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 HealthyAdvantage WVA (HMO) | $0.00 | $3,400 | No Rx Coverage | H2165 -014 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 HealthSpring Advantage WVA (HMO) | $0.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 HealthyAdvantage Preferred WVA (HMO) | $0.00 | $3,400 | $0 | Many Generics | H2165 -013 -0 | $5.00 | $12.00 | $45.00 | $45.00 | 2,990 2012 Formulary | ||
2013 HealthSpring Preferred WVA (HMO) | $0.00 | $3,400 | $0 | Many Generics | $5.00 | $12.00 | $45.00 | $45.00 | 3,056 2013 Formulary | |||
2012 Humana Gold Choice H8145-050 (PFFS) | $0.00 | $6,700 | No Rx Coverage | H8145 -050 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Humana Gold Choice H8145-050 (PFFS) | $0.00 | n/a | 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 R5826-062 (Regional PPO) | $0.00 | $3,400 | No Rx Coverage | R5826 -062 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 HumanaChoice R5826-062 (Regional PPO) | $0.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 SecureCare - Option I (HMO) | $0.00 | $3,400 | No Rx Coverage | H5151 -004 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 SecureCare - Option I (HMO) | $0.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2012 FreedomBlue PPO HD (PPO) | $0.00 | $2,850 | $150 | No additional gap coverage, only the Donut Hole Discount | H5106 -025 -0 | $9.00 | $45.00 | $90.00 | $90.00 | 4,948 2012 Formulary | ||
2013 Freedom Blue PPO HD (PPO) | $12.00 | $5,000 | $150 | No additional gap coverage, only the Donut Hole Discount | $9.00 | $45.00 | $90.00 | $90.00 | 5,246 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 SecureChoice - Option I (PPO) | $20.00 | $3,400 | No Rx Coverage | H8604 -004 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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2013 SecureChoice - Option I (PPO) | $30.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2012 -- |
H2165 -017 -0 | |||||||||||
2013 HealthSpring TotalCare WVA (HMO SNP) | $30.40 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 3,025 2013 Formulary | ||||||
2012 HealthyAdvantage Premier WVA (HMO-POS) | $26.00 | $3,400 | $0 | Many Generics | H2165 -015 -0 | $5.00 | $12.00 | $45.00 | $45.00 | 2,990 2012 Formulary | ||
2013 HealthSpring Premier WVA (HMO-POS) | $31.00 | $3,400 | $0 | Many Generics | $3.00 | $10.00 | $45.00 | $45.00 | 3,056 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 HumanaChoice H5041-001 (PPO) | $29.00 | $4,000 | $0 | Few Generics, Few Brands |
H5041 -001 -0 | $7.00 | $40.00 | $85.00 | $85.00 | 3,798 2012 Formulary | ||
2013 HumanaChoice H5041-001 (PPO) | $35.00 | $4,000 | $0 | Few Generics, Few Brands | $6.00 | $15.00 | $45.00 | $45.00 | 3,906 2013 Formulary | |||
2012 Humana Gold Choice H8145-051 (PFFS) | $39.00 | $6,700 | $0 | Few Generics, Few Brands |
H8145 -051 -0 | $8.00 | $40.00 | $84.00 | $84.00 | 3,798 2012 Formulary | ||
2013 Humana Gold Choice H8145-051 (PFFS) | $56.00 | n/a | $0 | Few Generics, Few Brands | $6.00 | $15.00 | $45.00 | $45.00 | 3,906 2013 Formulary | |||
2012 FreedomBlue PPO Value (PPO) | $46.00 | $4,000 | No Rx Coverage | H5106 -017 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2013 Freedom Blue PPO Value (PPO) | $58.00 | $4,000 | 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 |
