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 AARP MedicareComplete Plan 3 (HMO) | $0.00 | $3,900 | $0 | No additional gap coverage, only the Donut Hole Discount | H4456 -025 -0 | $4.00 | $7.00 | $44.00 | $44.00 | 3,825 2013 Formulary | ||
2014 AARP MedicareComplete Plan 3 (HMO) | $0.00 | $5,900 | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $8.00 | $44.00 | $44.00 | 3,604 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H0084 -004 -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 | |||
-- This plan not offered in 2013 -- |
H0084 -001 -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 | $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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2013 Coventry Advantra Platinum (PPO) | $0.00 | $3,300 | $0 | No additional gap coverage, only the Donut Hole Discount | H1608 -001 -0 | $3.00 | $7.00 | $42.00 | $42.00 | 3,224 2013 Formulary | ||
2014 Coventry Advantra Platinum (PPO) | $0.00 | $3,300 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $7.00 | $42.00 | $42.00 | 3,177 2014 Formulary | |||
2013 Coventry Advantra Silver (HMO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H1609 -001 -0 | $3.00 | $7.00 | $42.00 | $42.00 | 3,224 2013 Formulary | ||
2014 Coventry Advantra Silver (HMO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $7.00 | $42.00 | $42.00 | 3,177 2014 Formulary | |||
2013 HumanaChoice H5868-004 (PPO) | $0.00 | $3,400 | No Rx Coverage | H5868 -004 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 HumanaChoice H5868-004 (PPO) | $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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-- This plan not offered in 2013 -- |
H0084 -014 -0 | |||||||||||
2014 Care Improvement Plus Silver Rx (PPO SNP) | $19.40 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,604 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H5868 -009 -0 | |||||||||||
2014 HumanaChoice H5868-009 (PPO) | $56.00 | $6,700 | $310 | Few Generics, Few Brands | $5.00 | $10.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 AARP MedicareComplete Plan 1 (HMO) | $85.00 | $3,900 | $0 | No additional gap coverage, only the Donut Hole Discount | H4456 -015 -0 | $3.00 | $6.00 | $38.00 | $38.00 | 3,825 2013 Formulary | ||
2014 AARP MedicareComplete Plan 1 (HMO) | $85.00 | $4,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $7.00 | $38.00 | $38.00 | 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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2013 Care Improvement Plus Gold Rx (PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H0084 -011 -0 | $8.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | ||
-- Members will be assigned to Care Improvement Plus Gold Rx (PPO SNP) H0084-004 -- | ||||||||||||
2013 Care Improvement Plus Medicare Advantage (PPO) | $0.00 | $5,900 | $0 | No additional gap coverage, only the Donut Hole Discount | H0084 -013 -0 | $9.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | ||
-- Members will be assigned to Care Improvement Plus Medicare Advantage (PPO) H0084-001 -- | ||||||||||||
2013 Care Improvement Plus Silver Rx (PPO SNP) | $34.60 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H0084 -010 -0 | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | ||
-- Members will be assigned to Care Improvement Plus Silver Rx (PPO SNP) H0084-0014 -- | ||||||||||||
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 H5868-001 (PPO) | $30.00 | $4,000 | $0 | Few Generics, Few Brands |
H5868 -001 -0 | $7.00 | $12.00 | $45.00 | $45.00 | 3,906 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 Care Improvement Plus Dual Advantage (PPO SNP) | $34.60 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H0084 -012 -0 | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 Care Improvement Plus Chrome RX (PPO SNP) | $34.60 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H0084 -031 -0 | 25% | 25% | 25% | 25% | 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 |
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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 | H0084 -032 -0 | $8.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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