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 |
||||||
2013 AARP MedicareComplete (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H0303 -015 -0 | $4.00 | $7.00 | $45.00 | $45.00 | 3,825 2013 Formulary | ||
2014 AARP MedicareComplete (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $9.00 | $45.00 | $45.00 | 3,604 2014 Formulary | |||
2013 Aetna Medicare Select Plan (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H0318 -002 -0 | $7.00 | $33.00 | $45.00 | $45.00 | 3,323 2013 Formulary | ||
2014 Aetna Medicare Select Plan (HMO) | $0.00 | $6,700 | $0 | Few Generics | $10.00 | 25% | 50% | 50% | 3,134 2014 Formulary | |||
2013 Blue Medicare Advantage Classic (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H0302 -006 -0 | 22% | 22% | 22% | 22% | 3,402 2013 Formulary | ||
2014 Blue Medicare Advantage Classic (HMO) | $0.00 | $6,700 | $0 | Few Generics | $4.00 | $14.00 | $45.00 | $45.00 | 3,461 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 CareMore Breathe (HMO SNP) | $0.00 | n/a | $0 | All Generics, Few Brands |
H2593 -015 -0 | $0.00 | $5.00 | $35.00 | $35.00 | 2,830 2013 Formulary | ||
2014 CareMore Breathe (HMO SNP) | $0.00 | n/a | $0 | Many Generics, Few Brands | $0.00 | $5.00 | $35.00 | $35.00 | 2,751 2014 Formulary | |||
2013 CareMore Diabetes (HMO SNP) | $0.00 | n/a | $0 | All Generics, Few Brands |
H2593 -011 -0 | $0.00 | $5.00 | $35.00 | $35.00 | 2,830 2013 Formulary | ||
2014 CareMore Diabetes (HMO SNP) | $0.00 | n/a | $0 | Many Generics, Few Brands | $0.00 | $5.00 | $35.00 | $35.00 | 2,751 2014 Formulary | |||
2013 CareMore Heart (HMO SNP) | $0.00 | n/a | $0 | All Generics, Few Brands |
H2593 -014 -0 | $0.00 | $5.00 | $35.00 | $35.00 | 2,830 2013 Formulary | ||
2014 CareMore Heart (HMO SNP) | $0.00 | n/a | $0 | Many Generics, Few Brands | $0.00 | $5.00 | $35.00 | $35.00 | 2,751 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 StartSmart with CareMore (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H2593 -016 -0 | $5.00 | $10.00 | $45.00 | $45.00 | 2,830 2013 Formulary | ||
2014 CareMore StartSmart Plus (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $8.00 | $40.00 | $40.00 | 2,751 2014 Formulary | |||
2013 CareMore Value Plus (HMO) | $0.00 | $3,400 | $0 | All Generics, Few Brands |
H2593 -007 -0 | $0.00 | $5.00 | $35.00 | $35.00 | 2,830 2013 Formulary | ||
2014 CareMore Value Plus (HMO) | $0.00 | $3,400 | $0 | Many Generics | $0.00 | $5.00 | $35.00 | $35.00 | 2,751 2014 Formulary | |||
2013 Cigna Medicare Select Plus Rx-Diabetes Heart (HMO SNP) | $0.00 | n/a | $0 | Many Generics | H0354 -021 -0 | $2.00 | $5.00 | $45.00 | $45.00 | 3,854 2013 Formulary | ||
2014 Cigna Medicare Select Plus Rx-Diabetes Heart (HMO SNP) | $0.00 | n/a | $0 | Many Generics | $2.00 | $9.00 | $40.00 | $40.00 | 3,729 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 Cigna Medicare Select Plus Rx-Standard (HMO) | $0.00 | $5,000 | $0 | Many Generics | H0354 -001 -0 | $3.00 | $5.00 | $45.00 | $45.00 | 3,854 2013 Formulary | ||
2014 Cigna Medicare Select Plus Rx-Standard (HMO) | $0.00 | $6,700 | $0 | Many Generics | $3.00 | $10.00 | $40.00 | $40.00 | 3,729 2014 Formulary | |||
2013 Health Net Green (HMO) | $0.00 | $6,700 | No Rx Coverage | H0351 -030 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Health Net Green (HMO) | $0.00 | $6,700 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Health Net Jade (HMO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H0351 -038 -0 | $0.00 | $15.00 | $44.00 | $44.00 | 4,263 2013 Formulary | ||
2014 Health Net Jade (HMO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $44.00 | $44.00 | 4,195 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 |
||||||
-- This plan not offered in 2013 -- |
H0351 -042 -0 | |||||||||||
2014 Health Net Jade Cardiovascular (HMO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $44.00 | $44.00 | 4,195 2014 Formulary | |||
2013 Health Net Ruby 4 (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H0351 -036 -0 | $3.00 | $15.00 | $45.00 | $45.00 | 4,263 2013 Formulary | ||