||||||
2012 HumanaChoice R5826-081 (Regional PPO) | $58.00 | $6,700 | $320 | No additional gap coverage, only the Donut Hole Discount | R5826 -081 -0 | 25% | 25% | 25% | 25% | 3,798 2012 Formulary | ||
2013 HumanaChoice R5826-081 (Regional PPO) | $75.00 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,906 2013 Formulary | |||
2012 Humana Gold Choice H8145-049 (PFFS) | $69.00 | $5,000 | $0 | Few Generics, Few Brands |
H8145 -049 -0 | $6.00 | $40.00 | $80.00 | $80.00 | 3,798 2012 Formulary | ||
2013 Humana Gold Choice H8145-049 (PFFS) | $82.00 | n/a | $0 | Few Generics, Few Brands | $6.00 | $14.00 | $45.00 | $45.00 | 3,906 2013 Formulary | |||
2012 HumanaChoice R5826-002 (Regional PPO) | $79.00 | $5,000 | $0 | Few Generics, Few Brands |
R5826 -002 -0 | $8.00 | $44.00 | $85.00 | $85.00 | 3,798 2012 Formulary | ||
2013 HumanaChoice R5826-002 (Regional PPO) | $85.00 | $5,300 | $0 | Few Generics, Few Brands | $6.00 | $15.00 | $45.00 | $45.00 | 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 SecureCare - Option II (HMO) | $91.00 | $3,400 | $0 | Many Generics | H5151 -002 -0 | $8.00 | $40.00 | $95.00 | $95.00 | 3,250 2012 Formulary | ||
2013 SecureCare - Option II (HMO) | $94.50 | $3,400 | $0 | Many Generics | $8.00 | $15.00 | $40.00 | $40.00 | 3,381 2013 Formulary | |||
2012 SecureChoice - Option II (PPO) | $111.00 | $3,400 | $0 | Many Generics | H8604 -003 -0 | $8.00 | $40.00 | $95.00 | $95.00 | 3,250 2012 Formulary | ||
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2013 SecureChoice - Option II (PPO) | $114.50 | $3,400 | $0 | Many Generics | $8.00 | $15.00 | $40.00 | $40.00 | 3,381 2013 Formulary | |||
-- This plan not offered in 2012 -- |
H5041 -003 -0 | |||||||||||
2013 HumanaChoice H5041-003 (PPO) | $130.00 | $5,000 | $0 | Few Generics, Few Brands | $6.00 | $15.00 | $45.00 | $45.00 | 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 |
||||||
2012 SecureCare - Option III (HMO) | $117.00 | $3,400 | $0 | Many Generics | H5151 -006 -0 | $3.00 | $35.00 | $95.00 | $95.00 | 3,250 2012 Formulary | ||
2013 SecureCare - Option III (HMO) | $130.50 | $3,400 | $0 | Many Generics | $3.00 | $10.00 | $35.00 | $35.00 | 3,381 2013 Formulary | |||
2012 FreedomBlue PPO Standard (PPO) | $108.00 | $4,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H5106 -013 -0 | $10.00 | $45.00 | $90.00 | $90.00 | 4,948 2012 Formulary | ||
2013 Freedom Blue PPO Standard (PPO) | $143.00 | $4,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $45.00 | $90.00 | $90.00 | 5,246 2013 Formulary | |||
2012 SecureChoice - Option III (PPO) | $137.00 | $3,400 | $0 | Many Generics | H8604 -006 -0 | $3.00 | $35.00 | $95.00 | $95.00 | 3,250 2012 Formulary | ||
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2013 SecureChoice - Option III (PPO) | $150.50 | $3,400 | $0 | Many Generics | $3.00 | $10.00 | $35.00 | $35.00 | 3,381 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 FreedomBlue PPO Deluxe (PPO) | $151.00 | $3,400 | $0 | Many Generics | H5106 -014 -0 | $10.00 | $45.00 | $90.00 | $90.00 | 4,948 2012 Formulary | ||
2013 Freedom Blue PPO Deluxe (PPO) | $180.00 | $3,400 | $0 | Many Generics | $10.00 | $45.00 | $90.00 | $90.00 | 5,246 2013 Formulary | |||
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