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 SecureHorizons Essential (HMO) | $0.00 | $4,900 | No Rx Coverage | H0543 -121 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 AARP MedicareComplete SecureHorizons Essential (HMO) | $0.00 | $4,900 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 AARP MedicareComplete SecureHorizons Plan 1 (HMO) | $0.00 | $5,400 | $0 | Some Generics | H0543 -001 -0 | $3.00 | $6.00 | $45.00 | $45.00 | 3,825 2013 Formulary | ||
2014 AARP MedicareComplete SecureHorizons Plan 1 (HMO) | $0.00 | $5,400 | $0 | Some Generics | $4.00 | $8.00 | $45.00 | $45.00 | 3,604 2014 Formulary | |||
2013 AARP MedicareComplete SecureHorizons Plan 2 (HMO) | $0.00 | $3,400 | $0 | Some Generics | H0543 -151 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,825 2013 Formulary | ||
2014 AARP MedicareComplete SecureHorizons Plan 2 (HMO) | $0.00 | $3,400 | $0 | Some Generics | $0.00 | $7.00 | $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 |
||||||
2013 Aetna Medicare Select Plan (HMO) | $0.00 | $3,400 | $0 | Some Generics | H0523 -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 Cross Senior Secure Plan I (HMO) | $0.00 | $4,000 | $0 | Many Generics | H0564 -006 -0 | $4.00 | $13.00 | $45.00 | $45.00 | 4,173 2013 Formulary | ||
2014 Blue Cross Senior Secure Plan I (HMO) | $0.00 | $5,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $14.00 | $40.00 | $40.00 | 2,880 2014 Formulary | |||
2013 Blue Shield 65 Plus (HMO) | $0.00 | $3,000 | $0 | Many Generics | H0504 -015 -0 | $5.00 | $40.00 | $80.00 | $80.00 | 3,331 2013 Formulary | ||
2014 Blue Shield 65 Plus (HMO) | $0.00 | $2,800 | $0 | Many Generics | $0.00 | $5.00 | $45.00 | $45.00 | 3,231 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 Blue Shield 65 Plus Choice Plan (HMO) | $0.00 | $2,000 | $0 | Many Generics | H0504 -021 -0 | $0.00 | $35.00 | $70.00 | $70.00 | 3,330 2013 Formulary | ||
2014 Blue Shield 65 Plus Choice Plan (HMO) | $0.00 | $2,000 | $0 | Many Generics | $0.00 | $35.00 | $70.00 | $70.00 | 3,231 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H0838 -028 -0 | |||||||||||
2014 Brand New Day Dementia with Enhanced Drug Benefits (HMO SNP) | $0.00 | n/a | $0 | Many Generics | $3.00 | $9.00 | $45.00 | $45.00 | 3,193 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H0838 -026 -0 | |||||||||||
2014 Brand New Day Diabetes with Enhanced Drug Benefits (HMO SNP) | $0.00 | n/a | $0 | Many Generics | $3.00 | $9.00 | $45.00 | $45.00 | 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 Brand New Day (HMO) | $0.00 | $3,400 | $0 | Many Generics | H0838 -022 -0 | $5.00 | $40.00 | 3,285 2013 Formulary | ||||
2014 Brand New Day Enhanced Drug Savings for So Cal (HMO) | $0.00 | $6,700 | $0 | Many Generics | $3.00 | $9.00 | $45.00 | $45.00 | 3,193 2014 Formulary | |||
2013 Care1st AdvantageOptimum Plan (HMO) | $0.00 | $3,400 | $0 | Many Generics | H5928 -004 -0 | $0.00 | $5.00 | $30.00 | $30.00 | 2,752 2013 Formulary | ||
2014 Care1st AdvantageOptimum Plan (HMO) | $0.00 | $3,400 | $0 | Many Generics | $0.00 | $5.00 | $30.00 | $30.00 | 2,743 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H5928 -010 -0 | |||||||||||
2014 Care1st AdvantageOptimum Plan (HMO) | $0.00 | $3,400 | $0 | Many Generics | $0.00 | $7.00 | $35.00 | $35.00 | 2,743 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, All Brands |
