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 PacificSource Medicare Essentials 2 (HMO) | $19.00 | $3,400 | No Rx Coverage | H3864 -002 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 PacificSource Medicare Essentials 2 (HMO) | $25.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
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. | ||||||||
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 | |||
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 PacificSource Medicare Essentials Rx 14 (HMO) | $55.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H3864 -014 -0 | $8.00 | $40.00 | $85.00 | $85.00 | 4,762 2013 Formulary | ||
2014 PacificSource Medicare Essentials Rx 14 (HMO) | $88.00 | $3,400 | $0 | Few Generics | $4.00 | $10.00 | $45.00 | $45.00 | 3,887 2014 Formulary | |||
2013 PacificSource Medicare Explorer Rx 1 (PPO) | $79.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H4754 -001 -0 | $5.00 | $35.00 | $80.00 | $80.00 | 4,762 2013 Formulary | ||
2014 PacificSource Medicare Explorer Rx 1 (PPO) | $103.00 | $3,400 | $0 | Few Generics | $4.00 | $10.00 | $45.00 | $45.00 | 3,887 2014 Formulary | |||
2013 PacificSource Medicare Essentials Rx 6 (HMO) | $99.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H3864 -006 -0 | $5.00 | $35.00 | $80.00 | $80.00 | 4,762 2013 Formulary | ||
2014 PacificSource Medicare Essentials Rx 6 (HMO) | $126.00 | $3,400 | $0 | Few Generics | $4.00 | $10.00 | $45.00 | $45.00 | 3,887 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 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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