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 2 (HMO) | $0.00 | $4,200 | $0 | No additional gap coverage, only the Donut Hole Discount | H3805 -013 -0 | $4.00 | $7.00 | $45.00 | $45.00 | 3,825 2013 Formulary | ||
2014 AARP MedicareComplete Plan 2 (HMO) | $0.00 | $4,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $8.00 | $45.00 | $45.00 | 3,604 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H6815 -002 -0 | |||||||||||
-- | -- | |||||||||||
2014 Health Net Jade (HMO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $38.00 | $38.00 | 4,187 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H6815 -001 -0 | |||||||||||
-- | -- | |||||||||||
2014 Health Net Ruby (HMO) | $0.00 | $2,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $38.00 | $38.00 | 4,195 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 -- |
H5520 -012 -2 | |||||||||||
2014 Health Net Violet Option 2 (PPO) | $0.00 | $6,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $15.00 | $45.00 | $45.00 | 4,195 2014 Formulary | |||
2013 Humana Prime Choice H6609-070 (PPO) | $0.00 | $3,400 | No Rx Coverage | H6609 -070 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 HumanaChoice H6609-070 (PPO) | $0.00 | $4,000 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Samaritan Advantage Special Needs Plan (HMO SNP) | $37.40 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H3811 -003 -0 | 25% | 25% | 25% | 25% | 3,833 2013 Formulary | ||
2014 Samaritan Advantage Special Needs Plan (HMO SNP) | $34.80 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 3,338 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 Kaiser Permanente Senior Advantage Basic (HMO) | $39.00 | $3,400 | $0 | All Generics, Few Brands |
H9003 -006 -0 | $6.00 | $10.00 | $45.00 | $45.00 | 5,250 2013 Formulary | ||
2014 Kaiser Permanente Senior Advantage Basic (HMO) | $39.00 | $4,900 | $0 | All Generics, Few Brands | $5.00 | $10.00 | $45.00 | $45.00 | 5,237 2014 Formulary | |||
2013 Health Net Aqua (PPO) | $45.00 | $2,500 | No Rx Coverage | H5520 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Health Net Aqua (PPO) | $45.00 | $2,500 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 AARP MedicareComplete Plan 1 (HMO) | $49.00 | $3,750 | $0 | No additional gap coverage, only the Donut Hole Discount | H3805 -007 -0 | $3.00 | $6.00 | $44.00 | $44.00 | 3,825 2013 Formulary | ||
2014 AARP MedicareComplete Plan 1 (HMO) | $49.00 | $3,750 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $7.00 | $44.00 | $44.00 | 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 Regence MedAdvantage Basic (PPO) | $35.00 | $3,400 | No Rx Coverage | H3817 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Regence MedAdvantage Basic (PPO) | $49.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Regence MedAdvantage + Rx Classic (PPO) | $53.00 | $3,400 | $165 | No additional gap coverage, only the Donut Hole Discount | H3817 -002 -0 | $7.50 | $33.00 | $45.00 | $45.00 | 3,733 2013 Formulary | ||
2014 Regence MedAdvantage + Rx Classic (PPO) | $66.00 | $3,400 | $205 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $33.00 | $45.00 | $45.00 | 3,414 2014 Formulary | |||
2013 ODS Advantage PPO (PPO) | $57.00 | $3,400 | No Rx Coverage | H3813 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Moda Health PPO (PPO) | $67.00 | $3,400 | 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 |
||||||
2013 Samaritan Advantage Conventional Plan (HMO) | $72.00 | $3,400 | No Rx Coverage | H3811 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Samaritan Advantage Conventional Plan (HMO) | $72.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 ODS Advantage PPORX (PPO) | $68.00 | $3,400 | $120 | No additional gap coverage, only the Donut Hole Discount | H3813 -006 -0 | $5.00 | $33.00 | $41.00 | $41.00 | 3,458 2013 Formulary | ||
2014 Moda Health PPORX (PPO) | $82.00 | $3,400 | $120 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $33.00 | $41.00 | $41.00 | 3,267 2014 Formulary | |||
2013 Samaritan Advantage Premier Plan (HMO) | $105.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H3811 -002 -0 | $0.00 | $9.00 | $40.00 | $40.00 | 3,833 2013 Formulary | ||
2014 Samaritan Advantage Premier Plan (HMO) | $105.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $9.00 | $40.00 | $40.00 | 3,338 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 Violet Option 1 (PPO) | $99.00 | $2,500 | $0 | No additional gap coverage, only the Donut Hole Discount | H5520 -002 -0 | $3.00 | $15.00 | $42.00 | $42.00 | 4,263 2013 Formulary | ||
2014 Health Net Violet Option 1 (PPO) | $109.00 | $2,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $10.00 | $42.00 | $42.00 | 4,195 2014 Formulary | |||
2013 Kaiser Permanente Senior Advantage (HMO) | $99.00 | $2,500 | $0 | All Generics, Few Brands |
H9003 -001 -0 | $6.00 | $10.00 | $45.00 | $45.00 | 5,250 2013 Formulary | ||
2014 Kaiser Permanente Senior Advantage (HMO) | $109.00 | $2,500 | $0 | All Generics, Few Brands | $5.00 | $10.00 | $45.00 | $45.00 | 5,237 2014 Formulary | |||
2013 Samaritan Advantage Premier Plan Plus (HMO) | $135.00 | $3,400 | $0 | All Generics | H3811 -009 -0 | $0.00 | $9.00 | $40.00 | $40.00 | 3,833 2013 Formulary | ||
2014 Samaritan Advantage Premier Plan Plus (HMO) | $135.00 | $3,400 | $0 | Many Generics | $0.00 | $9.00 | $40.00 | $40.00 | 3,338 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 Regence MedAdvantage + Rx Enhanced (PPO) | $143.00 | $2,500 | $0 | Many Generics | H3817 -003 -0 | $5.00 | $33.00 | $45.00 | $45.00 | 3,733 2013 Formulary | ||
2014 Regence MedAdvantage + Rx Enhanced (PPO) | $178.00 | $2,500 | $0 | Many Generics | $5.00 | $33.00 | $45.00 | $45.00 | 3,414 2014 Formulary | |||
2013 Health Net Healthy Heart (PPO) | $159.00 | $2,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H5520 -009 -0 | $3.00 | $10.00 | $35.00 | $35.00 | 4,263 2013 Formulary | ||
2014 Health Net Healthy Heart (PPO) | $199.00 | $2,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $8.00 | $35.00 | $35.00 | 4,187 2014 Formulary | |||
2013 Humana Prime Choice H6609-073 (PPO) | $202.00 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | H6609 -073 -0 | 25% | 25% | 25% | 25% | 3,906 2013 Formulary | ||
2014 HumanaChoice H6609-073 (PPO) | $205.00 | $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 Health Net Violet Option 2 (PPO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H5520 -005 -0 | $3.00 | $20.00 | $45.00 | $45.00 | 4,263 2013 Formulary | ||
-- Members will be assigned to Health Net Violet Option 2 (PPO) H5520-0012 -- | ||||||||||||
2013 ODS Advantage PPORX Select (PPO) | $139.00 | $3,400 | $120 | No additional gap coverage, only the Donut Hole Discount | H3813 -003 -0 | $5.00 | $33.00 | $41.00 | $41.00 | 3,458 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 Humana Prime Choice H6609-068 (PPO) | $62.00 | $4,500 | $0 | Few Generics, Few Brands |
H6609 -068 -0 | $6.00 | $40.00 | $80.00 | $80.00 | 3,906 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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