H0544 -014 -0 | $0.00 | $5.00 | $25.00 | $25.00 | 2,830 2013 Formulary | ||
2014 CareMore Breathe (HMO SNP) | $0.00 | n/a | $0 | Many Generics, Few Brands | $0.00 | $5.00 | $30.00 | $30.00 | 2,751 2014 Formulary | |||
2013 CareMore Connect (HMO SNP) | $0.00 | n/a | $325 | All Generics, Few Brands |
H0544 -003 -0 | $0.00 | $0.00 | 25% | 25% | 2,830 2013 Formulary | ||
2014 CareMore Connect (HMO SNP) | $0.00 | n/a | $310 | Many Generics | $0.00 | $0.00 | 25% | 25% | 2,751 2014 Formulary | |||
2013 CareMore ESRD (HMO SNP) | $0.00 | n/a | $0 | All Generics, All Brands |
H0544 -015 -0 | $0.00 | $5.00 | $25.00 | $25.00 | 2,830 2013 Formulary | ||
2014 CareMore ESRD (HMO SNP) | $0.00 | n/a | $0 | Many Generics, Few Brands | $0.00 | $5.00 | $30.00 | $30.00 | 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 CareMore Heart (HMO SNP) | $0.00 | n/a | $0 | All Generics, All Brands |
H0544 -013 -0 | $0.00 | $5.00 | $25.00 | $25.00 | 2,830 2013 Formulary | ||
2014 CareMore Heart (HMO SNP) | $0.00 | n/a | $0 | Many Generics, Few Brands | $0.00 | $5.00 | $30.00 | $30.00 | 2,751 2014 Formulary | |||
2013 CareMore Reliance (HMO SNP) | $0.00 | n/a | $0 | All Generics, All Brands |
H0544 -004 -0 | $0.00 | $5.00 | $25.00 | $25.00 | 2,830 2013 Formulary | ||
2014 CareMore Reliance (HMO SNP) | $0.00 | n/a | $0 | Many Generics, Few Brands | $0.00 | $5.00 | $30.00 | $30.00 | 2,751 2014 Formulary | |||
2013 StartSmart with CareMore (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H0544 -007 -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 | $10.00 | $45.00 | $45.00 | 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 CareMore Touch (HMO SNP) | $0.00 | n/a | $0 | All Generics, All Brands |
H0544 -005 -0 | $0.00 | $5.00 | $25.00 | $25.00 | 2,830 2013 Formulary | ||
2014 CareMore Touch (HMO SNP) | $0.00 | n/a | $0 | Many Generics, Few Brands | $0.00 | $5.00 | $30.00 | $30.00 | 2,751 2014 Formulary | |||
2013 CareMore Value Plus (HMO) | $0.00 | $3,400 | $0 | All Generics, All Brands |
H0544 -002 -0 | $0.00 | $5.00 | $25.00 | $25.00 | 2,830 2013 Formulary | ||
2014 CareMore Value Plus (HMO) | $0.00 | $3,400 | $0 | Many Generics, Few Brands | $0.00 | $5.00 | $30.00 | $30.00 | 2,751 2014 Formulary | |||
2013 Central Health Medicare Plan (HMO) | $0.00 | $6,700 | $0 | All Generics | H5649 -001 -0 | $0.00 | $5.00 | $25.00 | $25.00 | 2,763 2013 Formulary | ||
2014 Central Health Medicare Plan (HMO) | $0.00 | $3,400 | $0 | All Generics | $0.00 | $5.00 | $25.00 | $25.00 | 2,870 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 Citizens Choice Healthplan (HMO) | $0.00 | $3,400 | $0 | Many Generics | H3815 -001 -0 | $0.00 | $15.00 | $60.00 | $60.00 | 3,072 2013 Formulary | ||
2014 Citizens Choice Healthplan (HMO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $30.00 | $75.00 | $75.00 | 2,987 2014 Formulary | |||
2013 Easy Choice Best Plan (HMO) | $0.00 | $6,700 | $0 | Many Generics | H5087 -005 -0 | $0.00 | $10.00 | $40.00 | $40.00 | 3,458 2013 Formulary | ||
-- | ||||||||||||
2014 Easy Choice Best Plan (HMO) | $0.00 | $6,700 | $0 | Many Generics | $0.00 | $10.00 | $45.00 | $45.00 | 3,267 2014 Formulary | |||
2013 Golden (HMO) | $0.00 | $3,400 | $0 | Many Generics | H2241 -001 -0 | $0.00 | $40.00 | $80.00 | $80.00 | 5,161 2013 Formulary | ||
-- | ||||||||||||
