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 BCN Advantage HMO-POS Basic (HMO-POS) | $0.00 | $4,200 | $325 | No additional gap coverage, only the Donut Hole Discount | H5883 -004 -1 | 25% | 25% | 25% | 25% | 3,686 2013 Formulary | ||
2014 BCN Advantage HMO-POS Basic (HMO-POS) | $0.00 | $4,200 | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,336 2014 Formulary | |||
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 -1 | 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 | |||
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 BCN Advantage HMO-POS Elements (HMO-POS) | $20.00 | $3,600 | No Rx Coverage | H5883 -001 -1 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 BCN Advantage HMO-POS Elements (HMO-POS) | $20.00 | $3,600 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
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. | ||||||||
-- This plan not offered in 2013 -- |
H5883 -006 -0 | |||||||||||
2014 BCN Advantage HMO MyChoice Wellness (HMO) | $33.00 | $3,400 | $0 | Some Generics | $5.00 | $15.00 | $45.00 | $45.00 | 3,336 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 Vitality (PPO) | $41.00 | $5,400 | $325 | No additional gap coverage, only the Donut Hole Discount | H9572 -002 -1 | 25% | 25% | 25% | 25% | 3,883 2013 Formulary | ||
2014 Medicare Plus Blue PPO Vitality (PPO) | $39.00 | $5,400 | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,472 2014 Formulary | |||
2013 PriorityMedicare Value (HMO-POS) | $32.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H2320 -011 -0 | $9.00 | $40.00 | $90.00 | $90.00 | 3,466 2013 Formulary | ||
2014 PriorityMedicare Value (HMO-POS) | $41.00 | $4,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $45.00 | $95.00 | $95.00 | 3,436 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H4875 -016 -5 | |||||||||||
2014 PriorityMedicare Merit (PPO) | $51.50 | $4,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $45.00 | $90.00 | $90.00 | 3,436 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 |
||||||
-- This plan not offered in 2013 -- |
H5216 -010 -0 | |||||||||||
2014 HumanaChoice H5216-010 (PPO) | $52.00 | $6,000 | $0 | Few Generics, Few Brands | $6.00 | $15.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 Humana Gold Choice H8145-005 (PFFS) | $72.00 | n/a | $0 | Few Generics, Few Brands |
H8145 -005 -0 | $7.00 | $42.00 | $80.00 | $80.00 | 3,906 2013 Formulary | ||
2014 Humana Gold Choice H8145-005 (PFFS) | $80.00 | n/a | $0 | Few Generics, Few Brands | $6.00 | $15.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 BCN Advantage HMO-POS Classic (HMO-POS) | $75.00 | $3,400 | $0 | Many Generics | H5883 -002 -1 | $3.00 | $10.00 | $40.00 | $40.00 | 3,686 2013 Formulary | ||
2014 BCN Advantage HMO-POS Classic (HMO-POS) | $85.00 | $3,400 | $0 | Some Generics | $3.00 | $10.00 | $40.00 | $40.00 | 3,336 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 |
||||||
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 Signature (PPO) | $96.00 | $4,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H9572 -001 -1 | $3.00 | $15.00 | $45.00 | $45.00 | 3,883 2013 Formulary | ||
2014 Medicare Plus Blue PPO Signature (PPO) | $99.00 | $4,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $15.00 | $45.00 | $45.00 | 3,472 2014 Formulary | |||
2013 PriorityMedicare (HMO-POS) | $89.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H2320 -007 -0 | $8.00 | $35.00 | $80.00 | $80.00 | 3,466 2013 Formulary | ||
2014 PriorityMedicare (HMO-POS) | $101.50 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $40.00 | $85.00 | $85.00 | 3,436 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 -- |
H4875 -017 -2 | |||||||||||
2014 PriorityMedicare Select (PPO) | $118.50 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $40.00 | $85.00 | $85.00 | 3,436 2014 Formulary | |||
2013 Medicare Plus Blue PPO Assure (PPO) | $151.00 | $3,400 | $0 | Many Generics | H9572 -003 -1 | $3.00 | $10.00 | $40.00 | $40.00 | 3,978 2013 Formulary | ||
2014 Medicare Plus Blue PPO Assure (PPO) | $169.00 | $3,400 | $0 | Some Generics | $3.00 | $10.00 | $40.00 | $40.00 | 3,532 2014 Formulary | |||
2013 BCN Advantage HMO-POS Prestige (HMO-POS) | $203.00 | $3,200 | $0 | Many Generics | H5883 -003 -1 | $3.00 | $10.00 | $35.00 | $35.00 | 3,686 2013 Formulary | ||
2014 BCN Advantage HMO-POS Prestige (HMO-POS) | $216.00 | $3,200 | $0 | Some Generics | $3.00 | $10.00 | $35.00 | $35.00 | 3,336 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 |
||||||
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 -- | ||||||||||||
2013 PriorityMedicare Select (PPO) | $97.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H4875 -012 -0 | $8.00 | $40.00 | $85.00 | $85.00 | 3,466 2013 Formulary | ||
-- Members will be assigned to PriorityMedicare Select (PPO) H4875-0017 -- | ||||||||||||
2013 HumanaChoice H5470-005 (PPO) | $62.00 | $6,000 | $0 | Few Generics, Few Brands |
H5470 -005 -0 | $6.00 | $45.00 | $90.00 | $90.00 | 3,906 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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