2013 / 2014 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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2013 Care Improvement Plus Gold Rx (Regional PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | R9896 -009 -0 | $8.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | ||
2014 Care Improvement Plus Gold Rx (Regional PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $9.00 | $45.00 | $45.00 | 3,604 2014 Formulary | |||
2013 Care Improvement Plus Medicare Advantage (Regional PPO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | R9896 -012 -0 | $8.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | ||
2014 Care Improvement Plus Medicare Advantage (Regional PPO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $10.00 | $45.00 | $45.00 | 3,604 2014 Formulary | |||
2013 Humana Gold Plus H4141-011 (HMO) | $0.00 | $3,400 | $0 | Few Generics, Few Brands |
H4141 -011 -0 | $2.00 | $13.00 | $45.00 | $45.00 | 3,906 2013 Formulary | ||
2014 Humana Gold Plus H4141-011 (HMO) | $0.00 | $5,900 | $150 | Few Generics, Few Brands | $6.00 | $18.00 | $45.00 | $45.00 | 3,711 2014 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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2013 HumanaChoice R5826-064 (Regional PPO) | $0.00 | $4,900 | No Rx Coverage | R5826 -064 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 HumanaChoice R5826-064 (Regional PPO) | $0.00 | $5,900 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 WellCare Value (HMO-POS) | $0.00 | $4,500 | $0 | No additional gap coverage, only the Donut Hole Discount | H1112 -027 -0 | $3.00 | $39.00 | $75.00 | $75.00 | 2,835 2013 Formulary | ||
2014 WellCare Value (HMO-POS) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $35.00 | $35.00 | 2,844 2014 Formulary | |||
2013 Care Improvement Plus Silver Rx (Regional PPO SNP) | $36.30 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | R9896 -008 -0 | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | ||
2014 Care Improvement Plus Silver Rx (Regional PPO SNP) | $14.60 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,604 2014 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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2013 WellCare Access (HMO SNP) | $17.90 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H1112 -006 -0 | $0.00 | $45.00 | $95.00 | $95.00 | 2,835 2013 Formulary | ||
2014 WellCare Access (HMO SNP) | $17.20 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $2.00 | $15.00 | $15.00 | 2,844 2014 Formulary | |||
2013 Humana Gold Plus SNP-DE H4141-010 (HMO SNP) | $25.50 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H4141 -010 -0 | $0.00 | $0.00 | $43.00 | $43.00 | 3,906 2013 Formulary | ||
2014 Humana Gold Plus SNP-DE H4141-010 (HMO SNP) | $19.40 | n/a | $150 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $11.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 BlueValue Basic (HMO) | $0.00 | $5,500 | $60 | No additional gap coverage, only the Donut Hole Discount | H5422 -006 -0 | $4.00 | $10.00 | $45.00 | $45.00 | 4,173 2013 Formulary | ||
2014 BlueValue Basic (HMO) | $21.00 | $5,500 | $145 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $16.00 | $40.00 | $40.00 | 2,998 2014 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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2013 Care Improvement Plus Dual Advantage (Regional PPO SNP) | $36.50 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | R9896 -021 -0 | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | ||
2014 Care Improvement Plus Dual Advantage (Regional PPO SNP) | $31.50 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 0% | 0% | 0% | 0% | 3,604 2014 Formulary | |||
2013 Medicare Preferred Core (PPO) | $25.00 | $5,500 | $91 | No additional gap coverage, only the Donut Hole Discount | H9947 -001 -0 | $5.00 | $10.00 | $45.00 | $45.00 | 4,173 2013 Formulary | ||
2014 Medicare Preferred Core (PPO) | $35.00 | $5,500 | $125 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $16.00 | $40.00 | $40.00 | 2,998 2014 Formulary | |||
2013 HumanaChoice H5214-009 (PPO) | $30.00 | $4,400 | $0 | Few Generics, Few Brands |
H5214 -009 -0 | $4.00 | $12.00 | $45.00 | $45.00 | 3,906 2013 Formulary | ||
2014 HumanaChoice H5214-009 (PPO) | $37.00 | $4,900 | $0 | Few Generics, Few Brands | $5.00 | $15.00 | $45.00 | $45.00 | 3,711 2014 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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2013 Humana Gold Choice H8145-079 (PFFS) | $72.00 | n/a | $0 | Few Generics, Few Brands |
H8145 -079 -0 | $5.00 | $12.00 | $45.00 | $45.00 | 3,906 2013 Formulary | ||
2014 Humana Gold Choice H8145-079 (PFFS) | $75.00 | n/a | $0 | Few Generics, Few Brands | $5.00 | $15.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 HumanaChoice R5826-077 (Regional PPO) | $79.00 | $6,200 | $150 | No additional gap coverage, only the Donut Hole Discount | R5826 -077 -0 | $4.00 | $12.00 | $45.00 | $45.00 | 3,906 2013 Formulary | ||
2014 HumanaChoice R5826-077 (Regional PPO) | $77.00 | $6,700 | $150 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $12.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 Care Improvement Plus Dual Advantage (PPO SNP) | $34.20 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H6528 -017 -0 | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | ||
-- Members will be assigned to Care Improvement Plus Dual Advantage (Regional PPO SNP) R9896-0021 -- | ||||||||||||
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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2013 Care Improvement Plus Silver Rx (PPO SNP) | $34.20 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H6528 -015 -0 | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | ||
-- Members will be assigned to Care Improvement Plus Silver Rx (Regional PPO SNP) R9896-008 -- | ||||||||||||
2013 BlueValue Secure (HMO) | $48.00 | $4,600 | $60 | No additional gap coverage, only the Donut Hole Discount | H5422 -002 -0 | $4.00 | $10.00 | $45.00 | $45.00 | 4,173 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 Humana Gold Choice H8145-117 (PFFS) | $15.00 | n/a | No Rx Coverage | H8145 -117 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- This plan not offered in 2014 -- |
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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 |
||||||
2013 Medicare Preferred Premier (PPO) | $60.00 | $4,500 | $91 | No additional gap coverage, only the Donut Hole Discount | H9947 -002 -0 | $5.00 | $10.00 | $45.00 | $45.00 | 4,173 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 Care Improvement Plus Medicare Advantage (PPO) | $0.00 | $5,900 | $0 | No additional gap coverage, only the Donut Hole Discount | H6528 -006 -0 | $6.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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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 | H6528 -016 -0 | $6.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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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 |
||||||
2013 Care Improvement Plus Chrome RX (PPO SNP) | $34.20 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H6528 -025 -0 | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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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 | H6528 -026 -0 | $6.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 Care Improvement Plus Chrome RX (Regional PPO SNP) | $36.50 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | R9896 -022 -0 | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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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 |
||||||
2013 Care Improvement Plus Copper RX (Regional PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | R9896 -023 -0 | $8.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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