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 New West Medicare Value (PPO) | $17.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H2701 -003 -0 | $0.00 | $20.00 | $45.00 | $45.00 | 5,138 2013 Formulary | ||
2014 New West Medicare Value (PPO) | $30.00 | $5,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $20.00 | $45.00 | $45.00 | 5,186 2014 Formulary | |||
2013 New West Medicare Standard (PPO) | $59.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H2701 -004 -0 | $0.00 | $15.00 | $40.00 | $40.00 | 5,138 2013 Formulary | ||
2014 New West Medicare Standard (PPO) | $72.00 | $4,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $40.00 | $40.00 | 5,186 2014 Formulary | |||
2013 New West Medicare Enhanced (PPO) | $120.00 | $3,400 | $0 | Many Generics | H2701 -001 -0 | $0.00 | $5.00 | $35.00 | $35.00 | 5,138 2013 Formulary | ||
2014 New West Medicare Enhanced (PPO) | $151.00 | $4,000 | $0 | Many Generics | $0.00 | $5.00 | $35.00 | $35.00 | 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 Windsor Medicare Extra Emerald Plan (HMO) | $66.00 | $6,700 | $0 | Some Generics | H5698 -169 -0 | $3.00 | $10.00 | $44.00 | $44.00 | 2,715 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 Windsor Medicare Extra Gold Plan (HMO) | $120.00 | $3,400 | $0 | Some Generics | H5698 -170 -0 | $3.00 | $10.00 | $43.00 | $43.00 | 2,715 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 Windsor Medicare Extra Diamond Plan (HMO) | $173.00 | $4,500 | $0 | Some Generics | H5698 -171 -0 | $3.00 | $10.00 | $40.00 | $40.00 | 2,715 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 Windsor Medicare Extra Silver Plan (HMO) | $50.00 | $3,400 | No Rx Coverage | H5698 -173 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- This plan not offered in 2014 -- |
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2013 Windsor Medicare Extra Comp Plus Plan (HMO SNP) | $27.10 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5698 -189 -0 | 25% | 25% | 25% | 25% | 2,715 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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