2014 Golden State Medicare Health Plan, Golden (HMO) | $0.00 | $3,400 | $0 | Many Generics, Few Brands | $4.00 | $40.00 | $80.00 | $80.00 | 5,147 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 -- |
H0562 -101 -1 | |||||||||||
2014 Health Net Gold Select (HMO) | $0.00 | $2,200 | $0 | Many Generics, Few Brands | $0.00 | $10.00 | $45.00 | $45.00 | 4,195 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H0562 -100 -1 | |||||||||||
2014 Health Net Healthy Heart (HMO) | $0.00 | $3,400 | $0 | Many Generics, Few Brands | $4.00 | $10.00 | $45.00 | $45.00 | 4,195 2014 Formulary | |||
2013 Health Net Jade (HMO SNP) | $0.00 | n/a | $0 | Many Generics | H0562 -092 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 4,263 2013 Formulary | ||
2014 Health Net Jade (HMO SNP) | $0.00 | n/a | $0 | Many Generics, Few Brands | $0.00 | $10.00 | $45.00 | $45.00 | 4,187 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 Net Seniority Plus Green (HMO) | $0.00 | $3,400 | No Rx Coverage | H0562 -044 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Health Net Seniority Plus Green (HMO) | $0.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2013 -- |
H0562 -099 -1 | |||||||||||
2014 Health Net Seniority Plus Ruby (HMO) | $0.00 | $3,400 | $0 | Many Generics, Few Brands | $4.00 | $10.00 | $45.00 | $45.00 | 4,195 2014 Formulary | |||
2013 Heart First (HMO SNP) | $0.00 | n/a | $0 | Many Generics, Few Brands |
H5425 -028 -0 | $0.00 | $5.00 | $30.00 | $30.00 | 2,703 2013 Formulary | ||
2014 Heart First (HMO SNP) | $0.00 | n/a | $0 | Many Generics, Few Brands | $3.00 | $7.00 | $40.00 | $40.00 | 2,747 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 Plus H0108-011 (HMO) | $0.00 | $3,400 | $0 | Some Generics, Few Brands |
H0108 -011 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,906 2013 Formulary | ||
2014 Humana Gold Plus H0108-011 (HMO) | $0.00 | $3,400 | $0 | Some Generics, Few Brands | $0.00 | $0.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 Inter Valley Health Plan Service To Seniors (HMO) | $0.00 | $3,400 | $0 | Some Generics | H0545 -001 -0 | $4.00 | $12.00 | $29.00 | $29.00 | 2,651 2013 Formulary | ||
2014 Inter Valley Health Plan Service To Seniors (HMO) | $0.00 | $3,400 | $0 | Some Generics | $5.00 | $15.00 | $39.00 | $39.00 | 2,710 2014 Formulary | |||
2013 Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) | $0.00 | $3,400 | $0 | All Generics, Few Brands |
H0524 -003 -0 | $3.00 | $7.00 | $40.00 | $40.00 | 5,250 2013 Formulary | ||
2014 Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) | $0.00 | $5,900 | $0 | All Generics, Few Brands | $3.00 | $10.00 | $45.00 | $45.00 | 5,237 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 Positive Healthcare Partners (HMO SNP) | $0.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5852 -001 -0 | 25% | 25% | 25% | 2,532 2013 Formulary | |||
2014 PHP (HMO SNP) | $0.00 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 2,474 2014 Formulary | ||||
2013 SCAN Balance (HMO SNP) | $0.00 | n/a | $0 | Many Generics, Few Brands |
H5425 -034 -0 | $0.00 | $5.00 | $30.00 | $30.00 | 2,703 2013 Formulary | ||
2014 SCAN Balance (HMO SNP) | $0.00 | n/a | $0 | Many Generics, Few Brands | $3.00 | $7.00 | $40.00 | $40.00 | 2,747 2014 Formulary | |||
2013 SCAN Classic (HMO) | $0.00 | $3,000 | $0 | Many Generics | H5425 -006 -0 | $3.00 | $8.00 | $40.00 | $40.00 | 2,703 2013 Formulary | ||
