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 -- |
H0504 -032 -0 | |||||||||||
2014 Blue Shield 65 Plus (HMO) | $0.00 | $2,900 | $0 | Many Generics | $5.00 | $45.00 | $90.00 | $90.00 | 3,231 2014 Formulary | |||
2013 Care1st AdvantageOptimum Plan (HMO) | $0.00 | $3,400 | $0 | Many Generics | H5928 -016 -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 | |||
2013 CareMore Connect (HMO SNP) | $0.00 | n/a | $325 | All Generics, Few Brands |
H0544 -041 -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 | |||
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 StartSmart with CareMore (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H0544 -021 -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 | 2,751 2014 Formulary | |||||||
-- This plan not offered in 2013 -- |
H3815 -007 -0 | |||||||||||
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 | |||
-- This plan not offered in 2013 -- |
H5087 -014 -0 | |||||||||||
-- | ||||||||||||
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 | |||
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 -- |
H0108 -040 -0 | |||||||||||
2014 Humana Gold Plus H0108-040 (HMO) | $0.00 | $6,700 | $310 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $10.00 | $40.00 | $40.00 | 3,711 2014 Formulary | |||
2013 Senior Advantage Medicare Medi-Cal Plan North (HMO SNP) | $16.60 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H0524 -030 -0 | $10.00 | $12.00 | $45.00 | $45.00 | 5,250 2013 Formulary | ||
2014 Senior Advantage Medicare Medi-Cal Plan North (HMO SNP) | $9.50 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $13.00 | $45.00 | $45.00 | 5,237 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H0108 -037 -0 | |||||||||||
2014 Humana Gold Plus H0108-037 (HMO) | $19.00 | $5,000 | $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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-- This plan not offered in 2013 -- |
H5765 -001 -0 | |||||||||||
new | new | new | ||||||||||
2014 Satellite Health Plan (HMO SNP) | $25.10 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $40.00 | $40.00 | 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 -- |
H5928 -025 -0 | |||||||||||
2014 Care1st TotalDual Plan (HMO SNP) | $28.10 | n/a | $310 | Few Generics | $0.00 | 25% | 25% | 25% | 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 |
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2013 Easy Choice Plus Plan (HMO) | $29.90 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | H5087 -002 -0 | 25% | 25% | 25% | 25% | 3,458 2013 Formulary | ||
-- | ||||||||||||
2014 Easy Choice Plus Plan (HMO) | $28.10 | $6,700 | $310 | Call plan for details | $0.00 | 25% | 25% | 25% | 3,267 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H0108 -034 -0 | |||||||||||
2014 Humana Gold Plus H0108-034 (HMO) | $49.00 | $3,400 | $0 | Some Generics, Few Brands | $0.00 | $10.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 CareMore Breathe (HMO SNP) | $49.00 | n/a | $0 | All Generics, Few Brands |
H0544 -024 -0 | $0.00 | $5.00 | $30.00 | $30.00 | 2,830 2013 Formulary | ||
2014 CareMore Breathe (HMO SNP) | $55.00 | n/a | $0 | Many Generics, Few Brands | 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 |
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2013 CareMore Diabetes (HMO SNP) | $49.00 | n/a | $0 | All Generics, Few Brands |
H0544 -025 -0 | $0.00 | $5.00 | $30.00 | $30.00 | 2,830 2013 Formulary | ||
2014 CareMore Diabetes (HMO SNP) | $55.00 | n/a | $0 | Many Generics, Few Brands | 2,751 2014 Formulary | |||||||
2013 CareMore Heart (HMO SNP) | $49.00 | n/a | $0 | All Generics, Few Brands |
H0544 -037 -0 | $0.00 | $5.00 | $30.00 | $30.00 | 2,830 2013 Formulary | ||
2014 CareMore Heart (HMO SNP) | $55.00 | n/a | $0 | Many Generics, Few Brands | 2,751 2014 Formulary | |||||||
2013 CareMore Value Plus (HMO) | $49.00 | $3,400 | $0 | All Generics, Few Brands |
H0544 -012 -0 | $0.00 | $5.00 | $30.00 | $30.00 | 2,830 2013 Formulary | ||
2014 CareMore Value Plus (HMO) | $55.00 | $3,400 | $0 | Many Generics | 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 |
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2013 Health Net Ruby Select (HMO) | $69.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H0562 -089 -0 | $3.00 | $15.00 | $45.00 | $45.00 | 4,263 2013 Formulary | ||
2014 Health Net Ruby Select (HMO) | $69.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $15.00 | $45.00 | $45.00 | 4,187 2014 Formulary | |||
2013 Kaiser Permanente Senior Advantage Santa Clara (HMO) | $72.00 | $3,400 | $0 | All Generics, Few Brands |
H0524 -039 -0 | $5.00 | $10.00 | $45.00 | $45.00 | 5,250 2013 Formulary | ||
2014 Kaiser Permanente Senior Advantage Santa Clara (HMO) | $72.00 | $5,900 | $0 | All Generics, Few Brands | $5.00 | $15.00 | $45.00 | $45.00 | 5,237 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H5425 -050 -0 | |||||||||||
2014 SCAN Balance (HMO SNP) | $76.00 | n/a | $0 | Some Generics, Few Brands | $5.00 | $10.00 | $45.00 | $45.00 | 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 |
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2013 SCAN Classic (HMO) | $59.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H5425 -020 -0 | $5.00 | $10.00 | $45.00 | $45.00 | 2,703 2013 Formulary | ||
2014 SCAN Classic (HMO) | $76.00 | $5,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $10.00 | $45.00 | $45.00 | 2,747 2014 Formulary | |||
2013 AARP MedicareComplete SecureHorizons (HMO) | $106.00 | $5,900 | $0 | No additional gap coverage, only the Donut Hole Discount | H0543 -029 -0 | $5.00 | $10.00 | $44.00 | $44.00 | 3,825 2013 Formulary | ||
2014 AARP MedicareComplete SecureHorizons (HMO) | $107.00 | $5,900 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $9.00 | $45.00 | $45.00 | 3,604 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H0562 -095 -0 | |||||||||||
2014 Health Net Seniority Plus Ruby (HMO) | $232.00 | $5,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $18.00 | $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 |
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2013 Care1st TotalDual Plan (HMO SNP) | $29.80 | n/a | $325 | Few Generics | H5928 -031 -0 | $0.00 | 25% | 25% | 25% | 2,752 2013 Formulary | ||
-- Members will be assigned to Care1st TotalDual Plan (HMO SNP) H5928-0025 -- | ||||||||||||
2013 Health Net Healthy Heart (HMO) | $99.00 | $5,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H0562 -037 -0 | $5.00 | $15.00 | $45.00 | $45.00 | 4,263 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 Health Net Seniority Plus Green (HMO) | $99.00 | $3,400 | No Rx Coverage | H0562 -045 -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 |
||||||
2013 CareMore Touch (HMO SNP) | $0.00 | n/a | $0 | All Generics, Few Brands |
H0544 -022 -0 | $0.00 | $5.00 | $30.00 | $30.00 | 2,830 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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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 | ||
-- | ||||||||||||
-- This plan not offered in 2014 -- |
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