2014 Health Net Ruby 4 (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $15.00 | $45.00 | $45.00 | 4,187 2014 Formulary | |||
2013 Health Net Ruby Select (HMO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H0351 -040 -0 | $0.00 | $15.00 | $44.00 | $44.00 | 4,263 2013 Formulary | ||
2014 Health Net Ruby Select (HMO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $44.00 | $44.00 | 4,195 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 |
||||||
-- This plan not offered in 2013 -- |
H9385 -003 -0 | |||||||||||
2014 Heart First (HMO SNP) | $0.00 | n/a | $0 | Some Generics, Few Brands | $5.00 | $10.00 | $45.00 | $45.00 | 2,747 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H2649 -032 -0 | |||||||||||
2014 Humana Gold Plus H2649-032 (HMO) | $0.00 | $3,400 | $0 | Few Generics, Few Brands | $0.00 | $10.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H2649 -037 -0 | |||||||||||
2014 Humana Gold Plus SNP-CLD H2649-037 (HMO SNP) | $0.00 | n/a | $0 | Some Generics, Few Brands | $0.00 | $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 |
||||||
-- This plan not offered in 2013 -- |
H2649 -036 -0 | |||||||||||
2014 Humana Gold Plus SNP-CVD/CHF/DM H2649-036 (HMO SNP) | $0.00 | n/a | $0 | Some Generics, Few Brands | $0.00 | $10.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 Humana Reader's Digest Healthy Living Plan (Regional PPO) | $0.00 | $6,700 | No Rx Coverage | R5826 -070 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 HumanaChoice R5826-070 P (Regional PPO) | $0.00 | $6,700 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Abrazo Advantage (HMO) | $0.00 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | H5985 -001 -0 | $0.00 | $10.00 | $35.00 | $35.00 | 3,102 2013 Formulary | ||
2014 Phoenix Advantage (HMO) | $0.00 | $5,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $45.00 | $45.00 | 3,124 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 |
||||||
-- This plan not offered in 2013 -- |
H9385 -004 -0 | |||||||||||
2014 SCAN Balance (HMO SNP) | $0.00 | n/a | $0 | Some Generics, Few Brands | $5.00 | $10.00 | $45.00 | $45.00 | 2,747 2014 Formulary | |||
2013 SCAN Classic (HMO) | $0.00 | $5,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H9385 -002 -0 | $3.00 | $10.00 | $45.00 | $45.00 | 2,703 2013 Formulary | ||
2014 SCAN Classic (HMO) | $0.00 | $5,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $10.00 | $45.00 | $45.00 | 2,747 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H0320 -008 -0 | |||||||||||
2014 WellCare Dividend (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $30.00 | $30.00 | 2,844 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 |
||||||
-- This plan not offered in 2013 -- |
H0320 -009 -0 | |||||||||||
2014 WellCare Value (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $30.00 | $30.00 | 2,844 2014 Formulary | |||
2013 Blue Medicare Advantage Plus (HMO) | $14.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H0302 -001 -0 | $4.00 | $40.00 | $80.00 | $80.00 | 3,402 2013 Formulary | ||
2014 Blue Medicare Advantage Plus (HMO) | $17.00 | $6,700 | $0 | Few Generics | $3.00 | $13.00 | $40.00 | $40.00 | 3,461 2014 Formulary | |||
2013 UnitedHealthcare Dual Complete (HMO SNP) | $29.30 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H0321 -002 -0 | 25% | 25% | 25% | 25% | 3,825 2013 Formulary | ||
2014 UnitedHealthcare Dual Complete (HMO SNP) | $19.10 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 15% | 15% | 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 |
||||||
-- This plan not offered in 2013 -- |
H9768 -001 -0 | |||||||||||
new | new | new | ||||||||||
2014 Complete Care Advantage (HMO SNP) | $19.20 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 3,192 2014 Formulary | ||||||
2013 ONECare by Care1st Health Plan Arizona, Inc. (HMO SNP) | $29.40 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5430 -001 -0 | 25% | 25% | 25% | 25% | 2,752 2013 Formulary | ||
