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 BCN Advantage HMO-POS Basic (HMO-POS) | $0.00 | $4,200 | $325 | No additional gap coverage, only the Donut Hole Discount | H5883 -004 -2 | 25% | 25% | 25% | 25% | 3,686 2013 Formulary | ||
2014 BCN Advantage HMO-POS Basic (HMO-POS) | $0.00 | $4,200 | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,336 2014 Formulary | |||
2013 HumanaChoice R5826-053 (Regional PPO) | $0.00 | $3,900 | No Rx Coverage | R5826 -053 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 HumanaChoice R5826-053 P (Regional PPO) | $0.00 | $4,500 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Medicare Plus Blue PPO Essential (PPO) | $12.50 | $6,400 | $325 | No additional gap coverage, only the Donut Hole Discount | H9572 -004 -2 | 25% | 25% | 25% | 25% | 3,883 2013 Formulary | ||
2014 Medicare Plus Blue PPO Essential (PPO) | $17.50 | $6,400 | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,472 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 Paramount Elite - Enhanced Medical Only (HMO) | $11.00 | $3,400 | No Rx Coverage | H3653 -018 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Paramount Elite - Enhanced Medical Only (HMO) | $20.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Humana Gold Choice H8145-121 (PFFS) | $19.00 | n/a | No Rx Coverage | H8145 -121 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Humana Gold Choice H8145-121 (PFFS) | $29.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 CareSource Advantage (HMO SNP) | $34.20 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H0141 -001 -0 | $0.00 | $45.00 | $95.00 | $95.00 | 2,941 2013 Formulary | ||
-- | -- | |||||||||||
2014 McLarenAdvantage (HMO SNP) | $32.50 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $45.00 | $95.00 | $95.00 | 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 BCN Advantage HMO-POS Elements (HMO-POS) | $28.00 | $3,600 | No Rx Coverage | H5883 -001 -2 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 BCN Advantage HMO-POS Elements (HMO-POS) | $33.00 | $3,600 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Paramount Elite - Standard Medical and Drug (HMO) | $0.00 | $3,400 | $75 | No additional gap coverage, only the Donut Hole Discount | H3653 -015 -0 | $5.00 | $15.00 | $45.00 | $45.00 | 3,588 2013 Formulary | ||
2014 Paramount Elite - Standard Medical and Drug (HMO) | $34.00 | $3,400 | $100 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $40.00 | $40.00 | 3,499 2014 Formulary | |||
2013 PriorityMedicare Value (HMO-POS) | $43.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H2320 -012 -0 | $9.00 | $40.00 | $90.00 | $90.00 | 3,466 2013 Formulary | ||
2014 PriorityMedicare Value (HMO-POS) | $54.00 | $4,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $45.00 | $95.00 | $95.00 | 3,436 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 HAP Senior Plus - Expanded Network (HMO-POS) | $44.00 | $3,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H2312 -012 -0 | $6.00 | $15.00 | $45.00 | $45.00 | 3,343 2013 Formulary | ||
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2014 HAP Senior Plus - Expanded Network (HMO-POS) | $58.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $10.00 | $45.00 | $45.00 | 3,193 2014 Formulary | |||
2013 PriorityMedicare Merit (PPO) | $47.00 | $5,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H4875 -016 -1 | $10.00 | $45.00 | $90.00 | $90.00 | 3,466 2013 Formulary | ||
2014 PriorityMedicare Merit (PPO) | $61.50 | $4,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $45.00 | $90.00 | $90.00 | 3,436 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H5216 -009 -0 | |||||||||||
2014 HumanaChoice H5216-009 (PPO) | $65.00 | $5,500 | $0 | Few Generics, Few Brands | $6.00 | $15.00 | $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 Medicare Plus Blue PPO Vitality (PPO) | $56.00 | $5,400 | $325 | No additional gap coverage, only the Donut Hole Discount | H9572 -002 -2 | 25% | 25% | 25% | 25% | 3,883 2013 Formulary | ||
2014 Medicare Plus Blue PPO Vitality (PPO) | $74.00 | $5,400 | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,472 2014 Formulary | |||
2013 Humana Gold Choice H8145-005 (PFFS) | $72.00 | n/a | $0 | Few Generics, Few Brands |
H8145 -005 -0 | $7.00 | $42.00 | $80.00 | $80.00 | 3,906 2013 Formulary | ||
2014 Humana Gold Choice H8145-005 (PFFS) | $80.00 | n/a | $0 | Few Generics, Few Brands | $6.00 | $15.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 HumanaChoice R5826-006 (Regional PPO) | $99.00 | $6,700 | $0 | Few Generics, Few Brands |
R5826 -006 -0 | $8.00 | $40.00 | $80.00 | $80.00 | 3,906 2013 Formulary | ||