2014 SCAN Classic (HMO) | $0.00 | $3,000 | $0 | Many Generics | $3.00 | $10.00 | $40.00 | $40.00 | 2,747 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 SCAN Healthy at Home (HMO SNP) | $0.00 | n/a | $0 | Many Generics | H9104 -006 -0 | $3.00 | $8.00 | $39.00 | $39.00 | 2,703 2013 Formulary | ||
2014 SCAN Healthy at Home (HMO SNP) | $0.00 | n/a | $0 | Many Generics | $3.00 | $10.00 | $39.00 | $39.00 | 2,747 2014 Formulary | |||
2013 Senior Advantage Medicare Medi-Cal Plan South (HMO SNP) | $11.40 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H0524 -029 -0 | $10.00 | $10.00 | $45.00 | $45.00 | 5,250 2013 Formulary | ||
2014 Senior Advantage Medicare Medi-Cal Plan South (HMO SNP) | $14.40 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $12.00 | $45.00 | $45.00 | 5,237 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H0543 -153 -0 | |||||||||||
2014 AARP MedicareComplete SecureHorizons Plan 3 (HMO) | $16.20 | $6,700 | $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 |
||||||
2013 Care1st TotalDual Plan (HMO SNP) | $29.80 | n/a | $325 | Few Generics | H5928 -001 -0 | $0.00 | 25% | 25% | 25% | 2,752 2013 Formulary | ||
2014 Care1st TotalDual Plan (HMO SNP) | $20.70 | n/a | $310 | Few Generics | $0.00 | 25% | 25% | 25% | 2,743 2014 Formulary | |||
2013 Molina Medicare Options Plus (HMO SNP) | $29.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5810 -001 -0 | $0.00 | $45.00 | $95.00 | $95.00 | 2,941 2013 Formulary | ||
2014 Molina Medicare Options Plus (HMO SNP) | $21.60 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $45.00 | $95.00 | $95.00 | 2,885 2014 Formulary | |||
2013 SCAN Connections (HMO SNP) | $29.90 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5425 -010 -0 | 25% | 25% | 25% | 25% | 2,703 2013 Formulary | ||
2014 SCAN Connections (HMO SNP) | $24.10 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 0% | 0% | 0% | 0% | 2,747 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 Freedom Plan (HMO SNP) | $29.90 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5087 -001 -0 | $0.00 | 25% | 25% | 25% | 3,458 2013 Formulary | ||
-- | ||||||||||||
2014 Easy Choice Freedom Plan (HMO SNP) | $24.40 | n/a | $310 | Call plan for details | $0.00 | 25% | 25% | 25% | 3,267 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H5928 -037 -0 | |||||||||||
2014 Coordinated Choice Plan (HMO) | $26.30 | $3,400 | $310 | Few Generics | $0.00 | 25% | 25% | 25% | 2,743 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H5425 -045 -0 | |||||||||||
2014 SCAN Plus (HMO) | $28.00 | $6,700 | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 2,747 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 -- |
H0838 -029 -0 | |||||||||||
2014 Brand New Day Dementia with Extra Care (HMO SNP) | $28.10 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,193 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H0838 -027 -0 | |||||||||||
2014 Brand New Day Diabetes with Extra Care (HMO SNP) | $28.10 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,193 2014 Formulary | |||
2013 Brand New Day D SNP (HMO SNP) | $29.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H0838 -024 -0 | 25% | 25% | 3,285 2013 Formulary | ||||
