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 AHM_Basic (HMO) | $0.00 | $3,000 | No Rx Coverage | H5774 -003 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- | ||||||||||||
2014 AHM Basic (HMO) | $0.00 | $3,000 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 AHM_Classic (HMO) | $0.00 | $3,400 | $0 | Many Generics, Few Brands |
H5774 -008 -0 | $7.00 | $15.00 | $35.00 | $35.00 | 2,981 2013 Formulary | ||
-- | ||||||||||||
2014 AHM Classic (HMO) | $0.00 | $3,400 | $0 | All Generics | $6.00 | $15.00 | $40.00 | $40.00 | 2,927 2014 Formulary | |||
2013 AHM_Classic Plus (HMO SNP) | $0.00 | n/a | $0 | Many Generics, Few Brands |
H5774 -009 -0 | $7.00 | $15.00 | $35.00 | $35.00 | 2,981 2013 Formulary | ||
-- | ||||||||||||
2014 AHM Classic Plus (HMO SNP) | $0.00 | n/a | $0 | All Generics | $3.00 | $8.00 | $35.00 | $35.00 | 2,927 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 AHM_Platino Plus (HMO SNP) | $0.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5774 -019 -0 | 25% | 25% | 2,980 2013 Formulary | ||||
-- | ||||||||||||
2014 AHM Platino Plus (HMO SNP) | $0.00 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 15% | 15% | 2,912 2014 Formulary | |||
2013 AHM_Standard (HMO) | $0.00 | $3,000 | $0 | Many Generics, Few Brands |
H5774 -005 -0 | $5.00 | $10.00 | $35.00 | $35.00 | 2,981 2013 Formulary | ||
-- | ||||||||||||
2014 AHM Standard (HMO) | $0.00 | $3,000 | $0 | All Generics | $3.00 | $8.00 | $35.00 | $35.00 | 2,927 2014 Formulary | |||
2013 First Care+Plus (HMO) | $0.00 | $6,700 | $0 | All Generics | H5887 -001 -0 | $5.00 | $25.00 | $45.00 | $45.00 | 3,449 2013 Formulary | ||
2014 First Care+Plus (HMO) | $0.00 | $6,700 | $0 | All Generics | $5.00 | $10.00 | $25.00 | $25.00 | 3,156 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 First+Plus Advantage (PPO) | $0.00 | $6,700 | No Rx Coverage | H4011 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 First+Plus Advantage (PPO) | $0.00 | $6,700 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 First+Plus Advantage Plus (PPO) | $0.00 | $6,700 | $0 | All Generics | H4011 -003 -0 | $5.00 | $25.00 | $45.00 | $45.00 | 3,449 2013 Formulary | ||
2014 First+Plus Advantage Plus (PPO) | $0.00 | $6,700 | $0 | All Generics | $6.00 | $12.00 | $35.00 | $35.00 | 3,156 2014 Formulary | |||
2013 First+Plus Complete (HMO SNP) | $0.00 | n/a | $0 | All Generics | H5887 -007 -0 | $4.00 | $20.00 | $40.00 | $40.00 | 3,449 2013 Formulary | ||
2014 First+Plus Complete (HMO SNP) | $0.00 | n/a | $0 | All Generics | $6.00 | $12.00 | $30.00 | $30.00 | 3,156 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 First+Plus Platino (HMO SNP) | $0.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5887 -010 -0 | 25% | 25% | 25% | 25% | 3,449 2013 Formulary | ||
2014 First+Plus Platino (HMO SNP) | $0.00 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 15% | 15% | 3,147 2014 Formulary | |||
2013 First+Plus Smart Premium (HMO) | $0.00 | $6,700 | $0 | All Generics | H5887 -012 -0 | $5.00 | $30.00 | $50.00 | $50.00 | 3,449 2013 Formulary | ||
2014 First+Plus Smart Premium (HMO) | $0.00 | $6,700 | $0 | All Generics | $5.00 | $10.00 | $35.00 | $35.00 | 3,156 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H5887 -013 -0 | |||||||||||
