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 Plus (HMO-POS) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H5253 -028 -0 | $3.00 | $6.00 | $44.00 | $44.00 | 3,614 2012 Formulary | ||
2013 AARP MedicareComplete Plus (HMO-POS) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $6.00 | $45.00 | $45.00 | 3,825 2013 Formulary | |||
2012 Gundersen Lutheran Sr. Pref. Value (no RX) (HMO) | $0.00 | $3,400 | No Rx Coverage | H5262 -004 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Gundersen Lutheran Sr. Pref. Value (no RX) (HMO) | $0.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2012 -- |
H8145 -153 -0 | |||||||||||
2013 Humana Gold Choice H8145-153 (PFFS) | $0.00 | $4,500 | 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 HumanaChoice R5826-023 (Regional PPO) | $0.00 | $3,400 | No Rx Coverage | R5826 -023 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 HumanaChoice R5826-023 (Regional PPO) | $0.00 | $4,500 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Gundersen Lutheran Senior Pref. Value (w/RX) (HMO) | $22.60 | $3,400 | $80 | No additional gap coverage, only the Donut Hole Discount | H5262 -003 -0 | $9.00 | $33.00 | $44.00 | $44.00 | 3,133 2012 Formulary | ||
2013 Gundersen Lutheran Senior Pref. Value (w/RX) (HMO) | $26.40 | $3,400 | $100 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $33.00 | $45.00 | $45.00 | 3,213 2013 Formulary | |||
2012 Humana Gold Plus H6622-003 (HMO) | $17.00 | $3,400 | $0 | Few Generics, Few Brands |
H6622 -003 -0 | $5.00 | $40.00 | $80.00 | $80.00 | 3,798 2012 Formulary | ||
2013 Humana Gold Plus H6622-003 (HMO-POS) | $32.00 | $6,700 | $0 | Few Generics, Few Brands | $5.00 | $40.00 | $80.00 | $80.00 | 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 |
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2012 UnitedHealthcare Dual Complete LP (HMO SNP) | $36.70 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H5253 -024 -0 | 15% | 15% | 3,614 2012 Formulary | ||||
2013 UnitedHealthcare Dual Complete LP (HMO SNP) | $36.40 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,825 2013 Formulary | |||
2012 UnitedHealthcare Nursing Home Plan (HMO-POS SNP) | $35.30 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H5253 -007 -0 | 25% | 25% | 25% | 25% | 3,614 2012 Formulary | ||
2013 UnitedHealthcare Nursing Home Plan (HMO-POS SNP) | $38.30 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,825 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H4270 -005 -0 | |||||||||||
2013 UCare for Seniors Essentials (HMO-POS) | $43.00 | $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 |
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-- This plan not offered in 2012 -- |
H4270 -006 -0 | |||||||||||
2013 UCare for Seniors Essentials Rx (HMO-POS) | $57.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $20.00 | $45.00 | $45.00 | 5,011 2013 Formulary | |||
2012 UCare for Seniors Value (HMO-POS) | $61.00 | $3,400 | No Rx Coverage | H4270 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 UCare for Seniors Value (HMO-POS) | $60.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 UCare for Seniors Standard D (HMO-POS) | $67.00 | $3,400 | $320 | No additional gap coverage, only the Donut Hole Discount | H4270 -004 -0 | 25% | 25% | 2,804 2012 Formulary | ||||
2013 UCare for Seniors Standard D (HMO-POS) | $66.00 | $3,400 | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 2,911 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 H8145-006 (PFFS) | $61.00 | $6,000 | $0 | Few Generics, Few Brands |
H8145 -006 -0 | $7.00 | $41.00 | $80.00 | $80.00 | 3,798 2012 Formulary | ||
2013 Humana Gold Choice H8145-006 (PFFS) | $72.00 | n/a | $0 | Few Generics, Few Brands | $7.00 | $41.00 | $80.00 | $80.00 | 3,906 2013 Formulary | |||
2012 HumanaChoice R5826-009 (Regional PPO) | $67.00 | $5,000 | $320 | No additional gap coverage, only the Donut Hole Discount | R5826 -009 -0 | 25% | 25% | 25% | 25% | 3,798 2012 Formulary | ||
2013 HumanaChoice R5826-009 (Regional PPO) | $89.00 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,906 2013 Formulary | |||
2012 UCare for Seniors Value Plus (HMO-POS) | $89.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H4270 -003 -0 | $10.00 | $35.00 | $70.00 | $70.00 | 4,776 2012 Formulary | ||
2013 UCare for Seniors Value Plus (HMO-POS) | $98.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $10.00 | $40.00 | $40.00 | 5,011 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 Gundersen Lutheran Sr. Pref. Elite (no RX) (HMO) | $100.00 | $3,400 | No Rx Coverage | H5262 -005 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Gundersen Lutheran Sr. Pref. Elite (no RX) (HMO) | $100.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 Gundersen Lutheran Senior Pref. Elite (w/RX) (HMO) | $139.60 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H5262 -001 -0 | $9.00 | $33.00 | $44.00 | $44.00 | 3,133 2012 Formulary | ||
2013 Gundersen Lutheran Senior Pref. Elite (w/RX) (HMO) | $142.20 | $3,400 | $50 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $30.00 | $45.00 | $45.00 | 3,213 2013 Formulary | |||
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