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 BlueSaver MSA (MSA) | $0.00 | n/a | No Rx Coverage | H9788 -002 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 BlueSaver MSA (MSA) | $0.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 UnitedHealthcare MedicareComplete Choice (Regional PPO) | $0.00 | $4,900 | $0 | No additional gap coverage, only the Donut Hole Discount | R5342 -001 -0 | $3.00 | $6.00 | $45.00 | $45.00 | 3,825 2013 Formulary | ||
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2014 UnitedHealthcare MedicareComplete Choice (Regional PPO) | $0.00 | $5,200 | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $8.00 | $45.00 | $45.00 | 3,604 2014 Formulary | |||
2013 UnitedHealthcare MedicareComplete Choice Essential (Regional PPO) | $0.00 | $3,900 | No Rx Coverage | R5342 -002 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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2014 UnitedHealthcare MedicareComplete Choice Essential (Regional PPO) | $0.00 | $5,200 | 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 Preferred Gold (HMO-POS) | $13.20 | $4,500 | No Rx Coverage | H9859 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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2014 Preferred Gold without Part D (HMO-POS) | $18.40 | $4,500 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 CDPHP Choice (HMO) | $25.00 | $2,500 | No Rx Coverage | H3388 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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2014 CDPHP Choice (HMO) | $24.00 | $2,500 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2013 -- |
H9615 -008 -0 | |||||||||||
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2014 BasiCare with Part D (PPO) | $27.00 | $4,000 | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,577 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 Today's Options Premier 600 (PFFS) | $30.00 | n/a | No Rx Coverage | H2816 -009 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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2014 Today's Options Premier 900 (PFFS) | $30.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 CDPHP Value Rx (HMO) | $34.00 | $3,300 | $0 | No additional gap coverage, only the Donut Hole Discount | H3388 -004 -0 | $0.00 | $9.00 | $45.00 | $45.00 | 3,003 2013 Formulary | ||
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2014 CDPHP Value Rx (HMO) | $32.00 | $3,300 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $9.00 | $45.00 | $45.00 | 2,922 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H5970 -012 -0 | |||||||||||
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2014 HumanaChoice H5970-012 (PPO) | $41.00 | $6,700 | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 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 GoldValue Rx (HMO-POS) | $41.80 | $6,000 | $0 | Few Generics | H9859 -013 -0 | $10.00 | $35.00 | $90.00 | $90.00 | 3,714 2013 Formulary | ||
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2014 GoldValue with Part D (HMO-POS) | $59.50 | $6,000 | $0 | Few Generics | $10.00 | $35.00 | $90.00 | $90.00 | 3,577 2014 Formulary | |||
2013 GoldAnywhere Rx Option 2 (PPO) | $33.80 | $4,000 | $0 | Few Generics | H9615 -007 -0 | $10.00 | $35.00 | $90.00 | $90.00 | 3,714 2013 Formulary | ||
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2014 GoldAnywhere with Part D - Option 2 (PPO) | $64.00 | $4,000 | $0 | Few Generics | $10.00 | $35.00 | $90.00 | $90.00 | 3,577 2014 Formulary | |||
2013 Today's Options Premier 200 (PFFS) | $70.00 | n/a | No Rx Coverage | H2816 -025 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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2014 Today's Options Premier 200 (PFFS) | $70.00 | 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 Today's Options Premier Plus 650B (PFFS) | $71.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H2816 -021 -0 | $5.00 | $12.00 | $45.00 | $45.00 | 4,885 2013 Formulary | ||
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2014 Today's Options Premier Plus 950B (PFFS) | $76.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $12.00 | $45.00 | $45.00 | 2,885 2014 Formulary | |||
2013 CDPHP Choice Rx (HMO) | $79.00 | $2,500 | $0 | Many Generics, Few Brands |
H3388 -002 -0 | $0.00 | $8.00 | $40.00 | $40.00 | 3,003 2013 Formulary | ||