2014 First+Plus Smart Value (HMO) | $0.00 | $6,700 | $0 | All Generics | $7.00 | $15.00 | $40.00 | $40.00 | 3,156 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 Humana Gold Plus H4007-012 (HMO) | $0.00 | $3,500 | $0 | Few Generics | H4007 -012 -0 | $0.00 | $25.00 | $45.00 | 3,346 2013 Formulary | |||
2014 Humana Gold Plus H4007-012 (HMO) | $0.00 | $3,500 | $310 | Few Generics, Few Brands | $0.00 | $15.00 | $30.00 | $30.00 | 3,711 2014 Formulary | |||
2013 Humana Gold Plus H4007-013 (HMO) | $0.00 | $5,000 | $325 | No additional gap coverage, only the Donut Hole Discount | H4007 -013 -0 | 25% | 25% | 25% | 3,346 2013 Formulary | |||
2014 Humana Gold Plus H4007-013 (HMO) | $0.00 | $5,000 | $0 | Few Generics | $0.00 | $25.00 | $45.00 | 3,294 2014 Formulary | ||||
2013 Humana Gold Plus SNP-DE H4007-005 (HMO SNP) | $0.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H4007 -005 -0 | 25% | 25% | 25% | 3,346 2013 Formulary | |||
2014 Humana Gold Plus SNP-DE H4007-005 (HMO SNP) | $0.00 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 3,294 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 -- |
H4007 -016 -0 | |||||||||||
2014 Humana Gold Plus SNP-DE H4007-016 (HMO SNP) | $0.00 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 3,294 2014 Formulary | ||||
2013 MCS Classicare B-Max (HMO) | $0.00 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | H4006 -025 -0 | 25% | 25% | 25% | 25% | 3,272 2013 Formulary | ||
2014 MCS Classicare B-Max (HMO) | $0.00 | $6,700 | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,129 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H5577 -008 -0 | |||||||||||
2014 MCS Classicare Essential (HMO-POS) | $0.00 | $3,400 | $0 | Many Generics | $4.00 | $5.00 | $29.00 | $29.00 | 3,129 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 MCS Classicare InteliCare (HMO) | $0.00 | $3,400 | $0 | Many Generics | H5577 -005 -0 | $5.00 | $25.00 | $50.00 | $50.00 | 2,860 2013 Formulary | ||
2014 MCS Classicare InteliCare (HMO) | $0.00 | $3,400 | $0 | Many Generics | $4.00 | $5.00 | $29.00 | $29.00 | 3,129 2014 Formulary | |||
2013 MCS Classicare MA (HMO) | $0.00 | $3,400 | No Rx Coverage | H4006 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 MCS Classicare MA (HMO) | $0.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 MCS Classicare Platino Ideal (HMO SNP) | $0.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5577 -002 -0 | 25% | 25% | 25% | 25% | 2,860 2013 Formulary | ||
2014 MCS Classicare Platino Ideal (HMO SNP) | $0.00 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 15% | 15% | 2,755 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 -- |
H5577 -009 -0 | |||||||||||
2014 MCS Classicare Platino M | $0.00 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 15% | 15% | 2,755 2014 Formulary | |||
2013 MCS Classicare Platino Superior (HMO SNP) | $0.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5577 -010 -0 | 25% | 25% | 25% | 25% | 2,860 2013 Formulary | ||
2014 MCS Classicare Platino Superior (HMO SNP) | $0.00 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 15% | 15% | 2,755 2014 Formulary | |||
