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 -5 | 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 | |||
-- This plan not offered in 2013 -- |
H2323 -015 -0 | |||||||||||
-- | ||||||||||||
2014 Fidelis Secure Respect (HMO) | $0.00 | $4,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $45.00 | $80.00 | $80.00 | 5,136 2014 Formulary | |||
2013 HealthPlus MedicarePlus-AdvantageHMO-POS Option 0 (HMO-POS) | $0.00 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | H2354 -015 -0 | $6.00 | $33.00 | $64.00 | $64.00 | 5,230 2013 Formulary | ||
2014 HealthPlus MedicarePlus AdvantageHMO-POS Option 0 (HMO-POS) | $0.00 | $6,700 | $310 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $42.00 | $95.00 | $95.00 | 5,186 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 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. | ||||||||
-- This plan not offered in 2013 -- |
H5475 -002 -0 | |||||||||||
-- | -- | |||||||||||
2014 Meridian Prime (HMO) | $0.00 | $4,000 | $310 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $45.00 | $45.00 | 3,144 2014 Formulary | |||
2013 Medicare Plus Blue PPO Essential (PPO) | $12.50 | $6,400 | $325 | No additional gap coverage, only the Donut Hole Discount | H9572 -004 -6 | 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 |
||||||
2013 UnitedHealthcare Dual Complete (HMO SNP) | $34.20 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H6952 -002 -0 | 25% | 25% | 25% | 25% | 3,825 2013 Formulary | ||
2014 UnitedHealthcare Dual Complete (HMO SNP) | $27.40 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 0% | 0% | 0% | 0% | 3,604 2014 Formulary | |||
2013 Molina Medicare Options Plus (HMO SNP) | $32.70 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5926 -001 -0 | $0.00 | $45.00 | $95.00 | $95.00 | 2,941 2013 Formulary | ||
2014 Molina Medicare Options Plus (HMO SNP) | $32.40 | 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 Fidelis Secure Comfort (HMO SNP) | $34.20 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H2323 -005 -0 | 25% | 25% | 25% | 25% | 3,800 2013 Formulary | ||
-- | ||||||||||||
2014 Fidelis Secure Comfort (HMO SNP) | $32.50 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 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 |
||||||
2013 Fidelis Secure Freedom (HMO SNP) | $16.60 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H2323 -011 -0 | 25% | 25% | 25% | 25% | 3,800 2013 Formulary | ||
-- | ||||||||||||
2014 Fidelis Secure Freedom (HMO SNP) | $32.50 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 3,124 2014 Formulary | ||||
2013 Fidelis Secure Liberty (HMO SNP) | $34.20 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H2323 -012 -0 | 25% | 25% | 25% | 25% | 3,800 2013 Formulary | ||
-- | ||||||||||||
2014 Fidelis Secure Liberty (HMO SNP) | $32.50 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 15% | 3,124 2014 Formulary | ||||
2013 HealthPlus MedicarePlus-Advantage D-SNP (HMO SNP) | $23.60 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H2354 -016 -0 | 25% | 25% | 25% | 25% | 5,230 2013 Formulary | ||
2014 HealthPlus MedicarePlus Advantage D-SNP (HMO SNP) | $32.50 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 0% | 0% | 0% | 0% | 5,186 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 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 | |||
2013 Meridian Advantage Plan of Michigan (HMO SNP) | $34.10 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5475 -001 -0 | 25% | 25% | 3,076 2013 Formulary | ||||
-- | -- | |||||||||||
2014 Meridian Advantage Plan of Michigan (HMO SNP) | $32.50 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 0% | 2,923 2014 Formulary | ||||||
2013 Midwest Advantage (HMO SNP) | $34.20 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H5685 -001 -0 | $0.00 | $0.00 | 2,917 2013 Formulary | ||||