2014 Brand New Day Dual Coverage (HMO SNP) | $28.10 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 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 Brand New Day HMO Extra Care (HMO) | $29.80 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | H0838 -023 -0 | 25% | 25% | 3,285 2013 Formulary | ||||
2014 Brand New Day Extra Care (HMO) | $28.10 | $6,700 | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,193 2014 Formulary | |||
2013 Brand New Day (HMO SNP) | $29.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H0838 -020 -0 | 25% | 25% | 3,285 2013 Formulary | ||||
2014 Brand New Day for Mental Illness (HMO SNP) | $28.10 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,193 2014 Formulary | |||
2013 Central Health Medi-Medi Plan (HMO SNP) | $29.90 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5649 -002 -0 | 25% | 25% | 25% | 25% | 2,763 2013 Formulary | ||
2014 Central Health Medi-Medi Plan (HMO SNP) | $28.10 | n/a | $310 | Many Generics | $0.00 | $0.00 | 25% | 25% | 2,870 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 Central Health Premier Plan (HMO) | $0.00 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | H5649 -004 -0 | 25% | 25% | 25% | 25% | 2,763 2013 Formulary | ||
2014 Central Health Premier Plan (HMO) | $28.10 | $6,700 | $310 | Many Generics | $0.00 | $0.00 | 25% | 25% | 2,870 2014 Formulary | |||
2013 Health Net Seniority Plus Amber I (HMO SNP) | $29.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H0562 -055 -0 | 25% | 25% | 25% | 25% | 4,263 2013 Formulary | ||
2014 Health Net Seniority Plus Amber I (HMO SNP) | $28.10 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $12.00 | $41.00 | $41.00 | 4,195 2014 Formulary | |||
2013 Health Net Seniority Plus Amber II (HMO SNP) | $29.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H0562 -070 -0 | 25% | 25% | 25% | 25% | 4,263 2013 Formulary | ||
2014 Health Net Seniority Plus Amber II (HMO SNP) | $28.10 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $13.00 | $45.00 | $45.00 | 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 |
||||||
2013 L.A. Care Health Plan Medicare Advantage (HMO SNP) | $29.90 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H2643 -001 -0 | 25% | 3,285 2013 Formulary | |||||
2014 L.A. Care Health Plan Medicare Advantage (HMO SNP) | $28.10 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 0% | 3,192 2014 Formulary | ||||||
2013 SCAN Connections at Home (HMO SNP) | $29.90 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5425 -029 -0 | 25% | 25% | 25% | 25% | 2,703 2013 Formulary | ||
2014 SCAN Connections at Home (HMO SNP) | $28.10 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 0% | 0% | 0% | 0% | 2,747 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H5943 -002 -0 | |||||||||||
-- | ||||||||||||
2014 VillageHealth (HMO SNP) | $28.10 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 2,747 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 Inter Valley Health Plan Total Fit (HMO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H0545 -011 -0 | $8.00 | $12.00 | $45.00 | $45.00 | 2,651 2013 Formulary | ||
2014 Inter Valley Health Plan Total Fit (HMO) | $30.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $15.00 | $45.00 | $45.00 | 2,710 2014 Formulary | |||