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2014 CDPHP Choice Rx (HMO) | $81.00 | $2,500 | $0 | Some Generics, Few Brands | $0.00 | $8.00 | $40.00 | $40.00 | 2,922 2014 Formulary | |||
2013 CDPHP Classic (PPO) | $100.00 | $2,500 | No Rx Coverage | H5042 -004 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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2014 CDPHP Classic (PPO) | $110.00 | $3,400 | 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 Medicare BlueBasic PPO (PPO) | $110.00 | $4,000 | No Rx Coverage | H3335 -045 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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2014 Medicare BlueBasic PPO (PPO) | $110.00 | $4,800 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Today's Options Premier Plus 250A (PFFS) | $107.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H2816 -027 -0 | $2.00 | $7.00 | $40.00 | $40.00 | 4,885 2013 Formulary | ||
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2014 Today's Options Premier Plus 350A (PFFS) | $112.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $7.00 | $40.00 | $40.00 | 2,885 2014 Formulary | |||
2013 Preferred Gold Rx (HMO-POS) | $98.30 | $4,500 | $0 | Few Generics | H9859 -002 -0 | $10.00 | $35.00 | $90.00 | $90.00 | 3,714 2013 Formulary | ||
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2014 Preferred Gold with Part D (HMO-POS) | $117.00 | $4,500 | $0 | Few Generics | $10.00 | $35.00 | $90.00 | $90.00 | 3,577 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 CDPHP Core Rx (PPO) | $113.00 | $3,300 | $0 | No additional gap coverage, only the Donut Hole Discount | H5042 -005 -0 | $0.00 | $9.00 | $45.00 | $45.00 | 3,003 2013 Formulary | ||
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2014 CDPHP Core Rx (PPO) | $126.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $12.00 | $45.00 | $45.00 | 2,922 2014 Formulary | |||
2013 Humana Reader's Digest Healthy Living Plan (PPO) | $141.00 | $5,000 | $0 | Few Generics, Few Brands |
H5970 -006 -0 | $6.00 | $15.00 | $45.00 | $45.00 | 3,906 2013 Formulary | ||
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2014 HumanaChoice H5970-006 (PPO) | $148.00 | $6,700 | $0 | Few Generics, Few Brands | $8.00 | $18.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 Medicare BluePlus PPO (PPO) | $158.00 | $3,500 | $200 | No additional gap coverage, only the Donut Hole Discount | H3335 -021 -0 | $8.00 | $45.00 | $95.00 | $95.00 | 4,989 2013 Formulary | ||
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2014 Medicare BluePlus PPO (PPO) | $160.00 | $4,000 | $225 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $45.00 | $95.00 | $95.00 | 4,925 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 CDPHP Classic Rx (PPO) | $159.00 | $2,500 | $0 | Many Generics, Few Brands |
H5042 -001 -0 | $0.00 | $8.00 | $40.00 | $40.00 | 3,003 2013 Formulary | ||
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2014 CDPHP Classic Rx (PPO) | $182.00 | $3,400 | $0 | Some Generics, Few Brands | $0.00 | $10.00 | $40.00 | $40.00 | 2,922 2014 Formulary | |||
2013 GoldAnywhere Rx Option 1 (PPO) | $192.00 | $2,000 | $0 | Few Generics | H9615 -002 -0 | $8.00 | $35.00 | $90.00 | $90.00 | 3,714 2013 Formulary | ||
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2014 GoldAnywhere with Part D - Option 1 (PPO) | $238.00 | $2,000 | $0 | Few Generics | $8.00 | $35.00 | $90.00 | $90.00 | 3,577 2014 Formulary | |||
2013 CDPHP Prime Rx (PPO) | $228.00 | $2,000 | $0 | Many Generics, Few Brands |
H5042 -007 -0 | $0.00 | $5.00 | $40.00 | $40.00 | 3,003 2013 Formulary | ||
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2014 CDPHP Prime Rx (PPO) | $256.00 | $3,400 | $0 | Some Generics, Few Brands | $0.00 | $8.00 | $40.00 | $40.00 | 2,922 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 Empire MediBlue Freedom II (PPO) | $66.00 | $3,900 | $75 | No additional gap coverage, only the Donut Hole Discount | H3342 -014 -0 | $7.00 | $10.00 | $45.00 | $45.00 | 4,173 2013 Formulary | ||
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-- This plan not offered in 2014 -- |
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2013 HumanaChoice H5970-005 (PPO) | $19.00 | $4,750 | $0 | Few Generics, Few Brands |
H5970 -005 -0 | $6.00 | $15.00 | $45.00 | $45.00 | 3,906 2013 Formulary | ||
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-- This plan not offered in 2014 -- |
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