-- | -- | |||||||||||
2014 Midwest Advantage (HMO SNP) | $32.50 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | 3,453 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 Total Medicare Plus (HMO SNP) | $34.20 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H1444 -001 -0 | 25% | 25% | 25% | 25% | 3,356 2013 Formulary | ||
-- | -- | -- | ||||||||||
2014 Total Medicare Plus (HMO SNP) | $32.50 | n/a | $310 | Many Generics | $0.00 | $0.00 | 25% | 25% | 3,452 2014 Formulary | |||
2013 BCN Advantage HMO-POS Elements (HMO-POS) | $39.00 | $3,600 | No Rx Coverage | H5883 -001 -5 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 BCN Advantage HMO-POS Elements (HMO-POS) | $44.00 | $3,600 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2013 -- |
H1595 -003 -0 | |||||||||||
2014 HealthPlus MedicarePlus AdvantagePPO Basic (PPO) | $48.00 | $6,500 | $310 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $45.00 | $95.00 | $95.00 | 5,186 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 - Henry Ford (HMO) | $35.00 | $3,000 | No Rx Coverage | H2312 -006 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- | ||||||||||||
2014 HAP Senior Plus - Henry Ford (HMO) | $50.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2013 -- |
H2323 -016 -0 | |||||||||||
-- | ||||||||||||
2014 Fidelis Secure Premier (HMO) | $52.00 | $4,400 | $0 | Many Generics | $5.00 | $40.00 | $80.00 | $80.00 | 5,136 2014 Formulary | |||
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 | ||
-- | ||||||||||||
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 | |||
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 Value (HMO-POS) | $55.60 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H2320 -021 -0 | $9.00 | $40.00 | $90.00 | $90.00 | 3,466 2013 Formulary | ||
2014 PriorityMedicare Value (HMO-POS) | $60.00 | $4,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $45.00 | $95.00 | $95.00 | 3,436 2014 Formulary | |||
2013 BCN Advantage HMO Focus (HMO) | $58.00 | $3,400 | $50 | No additional gap coverage, only the Donut Hole Discount | H5883 -005 -0 | $4.00 | $10.00 | $45.00 | $45.00 | 3,686 2013 Formulary | ||
2014 BCN Advantage HMO Local (HMO) | $66.00 | $3,400 | $50 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $45.00 | $45.00 | 3,336 2014 Formulary | |||
2013 HAP Senior Plus - Henry Ford (HMO) | $54.00 | $3,000 | $50 | No additional gap coverage, only the Donut Hole Discount | H2312 -004 -0 | $2.00 | $15.00 | $45.00 | $45.00 | 3,343 2013 Formulary | ||
-- | ||||||||||||
2014 HAP Senior Plus - Henry Ford (HMO) | $73.00 | $3,200 | $200 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $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 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 | |||
2013 HealthPlus MedicarePlus-AdvantageHMO-POS Option 1 (HMO-POS) | $79.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H2354 -001 -0 | $7.00 | $39.00 | $74.00 | $74.00 | 5,230 2013 Formulary | ||
2014 HealthPlus MedicarePlus AdvantageHMO-POS Option 1 (HMO-POS) | $98.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $40.00 | $95.00 | $95.00 | 5,186 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 | |||
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) | $86.00 | $5,400 | $325 | No additional gap coverage, only the Donut Hole Discount | H9572 -002 -6 | 25% | 25% | 25% | 25% | 3,883 2013 Formulary | ||
2014 Medicare Plus Blue PPO Vitality (PPO) | $99.00 | $5,400 | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,472 2014 Formulary | |||
2013 PriorityMedicare Merit (PPO) | $97.00 | $5,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H4875 -016 -3 | $10.00 | $45.00 | $90.00 | $90.00 | 3,466 2013 Formulary | ||
2014 PriorityMedicare Merit (PPO) | $99.50 | $4,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $45.00 | $90.00 | $90.00 | 3,436 2014 Formulary | |||