2013 Anthem Medicare Preferred Standard (PPO) | $28.00 | $4,500 | $90 | No additional gap coverage, only the Donut Hole Discount | H8552 -001 -0 | $6.00 | $14.00 | $42.00 | $42.00 | 4,173 2013 Formulary | ||
2014 Anthem Medicare Preferred Standard (PPO) | $80.00 | $4,500 | $149 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $16.00 | $40.00 | $40.00 | 2,880 2014 Formulary | |||
2013 Care1st TotalAdvantage Plan (HMO) | $0.00 | $3,400 | $0 | Many Generics | H5928 -018 -0 | $0.00 | $5.00 | $30.00 | $30.00 | 2,752 2013 Formulary | ||
-- Members will be assigned to Care1st AdvantageOptimum Plan (HMO) H5928-004 -- | ||||||||||||
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 Seniority Plus Ruby Plan 1 (HMO) | $0.00 | $3,400 | $0 | Many Generics | H0562 -083 -0 | $3.00 | $10.00 | $45.00 | $45.00 | 4,263 2013 Formulary | ||
-- Members will be assigned to Health Net Seniority Plus Ruby (HMO) H0562-0099 -- | ||||||||||||
2013 Health Net Healthy Heart Plan 2 (HMO) | $39.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H0562 -086 -0 | $3.00 | $10.00 | $45.00 | $45.00 | 4,263 2013 Formulary | ||
-- Members will be assigned to Health Net Seniority Plus Ruby (HMO) H0562-0099 -- | ||||||||||||
2013 Humana Gold Plus H0108-012 (HMO-POS) | $49.00 | $5,000 | $0 | Few Generics, Few Brands |
H0108 -012 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,906 2013 Formulary | ||
-- Members will be assigned to Humana Gold Plus H0108-011 (HMO) H0108-0011 -- | ||||||||||||
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 Healthy Heart Plan 1 (HMO) | $0.00 | $3,400 | $0 | Many Generics | H0562 -082 -0 | $3.00 | $10.00 | $45.00 | $45.00 | 4,263 2013 Formulary | ||
-- This plan not offered in 2014 -- |
||||||||||||
2013 Health Net Gold Select (HMO) | $0.00 | $3,400 | $0 | Many Generics | H0562 -085 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 4,263 2013 Formulary | ||
-- This plan not offered in 2014 -- |
||||||||||||
2013 UnitedHealthcare Dual Complete (HMO SNP) | $26.90 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H0543 -078 -0 | 25% | 25% | 25% | 25% | 3,825 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 Gold Plus H0108-031 (HMO) | $0.00 | $1,000 | No Rx Coverage | H0108 -031 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- This plan not offered in 2014 -- |
||||||||||||
2013 Blue Cross Senior Secure Plan II (HMO) | $0.00 | $4,000 | $0 | Many Generics | H0564 -048 -0 | $7.00 | $13.00 | $36.00 | $36.00 | 4,173 2013 Formulary | ||
-- This plan not offered in 2014 -- |
||||||||||||
2013 Humana Gold Plus SNP-DE H0108-015 (HMO SNP) | $27.30 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H0108 -015 -0 | 25% | 25% | 25% | 25% | 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 Freedom VIP Care (HMO SNP) | $0.00 | n/a | $0 | Many Generics | H5087 -007 -0 | $0.00 | $10.00 | $40.00 | $40.00 | 3,458 2013 Formulary | ||
-- | ||||||||||||
-- This plan not offered in 2014 -- |
||||||||||||
2013 Freedom VIP Care COPD (HMO SNP) | $0.00 | n/a | $0 | Many Generics | H5087 -008 -0 | $0.00 | $10.00 | $40.00 | $40.00 | 3,458 2013 Formulary | ||
-- | ||||||||||||
-- This plan not offered in 2014 -- |
||||||||||||
2013 Kaiser Permanente Senior Advantage B Only South (HMO) | $0.00 | n/a | $0 | n/a | H0524 -002 -0 | $5.00 | $8.00 | $45.00 | $45.00 | 5,250 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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