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 HumanaChoice R5826-053 (Regional PPO) | $0.00 | $3,900 | No Rx Coverage | R5826 -053 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 HumanaChoice R5826-053 P (Regional PPO) | $0.00 | $4,500 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Medicare Plus Blue PPO Essential (PPO) | $12.50 | $6,400 | $325 | No additional gap coverage, only the Donut Hole Discount | H9572 -004 -3 | 25% | 25% | 25% | 25% | 3,883 2013 Formulary | ||
2014 Medicare Plus Blue PPO Essential (PPO) | $17.50 | $6,400 | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,472 2014 Formulary | |||
2013 Humana Gold Choice H8145-121 (PFFS) | $19.00 | n/a | No Rx Coverage | H8145 -121 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Humana Gold Choice H8145-121 (PFFS) | $29.00 | 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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2013 Upper Peninsula Health Plan Plus (HMO SNP) | $34.10 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H2161 -001 -0 | 25% | 25% | 25% | 25% | 3,356 2013 Formulary | ||
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2014 Upper Peninsula Health Plan Plus (HMO SNP) | $32.40 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 15% | 15% | 3,452 2014 Formulary | |||
2013 HumanaChoice R5826-006 (Regional PPO) | $99.00 | $6,700 | $0 | Few Generics, Few Brands |
R5826 -006 -0 | $8.00 | $40.00 | $80.00 | $80.00 | 3,906 2013 Formulary | ||
2014 HumanaChoice R5826-006 P (Regional PPO) | $90.00 | $6,700 | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,711 2014 Formulary | |||
2013 Medicare Plus Blue PPO Vitality (PPO) | $76.00 | $5,400 | $325 | No additional gap coverage, only the Donut Hole Discount | H9572 -002 -3 | 25% | 25% | 25% | 25% | 3,883 2013 Formulary | ||
2014 Medicare Plus Blue PPO Vitality (PPO) | $94.00 | $5,400 | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,472 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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-- This plan not offered in 2013 -- |
H2161 -002 -0 | |||||||||||
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2014 Upper Peninsula Health Plan Advantage (HMO) | $98.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $10.00 | $42.00 | $42.00 | 3,452 2014 Formulary | |||
2013 Humana Gold Choice H8145-154 (PFFS) | $94.00 | n/a | $0 | Few Generics, Few Brands |
H8145 -154 -0 | $7.00 | $40.00 | $80.00 | $80.00 | 3,906 2013 Formulary | ||
2014 Humana Gold Choice H8145-154 (PFFS) | $112.00 | n/a | $0 | Few Generics, Few Brands | $6.00 | $15.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 Medicare Plus Blue PPO Signature (PPO) | $132.00 | $4,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H9572 -001 -3 | $3.00 | $15.00 | $45.00 | $45.00 | 3,883 2013 Formulary | ||
2014 Medicare Plus Blue PPO Signature (PPO) | $155.00 | $4,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $15.00 | $45.00 | $45.00 | 3,472 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 Medicare Plus Blue PPO Assure (PPO) | $240.00 | $3,400 | $0 | Many Generics | H9572 -003 -3 | $3.00 | $10.00 | $40.00 | $40.00 | 3,978 2013 Formulary | ||
2014 Medicare Plus Blue PPO Assure (PPO) | $268.00 | $3,400 | $0 | Some Generics | $3.00 | $10.00 | $40.00 | $40.00 | 3,532 2014 Formulary | |||
2013 HumanaChoice R5826-072 (Regional PPO) | $66.00 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | R5826 -072 -0 | 25% | 25% | 25% | 25% | 3,906 2013 Formulary | ||
-- Members will be assigned to HumanaChoice R5826-006 P (Regional PPO) R5826-006 -- | ||||||||||||
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