-- | ||||||||||||
2014 ONECare by Care1st Health Plan Arizona, Inc. (HMO SNP) | $23.70 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 0% | 25% | 25% | 25% | 2,743 2014 Formulary | |||
2013 Advantage by Bridgeway Health Solutions (HMO SNP) | $27.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5590 -002 -0 | 25% | 25% | 25% | 25% | 3,010 2013 Formulary | ||
-- | ||||||||||||
2014 Advantage by Bridgeway Health Solutions (HMO SNP) | $27.40 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 15% | 15% | 2,966 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 Health Choice Generations (HMO SNP) | $29.40 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5587 -002 -0 | 25% | 25% | 25% | 3,794 2013 Formulary | |||
-- | ||||||||||||
2014 Health Choice Generations (HMO SNP) | $27.40 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 15% | 15% | 3,786 2014 Formulary | |||
2013 Health Net Amber (HMO SNP) | $29.40 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H0351 -029 -0 | $0.00 | $11.00 | $41.00 | $41.00 | 4,263 2013 Formulary | ||
2014 Health Net Amber (HMO SNP) | $27.40 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $12.00 | $41.00 | $41.00 | 4,195 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H6623 -001 -0 | |||||||||||
new | new | new | ||||||||||
2014 Maricopa Care Advantage (HMO SNP) | $27.50 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 15% | 3,193 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 Mercy Care Advantage (HMO SNP) | $27.20 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5580 -001 -0 | 25% | 2,974 2013 Formulary | |||||
2014 Mercy Care Advantage (HMO SNP) | $27.50 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 2,885 2014 Formulary | |||||
2013 Mercy Care Advantage (HMO SNP) | $27.20 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5580 -004 -0 | 25% | 2,974 2013 Formulary | |||||
2014 Mercy Care Advantage (HMO SNP) | $27.50 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 2,885 2014 Formulary | |||||
2013 Mercy Care Advantage (HMO SNP) | $27.20 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5580 -005 -0 | 25% | 2,974 2013 Formulary | |||||
2014 Mercy Care Advantage (HMO SNP) | $27.50 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 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 |
||||||
-- This plan not offered in 2013 -- |
H9685 -001 -0 | |||||||||||
new | new | new | ||||||||||
2014 Mercy Maricopa Advantage (HMO SNP) | $27.50 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 2,885 2014 Formulary | |||||
2013 Abrazo Advantage Plus (HMO SNP) | $29.40 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5985 -002 -0 | 25% | 3,102 2013 Formulary | |||||
2014 Phoenix Advantage Plus (HMO SNP) | $27.50 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 3,124 2014 Formulary | ||||||
2013 UnitedHealthcare Nursing Home Plan (PPO SNP) | $27.20 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H0319 -001 -0 | 25% | 25% | 25% | 25% | 3,825 2013 Formulary | ||
-- | ||||||||||||
2014 UnitedHealthcare Nursing Home Plan (PPO SNP) | $27.50 | 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 |
||||||
-- This plan not offered in 2013 -- |
H5985 -005 -0 | |||||||||||
2014 Phoenix Advantage Select (HMO) | $39.00 | $3,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $45.00 | $45.00 | 3,124 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H0351 -043 -1 | |||||||||||
2014 Health Net Ruby 1 (HMO) | $49.00 | $5,300 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $15.00 | $45.00 | $45.00 | 4,195 2014 Formulary | |||
2013 Blue Medicare Advantage Premier (HMO) | $45.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H0302 -007 -0 | $4.00 | $30.00 | $80.00 | $80.00 | 3,402 2013 Formulary | ||
2014 Blue Medicare Advantage Premier (HMO) | $55.00 | $6,700 | $0 | Few Generics | $2.00 | $12.00 | $30.00 | $30.00 | 3,461 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 |
||||||
-- This plan not offered in 2013 -- |
