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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-- This plan not offered in 2013 -- |
H5509 -016 -0 | |||||||||||
2014 Advantra Freedom (PPO) | $0.00 | $4,800 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $10.00 | $42.00 | $42.00 | 3,225 2014 Formulary | |||
2013 Advantra Total Care (HMO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H2672 -010 -0 | $6.00 | $40.00 | $80.00 | $80.00 | 3,281 2013 Formulary | ||
2014 Advantra Total Care (HMO) | $0.00 | $4,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $10.00 | $42.00 | $42.00 | 3,225 2014 Formulary | |||
2013 AR Blue Cross - Medi-Pak Advantage MA (PFFS) | $0.00 | n/a | No Rx Coverage | H4213 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 AR Blue Cross - Medi-Pak Advantage MA (PFFS) | $0.00 | 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 AR Blue Cross - Medi-Pak Advantage MA-PD Option 1 (PFFS) | $0.00 | n/a | $170 | No additional gap coverage, only the Donut Hole Discount | H4213 -004 -0 | $2.00 | $11.00 | 25% | 25% | 2,923 2013 Formulary | ||
2014 AR Blue Cross - Medi-Pak Advantage MA-PD Option 1 (PFFS) | $0.00 | n/a | $250 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $15.00 | 25% | 25% | 2,839 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H6528 -016 -0 | |||||||||||
2014 Care Improvement Plus Gold Rx (PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $9.00 | $45.00 | $45.00 | 3,604 2014 Formulary | |||
2013 Care Improvement Plus Gold Rx (Regional PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | R3444 -009 -0 | $8.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | ||
2014 Care Improvement Plus Gold Rx (Regional PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $9.00 | $45.00 | $45.00 | 3,604 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 -- |
H6528 -006 -0 | |||||||||||
2014 Care Improvement Plus Medicare Advantage (PPO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $10.00 | 25% | 25% | 3,604 2014 Formulary | |||
2013 Care Improvement Plus Medicare Advantage (Regional PPO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | R3444 -012 -0 | $8.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | ||
2014 Care Improvement Plus Medicare Advantage (Regional PPO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $10.00 | $45.00 | $45.00 | 3,604 2014 Formulary | |||
2013 Humana Gold Plus H2012-001 (HMO) | $0.00 | $4,000 | $0 | Few Generics, Few Brands |
H2012 -001 -0 | $5.00 | $10.00 | $42.00 | $42.00 | 3,906 2013 Formulary | ||
2014 Humana Gold Plus H2012-001 (HMO) | $0.00 | $5,100 | $0 | Few Generics, Few Brands | $5.00 | $10.00 | $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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2013 HumanaChoice R5826-067 (Regional PPO) | $0.00 | $3,400 | No Rx Coverage | R5826 -067 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 HumanaChoice R5826-067 (Regional PPO) | $0.00 | $4,000 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2013 -- |
H9699 -001 -0 | |||||||||||
new | new | new | ||||||||||
2014 Medi-Pak Advantage (HMO) | $0.00 | $6,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $15.00 | 25% | 25% | 2,839 2014 Formulary | |||
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. | |||||||
2014 Windsor Medicare Extra Silver Plan (HMO) | $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 |
||||||
2013 Humana Gold Choice H8145-120 (PFFS) | $0.00 | n/a | No Rx Coverage | H8145 -120 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Humana Gold Choice H8145-120 (PFFS) | $15.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Humana Gold Plus SNP-DE H2012-081 (HMO SNP) | $30.90 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H2012 -081 -0 | 25% | 25% | 25% | 25% | 3,906 2013 Formulary | ||
2014 Humana Gold Plus SNP-DE H2012-081 (HMO SNP) | $18.40 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 0% | 0% | 0% | 0% | 3,711 2014 Formulary | |||
2013 Care Improvement Plus Silver Rx (Regional PPO SNP) | $34.40 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | R3444 -008 -0 | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | ||
2014 Care Improvement Plus Silver Rx (Regional PPO SNP) | $20.60 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,604 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) | $20.00 | n/a | No Rx Coverage | H6169 -012 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- | ||||||||||||
2014 Today's Options Premier 900 (PFFS) | $22.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Care Improvement Plus Dual Advantage (Regional PPO SNP) | $34.40 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | R3444 -011 -0 | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | ||
2014 Care Improvement Plus Dual Advantage (Regional PPO SNP) | $24.90 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 0% | 0% | 0% | 0% | 3,604 2014 Formulary | |||
2013 Windsor Medicare Extra Comp Plus Plan (HMO SNP) | $26.50 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5698 -128 -0 | 25% | 25% | 25% | 25% | 2,715 2013 Formulary | ||
2014 Windsor Medicare Extra Comp Plus Plan (HMO SNP) | $25.50 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 0% | 0% | 0% | 0% | 2,885 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 Windsor Medicare Extra Emerald Plan (HMO) | $0.00 | $6,700 | $0 | Some Generics | H5698 -063 -0 | $3.00 | $10.00 | $44.00 | $44.00 | 2,715 2013 Formulary | ||