2013 MCS Classicare Premium Health (HMO) | $0.00 | $3,400 | $0 | Many Generics | H4006 -007 -0 | $5.00 | $25.00 | $50.00 | $50.00 | 3,272 2013 Formulary | ||
2014 MCS Classicare Premium Health (HMO) | $0.00 | $3,400 | $0 | Many Generics | $4.00 | $5.00 | $29.00 | $29.00 | 3,129 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 y Mucho Mas - BASICO EXTRA (HMO) | $0.00 | $3,400 | $325 | No additional gap coverage, only the Donut Hole Discount | H4003 -024 -0 | 25% | 25% | 25% | 2,675 2013 Formulary | |||
2014 Medicare y Mucho Mas - BASICO EXTRA (HMO) | $0.00 | $3,250 | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 2,635 2014 Formulary | ||||
2013 Medicare y Mucho Mas - DIAMANTE CHOICE (HMO SNP) | $0.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H4003 -017 -0 | 25% | 25% | 25% | 2,675 2013 Formulary | |||
2014 Medicare y Mucho Mas - DIAMANTE CHOICE (HMO SNP) | $0.00 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 15% | 2,635 2014 Formulary | ||||
2013 Medicare y Mucho Mas - DIAMANTE EXTRA (HMO SNP) | $0.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H4003 -021 -0 | 25% | 25% | 25% | 2,675 2013 Formulary | |||
2014 Medicare y Mucho Mas - DIAMANTE EXTRA (HMO SNP) | $0.00 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 15% | 2,635 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 -- |
H4003 -027 -0 | |||||||||||
2014 Medicare y Mucho Mas - ELITE ULTRA (HMO-POS) | $0.00 | $3,250 | $0 | Some Generics | $10.00 | $40.00 | 25% | 2,635 2014 Formulary | ||||
2013 Medicare y Mucho Mas - BASICO SELECT (HMO) | $0.00 | $3,250 | $0 | No additional gap coverage, only the Donut Hole Discount | H4003 -015 -0 | $5.00 | $35.00 | 30% | 2,675 2013 Formulary | |||
2014 Medicare y Mucho Mas - UNICO EXTRA (HMO) | $0.00 | $3,250 | $0 | Some Generics | $7.00 | $40.00 | $60.00 | $60.00 | 2,683 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H4004 -053 -0 | |||||||||||
-- | ||||||||||||
2014 PMC Max - EXTRA (HMO-POS) | $0.00 | $3,250 | $0 | Some Generics | $10.00 | $40.00 | 25% | 2,635 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 Premier Preferred (HMO SNP) | $0.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H4004 -048 -0 | 25% | 25% | 25% | 2,675 2013 Formulary | |||
-- | ||||||||||||
2014 Premier Preferred (HMO SNP) | $0.00 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 15% | 2,635 2014 Formulary | ||||
2013 Triple-S Medicare Optimo (PPO) | $0.00 | $6,700 | No Rx Coverage | H4005 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Triple-S Medicare Optimo (PPO) | $0.00 | $6,700 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Triple-S Medicare Optimo Select (HMO) (HMO) | $0.00 | $6,700 | $0 | Many Generics | H4012 -008 -0 | $5.00 | $20.00 | $45.00 | $45.00 | 2,426 2013 Formulary | ||
2014 Triple-S Medicare Optimo Select (HMO) (HMO) | $0.00 | $6,700 | $0 | All Generics | $5.00 | $10.00 | $35.00 | $35.00 | 2,927 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 Triple-S Medicare Selecto with Medicare Platino (HMO SNP) | $0.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H4012 -003 -0 | 25% | 25% | 25% | 25% | 2,426 2013 Formulary | ||
