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 HealthSpring Advantage (HMO) | $0.00 | $3,400 | No Rx Coverage | H0150 -012 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Cigna-HealthSpring Advantage (HMO) | $0.00 | $6,700 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 HealthSpring Preferred (HMO) | $0.00 | $3,400 | $0 | Many Generics | H0150 -001 -0 | $3.00 | $10.00 | $45.00 | $45.00 | 3,056 2013 Formulary | ||
2014 Cigna-HealthSpring Preferred (HMO) | $0.00 | $6,700 | $0 | Many Generics | $3.00 | $12.00 | $45.00 | $45.00 | 2,946 2014 Formulary | |||
2013 HumanaChoice R5826-065 (Regional PPO) | $0.00 | $3,400 | No Rx Coverage | R5826 -065 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 HumanaChoice R5826-065 (Regional PPO) | $0.00 | $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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-- This plan not offered in 2013 -- |
H0154 -014 -0 | |||||||||||
2014 VIVA Medicare Me (HMO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $45.00 | $45.00 | 4,781 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H0154 -001 -0 | |||||||||||
2014 VIVA Medicare Plus (HMO) | $0.00 | $5,500 | $125 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $45.00 | $45.00 | 4,781 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H0154 -008 -0 | |||||||||||
2014 VIVA Medicare Select (HMO) | $0.00 | $5,000 | 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 Humana Gold Plus SNP-DE H2012-070 (HMO SNP) | $29.70 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H2012 -070 -0 | $0.00 | $0.00 | $40.00 | $40.00 | 3,906 2013 Formulary | ||
2014 Humana Gold Plus SNP-DE H2012-070 (HMO SNP) | $18.00 | n/a | $185 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $3.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 HealthSpring TotalCare (HMO SNP) | $32.40 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H0150 -007 -0 | 25% | 3,025 2013 Formulary | |||||
2014 Cigna-HealthSpring TotalCare (HMO SNP) | $21.80 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 2,946 2014 Formulary | ||||||
-- This plan not offered in 2013 -- |
H0154 -012 -0 | |||||||||||
2014 VIVA Medicare Extra Value (HMO SNP) | $29.60 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 15% | 15% | 4,781 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 HumanaChoice R5826-001 (Regional PPO) | $62.00 | $4,900 | $100 | No additional gap coverage, only the Donut Hole Discount | R5826 -001 -0 | $8.00 | $8.00 | $38.00 | $38.00 | 3,906 2013 Formulary | ||
2014 HumanaChoice R5826-001 (Regional PPO) | $69.00 | $5,900 | $40 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $7.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 Blue Advantage Complete (PPO) | $103.00 | $3,400 | $290 | No additional gap coverage, only the Donut Hole Discount | H0104 -011 -3 | $4.00 | $10.00 | $45.00 | $45.00 | 2,905 2013 Formulary | ||
2014 Blue Advantage Complete (PPO) | $72.00 | $3,400 | $250 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $45.00 | $45.00 | 2,839 2014 Formulary | |||
2013 Humana Gold Choice H8145-075 (PFFS) | $67.00 | n/a | $0 | Few Generics, Few Brands |
H8145 -075 -0 | $6.00 | $12.00 | $45.00 | $45.00 | 3,906 2013 Formulary | ||
2014 Humana Gold Choice H8145-075 (PFFS) | $92.00 | n/a | $100 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $12.00 | $45.00 | $45.00 | 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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-- This plan not offered in 2013 -- |
H0154 -011 -0 | |||||||||||
2014 VIVA Medicare Premier (HMO) | $118.00 | $3,400 | $0 | Some Generics | $0.00 | $15.00 | $45.00 | $45.00 | 4,781 2014 Formulary | |||
2013 HealthSpring Premier (HMO-POS) | $69.50 | $2,950 | $0 | Many Generics | H0150 -023 -0 | $3.00 | $6.00 | $45.00 | $45.00 | 3,056 2013 Formulary | ||
-- Members will be assigned to Cigna-HealthSpring Preferred (HMO) H0150-001 -- | ||||||||||||
2013 Humana Gold Choice H8145-111 (PFFS) | $0.00 | n/a | No Rx Coverage | H8145 -111 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- This plan not offered in 2014 -- |
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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 Windsor Medicare Extra Silver Plan (HMO) | $0.00 | $3,400 | No Rx Coverage | H5698 -035 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- This plan not offered in 2014 -- |
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2013 Windsor Medicare Extra Comp Plus Plan (HMO SNP) | $33.70 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5698 -122 -0 | 25% | 25% | 25% | 25% | 2,715 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 Windsor Medicare Extra Diabetes Plan (HMO SNP) | $133.00 | n/a | $0 | Some Generics | H5698 -153 -0 | $4.00 | $10.00 | $40.00 | $40.00 | 2,715 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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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 Humana Gold Plus H2012-002 (HMO) | $0.00 | $4,900 | $0 | Few Generics, Few Brands |
H2012 -002 -0 | $4.00 | $12.00 | $45.00 | $45.00 | 3,906 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 Windsor Medicare Extra Gold Plan (HMO) | $40.00 | $3,400 | $0 | Some Generics | H5698 -036 -0 | $3.00 | $10.00 | $43.00 | $43.00 | 2,715 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 Windsor Medicare Extra Emerald Plan (HMO) | $0.00 | $6,700 | $0 | Some Generics | H5698 -062 -0 | $3.00 | $10.00 | $44.00 | $44.00 | 2,715 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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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 Windsor Medicare Extra Diamond Plan (HMO) | $128.00 | $4,500 | $0 | Some Generics | H5698 -068 -0 | $3.00 | $10.00 | $40.00 | $40.00 | 2,715 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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