2014 Windsor Medicare Extra Emerald Plan (HMO) | $30.00 | $6,700 | $0 | Some Generics | $3.00 | $12.00 | $45.00 | $45.00 | 2,885 2014 Formulary | |||
2013 HumanaChoice H7188-006 (PPO) | $48.00 | $5,500 | $325 | Few Generics | H7188 -006 -0 | $1.00 | $3.00 | 19% | 19% | 3,251 2013 Formulary | ||
2014 HumanaChoice H7188-006 (PPO) | $60.00 | $6,700 | $75 | Few Generics | $1.00 | $3.00 | 15% | 15% | 3,176 2014 Formulary | |||
2013 Today's Options Premier Plus 650B (PFFS) | $64.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H6169 -032 -0 | $5.00 | $12.00 | $45.00 | $45.00 | 4,885 2013 Formulary | ||
-- | ||||||||||||
2014 Today's Options Premier Plus 950B (PFFS) | $71.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $12.00 | $45.00 | $45.00 | 2,885 2014 Formulary | |||
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 H7188-003 (PPO) | $71.00 | $5,000 | $0 | Few Generics, Few Brands |
H7188 -003 -0 | $6.00 | $11.00 | $43.00 | $43.00 | 3,906 2013 Formulary | ||
2014 HumanaChoice H7188-003 (PPO) | $87.00 | $6,500 | $0 | Few Generics, Few Brands | $6.00 | $11.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 Humana Gold Choice H8145-122 (PFFS) | $79.00 | n/a | $0 | Few Generics, Few Brands |
H8145 -122 -0 | $7.00 | $12.00 | $43.00 | $43.00 | 3,906 2013 Formulary | ||
2014 Humana Gold Choice H8145-122 (PFFS) | $97.00 | n/a | $0 | Few Generics, Few Brands | $7.00 | $12.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 HumanaChoice R5826-010 (Regional PPO) | $114.00 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | R5826 -010 -0 | 25% | 25% | 25% | 25% | 3,906 2013 Formulary | ||
2014 HumanaChoice R5826-010 (Regional PPO) | $114.00 | $5,500 | $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 |
||||||
2013 Care Improvement Plus Dual Advantage (PPO SNP) | $34.20 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H6528 -011 -0 | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | ||
-- Members will be assigned to Care Improvement Plus Dual Advantage (Regional PPO SNP) R3444-0011 -- | ||||||||||||
2013 Care Improvement Plus Gold Rx (PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H6528 -010 -0 | $6.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | ||
-- Members will be assigned to Care Improvement Plus Gold Rx (PPO SNP) H6528-0016 -- | ||||||||||||
2013 Care Improvement Plus Medicare Advantage (PPO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H6528 -001 -0 | $6.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | ||
-- Members will be assigned to Care Improvement Plus Medicare Advantage (PPO) H6528-006 -- | ||||||||||||
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 Care Improvement Plus Silver Rx (PPO SNP) | $34.20 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H6528 -009 -0 | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | ||
-- Members will be assigned to Care Improvement Plus Silver Rx (Regional PPO SNP) R3444-008 -- | ||||||||||||
2013 Today's Options Premier 300 (PFFS) | $50.00 | n/a | No Rx Coverage | H6169 -050 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- | ||||||||||||
-- Members will be assigned to Today's Options Premier 900 (PFFS) H6169-0012 -- | ||||||||||||
2013 Today's Options Premier Plus 350A (PFFS) | $117.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H6169 -054 -0 | $2.00 | $7.00 | $40.00 | $40.00 | 4,885 2013 Formulary | ||
-- | ||||||||||||
-- Members will be assigned to Today's Options Premier Plus 950B (PFFS) H6169-0032 -- | ||||||||||||
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 AR Blue Cross - Medi-Pak Advantage MA-PD Option 2 (PFFS) | $48.20 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H4213 -007 -0 | $2.00 | $11.00 | 25% | 25% | 2,923 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 Advantra Premier Plus (PPO) | $0.00 | $4,800 | $0 | No additional gap coverage, only the Donut Hole Discount | H2611 -008 -0 | $5.00 | $40.00 | $80.00 | $80.00 | 3,281 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 AARP MedicareComplete (HMO) | $0.00 | $3,950 | $0 | No additional gap coverage, only the Donut Hole Discount | H0401 -002 -0 | $3.00 | $6.00 | $45.00 | $45.00 | 3,825 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) | $138.00 | $4,500 | $0 | Some Generics | H5698 -069 -0 | $3.00 | $10.00 | $40.00 | $40.00 | 2,715 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 -020 -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 Diabetes Plan (HMO SNP) | $103.00 | n/a | $0 | Some Generics | H5698 -154 -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 Windsor Medicare Extra Fusion Plan (HMO SNP) | $63.00 | n/a | $0 | Some Generics | H5698 -129 -0 | $5.00 | $10.00 | $40.00 | $40.00 | 2,715 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 Care Improvement Plus Chrome RX (PPO SNP) | $34.20 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H6528 -021 -0 | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 Care Improvement Plus Copper RX (PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H6528 -022 -0 | $6.00 | $45.00 | $95.00 | $95.00 | 3,401 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 Care Improvement Plus Chrome RX (Regional PPO SNP) | $34.40 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | R3444 -021 -0 | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 Care Improvement Plus Copper RX (Regional PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | R3444 -022 -0 | $8.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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