2014 Triple-S Medicare Selecto with Medicare Platino (HMO SNP) | $0.00 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 15% | 15% | 2,912 2014 Formulary | |||
2013 PMC Max (HMO) | $0.00 | $3,250 | $0 | Many Generics | H4004 -050 -0 | $5.00 | $25.00 | 25% | 2,675 2013 Formulary | |||
-- | ||||||||||||
2014 PMC Max (HMO) | $10.00 | $3,250 | $0 | Some Generics | $7.00 | $35.00 | 25% | 2,635 2014 Formulary | ||||
2013 Medicare y Mucho Mas - Unico (HMO) | $0.00 | $3,250 | $0 | Many Generics | H4003 -019 -0 | $4.00 | $30.00 | $60.00 | $60.00 | 2,738 2013 Formulary | ||
2014 Medicare y Mucho Mas - Unico (HMO) | $25.00 | $3,250 | $0 | Some Generics | $4.00 | $30.00 | $60.00 | $60.00 | 2,683 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 Triple-S Medicare Optimo Premier (HMO) | $17.50 | $6,700 | $0 | Many Generics | H5732 -001 -0 | $5.00 | $30.00 | $50.00 | $50.00 | 3,492 2013 Formulary | ||
2014 Triple-S Medicare Optimo Premier (HMO) | $27.00 | $6,700 | $0 | All Generics | $5.00 | $15.00 | $35.00 | $35.00 | 3,537 2014 Formulary | |||
2013 Dorado (HMO) | $0.00 | $3,250 | No Rx Coverage | H4004 -025 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- | ||||||||||||
2014 Dorado (HMO) | $30.00 | $3,250 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Medicare y Mucho Mas - Original (HMO) | $0.00 | $3,250 | No Rx Coverage | H4003 -018 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Medicare y Mucho Mas - Original (HMO) | $30.00 | $3,250 | 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 AHM_Opal (HMO-POS) | $10.00 | $3,400 | $0 | Many Generics, Few Brands |
H5774 -014 -0 | $7.00 | $15.00 | $35.00 | $35.00 | 2,981 2013 Formulary | ||
-- | ||||||||||||
2014 AHM Opal (HMO-POS) | $33.00 | $3,400 | $0 | All Generics | $5.00 | $10.00 | $35.00 | $35.00 | 3,537 2014 Formulary | |||
2013 Medicare y Mucho Mas - ELITE (HMO-POS) | $0.00 | $3,250 | $0 | Many Generics | H4003 -001 -0 | $5.00 | $29.00 | $50.00 | $50.00 | 2,738 2013 Formulary | ||
2014 Medicare y Mucho Mas - ELITE (HMO-POS) | $33.50 | $3,250 | $0 | Some Generics | $4.00 | $20.00 | $50.00 | $50.00 | 2,683 2014 Formulary | |||
2013 Medicare y Mucho Mas - SUPREMO (HMO SNP) | $0.00 | n/a | $0 | Many Generics | H4003 -009 -0 | $3.00 | $5.00 | $20.00 | $20.00 | 2,678 2013 Formulary | ||
2014 Medicare y Mucho Mas - SUPREMO (HMO SNP) | $34.00 | n/a | $0 | Some Generics | $3.00 | $5.00 | $45.00 | $45.00 | 2,635 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 Elite Dorado (HMO-POS) | $0.00 | $3,250 | $0 | Many Generics | H4004 -015 -0 | $5.00 | $29.00 | $50.00 | $50.00 | 2,738 2013 Formulary | ||
-- | ||||||||||||
2014 Elite Dorado (HMO-POS) | $34.50 | $3,250 | $0 | Some Generics | $5.00 | $29.00 | $50.00 | $50.00 | 2,683 2014 Formulary | |||
2013 HumanaChoice H2029-001 (PPO) | $42.00 | $6,700 | $0 | Some Generics, Few Brands |
H2029 -001 -0 | $4.00 | $10.00 | $45.00 | $45.00 | 3,906 2013 Formulary | ||
-- | ||||||||||||
2014 HumanaChoice H2029-001 (PPO) | $45.00 | $6,700 | $0 | Some Generics, Few Brands | $4.00 | $10.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 Triple-S Medicare Optimo Plus (PPO) | $62.50 | $6,700 | $0 | Many Generics | H4005 -004 -0 | $5.00 | $25.00 | 25% | 25% | 3,492 2013 Formulary | ||