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 | |||
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 -- |
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 | |||
2013 BCN Advantage HMO-POS Classic (HMO-POS) | $113.00 | $3,400 | $0 | Many Generics | H5883 -002 -7 | $3.00 | $10.00 | $40.00 | $40.00 | 3,686 2013 Formulary | ||
2014 BCN Advantage HMO-POS Classic (HMO-POS) | $130.00 | $3,400 | $0 | Some Generics | $3.00 | $10.00 | $40.00 | $40.00 | 3,336 2014 Formulary | |||
2013 PriorityMedicare (HMO-POS) | $136.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H2320 -019 -0 | $8.00 | $35.00 | $80.00 | $80.00 | 3,466 2013 Formulary | ||
2014 PriorityMedicare (HMO-POS) | $138.50 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $40.00 | $85.00 | $85.00 | 3,436 2014 Formulary | |||
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 Signature (PPO) | $125.00 | $4,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H9572 -001 -6 | $3.00 | $15.00 | $45.00 | $45.00 | 3,883 2013 Formulary | ||
2014 Medicare Plus Blue PPO Signature (PPO) | $148.00 | $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 HealthPlus MedicarePlus-AdvantageHMO-POS Option 2 (HMO-POS) | $125.00 | $3,400 | $0 | All Generics | H2354 -013 -0 | $6.00 | $35.00 | $70.00 | $70.00 | 5,230 2013 Formulary | ||
2014 HealthPlus MedicarePlus AdvantageHMO-POS Option 2 (HMO-POS) | $150.00 | $3,400 | $0 | Many Generics | $6.00 | $38.00 | $90.00 | $90.00 | 5,186 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H4875 -017 -5 | |||||||||||
2014 PriorityMedicare Select (PPO) | $165.50 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $40.00 | $85.00 | $85.00 | 3,436 2014 Formulary | |||
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 HealthPlus MedicarePlus-AdvantagePPO Enhanced (PPO) | $136.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H1595 -002 -0 | $6.00 | $35.00 | $70.00 | $70.00 | 5,230 2013 Formulary | ||
2014 HealthPlus MedicarePlus AdvantagePPO Enhanced (PPO) | $176.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $40.00 | $95.00 | $95.00 | 5,186 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 | |||
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 | |||
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 Prestige (HMO-POS) | $218.00 | $3,200 | $0 | Many Generics | H5883 -003 -5 | $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 | |||
2013 Medicare Plus Blue PPO Assure (PPO) | $244.00 | $3,400 | $0 | Many Generics | H9572 -003 -6 | $3.00 | $10.00 | $40.00 | $40.00 | 3,978 2013 Formulary | ||
2014 Medicare Plus Blue PPO Assure (PPO) | $272.00 | $3,400 | $0 | Some Generics | $3.00 | $10.00 | $40.00 | $40.00 | 3,532 2014 Formulary | |||
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 -- | ||||||||||||
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 Select (PPO) | $154.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H4875 -015 -0 | $8.00 | $40.00 | $85.00 | $85.00 | 3,466 2013 Formulary | ||
-- Members will be assigned to PriorityMedicare Select (PPO) H4875-0017 -- | ||||||||||||
2013 HAP Senior Plus - Henry Ford (HMO) | $122.00 | $2,800 | $50 | All Generics | H2312 -009 -0 | $2.00 | $10.00 | $40.00 | $40.00 | 3,343 2013 Formulary | ||
-- | ||||||||||||
-- This plan not offered in 2014 -- |
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2013 Fidelis Secure Comfort Plus (HMO SNP) | $98.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H2323 -006 -0 | $5.00 | $30.00 | $65.00 | $65.00 | 3,800 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 Fidelis Secure Independence (HMO SNP) | $149.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H2323 -007 -0 | $5.00 | $30.00 | $65.00 | $65.00 | 3,800 2013 Formulary | ||
-- | ||||||||||||
-- This plan not offered in 2014 -- |
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