2014 HumanaChoice R5826-006 P (Regional PPO) | $90.00 | $6,700 | $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 Paramount Elite - Enhanced Medical and Drug (HMO) | $86.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H3653 -004 -0 | $2.00 | $8.00 | $40.00 | $40.00 | 3,588 2013 Formulary | ||
2014 Paramount Elite - Enhanced Medical and Drug (HMO) | $93.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $40.00 | $40.00 | 3,499 2014 Formulary | |||
2013 HAP Senior Plus - Expanded Network (HMO-POS) | $94.00 | $3,000 | $25 | No additional gap coverage, only the Donut Hole Discount | H2312 -007 -0 | $2.00 | $15.00 | $45.00 | $45.00 | 3,343 2013 Formulary | ||
-- | ||||||||||||
2014 HAP Senior Plus - Expanded Network (HMO-POS) | $99.00 | $3,200 | $100 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $45.00 | $45.00 | 3,193 2014 Formulary | |||
2013 BCN Advantage HMO-POS Classic (HMO-POS) | $88.00 | $3,400 | $0 | Many Generics | H5883 -002 -2 | $3.00 | $10.00 | $40.00 | $40.00 | 3,686 2013 Formulary | ||
2014 BCN Advantage HMO-POS Classic (HMO-POS) | $105.00 | $3,400 | $0 | Some Generics | $3.00 | $10.00 | $40.00 | $40.00 | 3,336 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 PriorityMedicare (HMO-POS) | $107.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H2320 -008 -0 | $8.00 | $35.00 | $80.00 | $80.00 | 3,466 2013 Formulary | ||
2014 PriorityMedicare (HMO-POS) | $123.50 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $40.00 | $85.00 | $85.00 | 3,436 2014 Formulary | |||
2013 Alliance Medicare PPO (PPO) | $103.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H2322 -008 -0 | $2.00 | $15.00 | $45.00 | $45.00 | 3,343 2013 Formulary | ||
2014 Alliance Medicare PPO (PPO) | $124.00 | $3,401 | $0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $45.00 | $45.00 | 3,193 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H0141 -002 -0 | |||||||||||
-- | -- | |||||||||||
2014 McLarenAdvantage (HMO) | $128.00 | $3,300 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $30.00 | $70.00 | $70.00 | 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 |
||||||
-- This plan not offered in 2013 -- |
H4875 -017 -3 | |||||||||||
2014 PriorityMedicare Select (PPO) | $132.50 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $40.00 | $85.00 | $85.00 | 3,436 2014 Formulary | |||
2013 Medicare Plus Blue PPO Signature (PPO) | $128.00 | $4,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H9572 -001 -2 | $3.00 | $15.00 | $45.00 | $45.00 | 3,883 2013 Formulary | ||
2014 Medicare Plus Blue PPO Signature (PPO) | $151.00 | $4,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $15.00 | $45.00 | $45.00 | 3,472 2014 Formulary | |||
2013 HAP Senior Plus - Expanded Network (HMO-POS) | $169.00 | $2,800 | $25 | All Generics | H2312 -010 -0 | $2.00 | $10.00 | $45.00 | $45.00 | 3,343 2013 Formulary | ||
-- | ||||||||||||
2014 HAP Senior Plus - Expanded Network (HMO-POS) | $179.00 | $3,000 | $50 | All Generics | $4.00 | $10.00 | $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 Alliance Medicare PPO (PPO) | $174.00 | $3,400 | $50 | All Generics | H2322 -004 -0 | $4.00 | $10.00 | $40.00 | $40.00 | 3,343 2013 Formulary | ||
2014 Alliance Medicare PPO (PPO) | $203.00 | $3,401 | $150 | All Generics | $4.00 | $10.00 | $40.00 | $40.00 | 3,193 2014 Formulary | |||
2013 Medicare Plus Blue PPO Assure (PPO) | $194.00 | $3,400 | $0 | Many Generics | H9572 -003 -2 | $3.00 | $10.00 | $40.00 | $40.00 | 3,978 2013 Formulary | ||
2014 Medicare Plus Blue PPO Assure (PPO) | $222.00 | $3,400 | $0 | Some Generics | $3.00 | $10.00 | $40.00 | $40.00 | 3,532 2014 Formulary | |||
2013 BCN Advantage HMO-POS Prestige (HMO-POS) | $218.00 | $3,200 | $0 | Many Generics | H5883 -003 -2 | $3.00 | $10.00 | $35.00 | $35.00 | 3,686 2013 Formulary | ||
2014 BCN Advantage HMO-POS Prestige (HMO-POS) | $246.00 | $3,200 | $0 | Some Generics | $3.00 | $10.00 | $35.00 | $35.00 | 3,336 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 H5470-002 (PPO) | $62.00 | $5,500 | $0 | Few Generics, Few Brands |
H5470 -002 -0 | $7.00 | $40.00 | $83.00 | $83.00 | 3,906 2013 Formulary | ||
-- Members will be assigned to HumanaChoice H5216-009 (PPO) H5216-009 -- | ||||||||||||
2013 HumanaChoice R5826-072 (Regional PPO) | $66.00 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | R5826 -072 -0 | 25% | 25% | 25% | 25% | 3,906 2013 Formulary | ||
-- Members will be assigned to HumanaChoice R5826-006 P (Regional PPO) R5826-006 -- | ||||||||||||
2013 PriorityMedicare Select (PPO) | $111.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H4875 -013 -0 | $8.00 | $40.00 | $85.00 | $85.00 | 3,466 2013 Formulary | ||
-- Members will be assigned to PriorityMedicare Select (PPO) H4875-0017 -- | ||||||||||||
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