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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-- This plan not offered in 2013 -- |
H0840 -002 -0 | |||||||||||
new | new | new | ||||||||||
2014 FamilyCare MyPlan S (PPO) | $20.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 MyPlan C (HMO SNP) | $37.50 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H3818 -002 -0 | 25% | 25% | 25% | 25% | 2,721 2013 Formulary | ||
2014 FamilyCare MyPlan C (HMO SNP) | $34.80 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 15% | 15% | 2,885 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H0840 -001 -0 | |||||||||||
new | new | new | ||||||||||
2014 FamilyCare MyPlan S + Rx (PPO) | $59.00 | $3,400 | $100 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $7.00 | $30.00 | $30.00 | 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 |
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2013 MyPlan R (HMO) | $55.00 | $3,400 | No Rx Coverage | H3818 -004 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 FamilyCare MyPlan R (HMO) | $60.00 | $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 MyPlan A (HMO) | $74.00 | $3,400 | $190 | No additional gap coverage, only the Donut Hole Discount | H3818 -003 -0 | $7.00 | $30.00 | $70.00 | $70.00 | 2,721 2013 Formulary | ||
2014 FamilyCare MyPlan A (HMO) | $80.00 | $3,400 | $200 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $7.00 | $30.00 | $30.00 | 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 |
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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 MyPlan E (HMO) | $136.00 | $3,400 | $100 | No additional gap coverage, only the Donut Hole Discount | H3818 -014 -0 | $7.00 | $30.00 | $70.00 | $70.00 | 2,721 2013 Formulary | ||
2014 FamilyCare MyPlan E (HMO) | $143.00 | $3,400 | $100 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $7.00 | $30.00 | $30.00 | 2,885 2014 Formulary | |||
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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