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 Senior Advantage Medicare Medi-Cal Plan North (HMO SNP) | $16.60 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H0524 -030 -0 | $10.00 | $12.00 | $45.00 | $45.00 | 5,250 2013 Formulary | ||
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2014 Senior Advantage Medicare Medi-Cal Plan North (HMO SNP) | $9.50 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $13.00 | $45.00 | $45.00 | 5,237 2014 Formulary | |||
2013 HPSM CareAdvantage (HMO SNP) | $29.90 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5428 -001 -0 | $0.00 | $45.00 | 3,095 2013 Formulary | ||||
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2014 HPSM CareAdvantage (HMO SNP) | $28.10 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $45.00 | 3,042 2014 Formulary | |||||
2013 CCHP Senior Program (HMO) | $45.00 | $3,400 | $325 | No additional gap coverage, only the Donut Hole Discount | H0571 -001 -0 | $10.00 | $40.00 | 20% | 3,160 2013 Formulary | |||
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2014 CCHP Senior Program (HMO) | $40.00 | $3,400 | $310 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $7.00 | $40.00 | $40.00 | 4,936 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 Kaiser Permanente Senior Advantage Marin San Mateo (HMO) | $99.00 | $3,400 | $0 | All Generics, Few Brands |
H0524 -031 -0 | $5.00 | $10.00 | $45.00 | $45.00 | 5,250 2013 Formulary | ||
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2014 Kaiser Permanente Senior Advantage Marin San Mateo (HMO) | $96.00 | $5,900 | $0 | All Generics, Few Brands | $5.00 | $15.00 | $45.00 | $45.00 | 5,237 2014 Formulary | |||
2013 AARP MedicareComplete SecureHorizons (HMO) | $99.00 | $4,900 | $0 | No additional gap coverage, only the Donut Hole Discount | H0543 -028 -0 | $3.00 | $6.00 | $45.00 | $45.00 | 3,825 2013 Formulary | ||
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2014 AARP MedicareComplete SecureHorizons (HMO) | $99.00 | $4,900 | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $8.00 | $45.00 | $45.00 | 3,604 2014 Formulary | |||
2013 Health Net Seniority Plus Ruby (HMO) | $182.00 | $5,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H0562 -017 -0 | $3.00 | $10.00 | $45.00 | $45.00 | 4,263 2013 Formulary | ||
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-- Members will be assigned to Health Net Seniority Plus Ruby (HMO) H0562-0098 -- | ||||||||||||
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 Health Net Seniority Plus Green (HMO) | $99.00 | $3,400 | No Rx Coverage | H0562 -045 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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-- This plan not offered in 2014 -- |
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2013 Anthem Medicare Preferred Standard (PPO) | $203.00 | $4,000 | $90 | No additional gap coverage, only the Donut Hole Discount | H8552 -011 -0 | $4.00 | $9.00 | $40.00 | $40.00 | 2,838 2013 Formulary | ||
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-- This plan not offered in 2014 -- |
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2013 CCHP Senior Plan B-only Plan (HMO) | $0.00 | n/a | $325 | n/a | H0571 -002 -0 | $10.00 | $40.00 | 20% | 3,160 2013 Formulary | |||
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-- This plan not offered in 2014 -- |
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