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 -- |
H5253 -031 -0 | |||||||||||
2013 AARP MedicareComplete Plan 1 (HMO) | $0.00 | $4,900 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $6.00 | $45.00 | $45.00 | 3,825 2013 Formulary | |||
2012 AARP MedicareComplete Plus (HMO-POS) | $0.00 | $4,450 | $0 | No additional gap coverage, only the Donut Hole Discount | H5253 -004 -0 | $3.00 | $6.00 | $45.00 | $45.00 | 3,614 2012 Formulary | ||
2013 AARP MedicareComplete Plus (HMO-POS) | $0.00 | $4,450 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $6.00 | $45.00 | $45.00 | 3,825 2013 Formulary | |||
2012 AARP MedicareComplete Plus Essential (HMO-POS) | $0.00 | $3,950 | No Rx Coverage | H5253 -021 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 AARP MedicareComplete Plus Essential (HMO-POS) | $0.00 | $3,950 | 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 -- |
H0294 -008 -0 | |||||||||||
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2013 Care Improvement Plus Copper RX (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 (PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H0294 -002 -0 | $8.00 | $45.00 | $95.00 | $95.00 | 3,159 2012 Formulary | ||
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2013 Care Improvement Plus Gold Rx (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 (PPO) | $53.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H0294 -004 -0 | $10.00 | $43.00 | $95.00 | $95.00 | 3,159 2012 Formulary | ||
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2013 Care Improvement Plus Medicare Advantage (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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-- 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. | ||||||||
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 Anthem Medicare Preferred Core (PPO) | $0.00 | $4,500 | $60 | Many Generics | H4036 -004 -0 | $0.00 | $45.00 | $95.00 | $95.00 | 4,453 2012 Formulary | ||
2013 Anthem Medicare Preferred Core (PPO) | $26.00 | $4,000 | $60 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $45.00 | $45.00 | 4,173 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 Humana Gold Plus H6622-002 (HMO-POS) | $19.00 | $3,400 | $0 | Few Generics, Few Brands |
H6622 -002 -0 | $4.00 | $40.00 | $80.00 | $80.00 | 3,798 2012 Formulary | ||
2013 Humana Gold Plus H6622-002 (HMO) | $26.00 | $6,700 | $0 | Few Generics, Few Brands | $10.00 | $45.00 | $95.00 | $95.00 | 3,906 2013 Formulary | |||
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 Community Care's Partnership Program (HMO SNP) | $36.70 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H2034 -001 -0 | 0% | 0% | 2,113 2012 Formulary | ||||
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2013 Community Care's Partnership Program (HMO SNP) | $38.20 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 2,340 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 Care's Partnership Program Disabled (HMO SNP) | $35.40 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H2034 -002 -0 | 0% | 0% | 2,113 2012 Formulary | ||||
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2013 Community Care's Partnership Program Disabled (HMO SNP) | $38.20 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 2,340 2013 Formulary | |||||
-- This plan not offered in 2012 -- |
H0294 -007 -0 | |||||||||||
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2013 Care Improvement Plus Chrome RX (PPO SNP) | $38.30 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H0294 -006 -0 | |||||||||||
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2013 Care Improvement Plus Dual Advantage (PPO SNP) | $38.30 | 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 |
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2012 Care Improvement Plus Silver Rx (PPO SNP) | $36.70 | n/a | $205 | No additional gap coverage, only the Donut Hole Discount | H0294 -001 -0 | $10.00 | $45.00 | $95.00 | $95.00 | 3,159 2012 Formulary | ||
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2013 Care Improvement Plus Silver Rx (PPO SNP) | $38.30 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | |||
2012 iCare Medicare Plan (HMO SNP) | $36.70 | n/a | $320 | No additional gap coverage, only the Donut Hole Discount | H2237 -001 -0 | $10.00 | $48.00 | 3,125 2012 Formulary | ||||
2013 iCare Medicare Plan (HMO SNP) | $38.30 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $48.00 | 3,285 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 | |||
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 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 H5216-001 (PPO) | $67.00 | $4,500 | $0 | Few Generics, Few Brands |
H5216 -001 -0 | $8.00 | $42.00 | $80.00 | $80.00 | 3,798 2012 Formulary | ||
2013 HumanaChoice H5216-001 (PPO) | $72.00 | $4,900 | $0 | Few Generics, Few Brands | $8.00 | $42.00 | $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 | |||
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