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 AB Basic Plan (Cost) | $3.00 | n/a | No Rx Coverage | H0602 -026 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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2014 AB Basic Plan (Cost) | $5.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Rocky Mountain Green Plan (Cost) | $5.00 | $6,700 | No Rx Coverage | H0602 -042 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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2014 Rocky Mountain Green Plan (Cost) | $10.00 | $6,700 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Rocky Mountain Thrifty Plan (Cost) | $25.00 | $6,000 | No Rx Coverage | H0602 -027 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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2014 Rocky Mountain Thrifty Plan (Cost) | $29.00 | $6,000 | 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 Rocky Mountain Standard Plan (Cost) | $64.00 | $5,000 | No Rx Coverage | H0602 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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2014 Rocky Mountain Standard Plan (Cost) | $68.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Rocky Mountain Green Plan + Rx (Cost) | $56.00 | $6,700 | $125 | No additional gap coverage, only the Donut Hole Discount | H0602 -043 -0 | $2.00 | $13.00 | $40.00 | $40.00 | 4,905 2013 Formulary | ||
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2014 Rocky Mountain Green Plan + Rx (Cost) | $69.40 | n/a | $120 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $25.00 | $40.00 | $40.00 | 4,857 2014 Formulary | |||
2013 Rocky Mountain Thrifty Plan + Rx (Cost) | $74.30 | $6,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H0602 -039 -0 | $3.00 | $12.00 | $45.00 | $45.00 | 4,905 2013 Formulary | ||
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2014 Rocky Mountain Thrifty Plan + Rx (Cost) | $80.90 | n/a | $75 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $25.00 | $45.00 | $45.00 | 4,857 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 Rocky Mountain Standard Plan + Rx (Cost) | $120.60 | $5,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H0602 -017 -0 | $3.00 | $12.00 | $45.00 | $45.00 | 4,905 2013 Formulary | ||
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2014 Rocky Mountain Standard Plan + Rx (Cost) | $127.70 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $30.00 | $45.00 | $45.00 | 4,857 2014 Formulary | |||
2013 Rocky Mountain Plus Plan (Cost) | $147.00 | n/a | No Rx Coverage | H0602 -003 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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2014 Rocky Mountain Plus Plan (Cost) | $158.00 | $5,000 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Rocky Mountain Plus Plan + Rx (Cost) | $249.80 | n/a | $0 | All Generics | H0602 -019 -0 | $3.00 | $9.00 | $40.00 | $40.00 | 4,905 2013 Formulary | ||
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2014 Rocky Mountain Plus Plan + Rx (Cost) | $261.30 | n/a | $0 | Many Generics | $3.00 | $25.00 | $40.00 | $40.00 | 4,857 2014 Formulary | |||
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