H2649 -030 -0 | |||||||||||
2014 Humana Gold Plus H2649-030 (HMO-POS) | $79.00 | $5,000 | $0 | Few Generics, Few Brands | $0.00 | $10.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 Humana Reader's Digest Healthy Living Plan (PPO) | $102.00 | $5,000 | $0 | Few Generics, Few Brands |
H0317 -001 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,906 2013 Formulary | ||
2014 HumanaChoice H0317-001 (PPO) | $122.00 | $5,000 | $0 | Few Generics, Few Brands | $0.00 | $10.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 Humana Reader's Digest Healthy Living Plan (Regional PPO) | $142.10 | $6,700 | $0 | Few Generics, Few Brands |
R5826 -014 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,906 2013 Formulary | ||
2014 HumanaChoice R5826-014 P (Regional PPO) | $152.00 | $6,700 | $175 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $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 |
||||||
2013 Humana Gold Choice H8145-103 (PFFS) | $177.00 | n/a | $0 | Few Generics, Few Brands |
H8145 -103 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,906 2013 Formulary | ||
2014 Humana Gold Choice H8145-103 (PFFS) | $180.00 | n/a | $0 | Few Generics, Few Brands | $0.00 | $10.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 Cigna Medicare Select Plus Rx-Premium (HMO) | $25.00 | $5,000 | $0 | Many Generics | H0354 -018 -0 | $0.00 | $5.00 | $35.00 | $35.00 | 3,854 2013 Formulary | ||
-- Members will be assigned to Cigna Medicare Select Plus Rx-Standard (HMO) H0354-001 -- | ||||||||||||
2013 Health Choice Generations (HMO SNP) | $29.40 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5587 -001 -0 | 25% | 25% | 25% | 3,794 2013 Formulary | |||
-- | ||||||||||||
-- Members will be assigned to Health Choice Generations (HMO SNP) H5587-002 -- | ||||||||||||
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 Health Net Ruby 1 (HMO) | $49.00 | $5,300 | $0 | No additional gap coverage, only the Donut Hole Discount | H0351 -014 -0 | $3.00 | $15.00 | $45.00 | $45.00 | 4,263 2013 Formulary | ||
-- Members will be assigned to Health Net Ruby 1 (HMO) H0351-0043 -- | ||||||||||||
2013 Humana Reader's Digest Healthy Living Plan (HMO-POS) | $62.00 | $5,500 | $0 | Few Generics, Few Brands |
H0307 -008 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,906 2013 Formulary | ||
-- This plan not offered in 2014 -- |
||||||||||||
2013 Humana Reader's Digest Healthy Living Plan (HMO) | $0.00 | $5,000 | $0 | Few Generics, Few Brands |
H0307 -011 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,906 2013 Formulary | ||
-- This plan not offered in 2014 -- |
||||||||||||
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 Reader's Digest Healthy Living Plan (Regional PPO) | $154.00 | $3,400 | $325 | No additional gap coverage, only the Donut Hole Discount | R5826 -076 -0 | 25% | 25% | 25% | 25% | 3,906 2013 Formulary | ||
-- This plan not offered in 2014 -- |
||||||||||||
2013 CareMore Touch (HMO SNP) | $0.00 | n/a | $0 | All Generics, Few Brands |
H2593 -009 -0 | $0.00 | $5.00 | $35.00 | $35.00 | 2,830 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 Cigna Medicare Select Plus Rx-Dual (HMO SNP) | $28.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H0354 -012 -0 | 25% | 25% | 25% | 25% | 3,854 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 SCAN Connections (HMO SNP) | $29.40 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H9385 -001 -0 | 25% | 25% | 25% | 25% | 2,703 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 UnitedHealthcare Dual Complete LP (HMO SNP) | $28.20 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H0303 -034 -0 | 25% | 25% | 25% | 25% | 3,825 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 University Care Advantage (HMO SNP) | $29.40 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H7352 -003 -0 | 25% | 25% | 25% | 3,128 2013 Formulary | |||
-- | ||||||||||||
-- This plan not offered in 2014 -- |
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