary | ||
2013 Regence MedAdvantage + Rx Classic (PPO) | $99.00 | $3,400 | $205 | No additional gap coverage, only the Donut Hole Discount | $7.50 | $33.00 | $45.00 | $45.00 | 3,733 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 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 | |||
-- This plan not offered in 2012 -- |
H6609 -073 -0 | |||||||||||
2013 Humana Prime Choice H6609-073 (PPO) | $202.00 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,906 2013 Formulary | |||
2012 Regence MedAdvantage + Rx Enhanced (PPO) | $211.00 | $2,800 | $0 | Many Generics | H5009 -004 -0 | $5.00 | $33.00 | $45.00 | $45.00 | 4,317 2012 Formulary | ||
2013 Regence MedAdvantage + Rx Enhanced (PPO) | $241.00 | $2,800 | $0 | Many Generics | $5.00 | $33.00 | $45.00 | $45.00 | 3,733 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 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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