2014 Triple-S Medicare Optimo Plus (PPO) | $73.00 | $6,700 | $0 | All Generics | $5.00 | $10.00 | $20.00 | $20.00 | 3,537 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 y Mucho Mas - ELITE EXTRA (HMO-POS) | $41.80 | $3,250 | $0 | Many Generics | H4003 -025 -0 | $2.00 | $5.00 | $25.00 | $25.00 | 3,097 2013 Formulary | ||
2014 Medicare y Mucho Mas - ELITE EXTRA (HMO-POS) | $76.30 | $3,250 | $0 | Some Generics | $2.00 | $5.00 | $25.00 | $25.00 | 2,988 2014 Formulary | |||
2013 MCS Classicare Advanced Health (HMO-POS) | $91.00 | $3,400 | $0 | Many Generics | H4006 -008 -0 | $0.00 | $3.00 | $18.00 | $18.00 | 3,272 2013 Formulary | ||
2014 MCS Classicare Advanced Health (HMO-POS) | $79.00 | $3,400 | $0 | Many Generics | $0.00 | $3.00 | $18.00 | $18.00 | 3,129 2014 Formulary | |||
2013 HumanaChoice H2029-002 (PPO) | $100.00 | $3,400 | $0 | Some Generics, Few Brands |
H2029 -002 -0 | $3.00 | $10.00 | $30.00 | $30.00 | 3,906 2013 Formulary | ||
-- | ||||||||||||
2014 HumanaChoice H2029-002 (PPO) | $103.00 | $3,400 | $0 | Some Generics, Few Brands | $3.00 | $10.00 | $30.00 | $30.00 | 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 First+Plus Smart Plus (HMO) | $0.00 | $6,700 | $0 | All Generics | H5887 -011 -0 | $5.00 | $30.00 | $50.00 | $50.00 | 3,449 2013 Formulary | ||
-- Members will be assigned to First+Plus Smart Premium (HMO) H5887-0012 -- | ||||||||||||
2013 MCS Classicare FlexiCare (HMO-POS) | $43.00 | $3,400 | $0 | Many Generics | H5577 -012 -0 | $0.00 | $0.00 | $14.00 | $14.00 | 3,272 2013 Formulary | ||
-- Members will be assigned to MCS Classicare Advanced Health (HMO-POS) H4006-008 -- | ||||||||||||
2013 MCS Classicare Platino Esencial (HMO SNP) | $4.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5577 -011 -0 | 25% | 25% | 25% | 25% | 2,860 2013 Formulary | ||
-- Members will be assigned to MCS Classicare Platino Ideal (HMO SNP) H5577-002 -- | ||||||||||||
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 MCS Classicare Platino Especial (HMO SNP) | $0.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H4006 -013 -0 | 25% | 25% | 25% | 25% | 2,860 2013 Formulary | ||
-- Members will be assigned to MCS Classicare Platino Superior (HMO SNP) H5577-0010 -- | ||||||||||||
2013 Triple-S Medicare Selecto with Medicare Platino 2 (HMO SNP) | $0.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H4012 -009 -0 | 25% | 25% | 25% | 25% | 2,426 2013 Formulary | ||
-- Members will be assigned to Triple-S Medicare Selecto with Medicare Platino (HMO SNP) H4012-003 -- | ||||||||||||
2013 MAPFRE Medicare Excel Extended (HMO-POS) | $58.00 | $6,700 | $0 | Many Generics, Few Brands |
H5821 -013 -0 | 0% | $3.00 | $25.00 | $25.00 | 2,899 2013 Formulary | ||
-- This plan not offered in 2014 -- |
||||||||||||
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 MAPFRE Medicare Excel VIP (HMO) | $23.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H5821 -020 -0 | 0% | $5.00 | $18.00 | $18.00 | 2,899 2013 Formulary | ||
-- This plan not offered in 2014 -- |
||||||||||||
2013 Medicare en el Hogar Plus (HMO SNP) | $0.00 | n/a | $0 | Many Generics | H4004 -035 -0 | $5.00 | $29.00 | 25% | 2,675 2013 Formulary | |||
-- | ||||||||||||
-- This plan not offered in 2014 -- |
||||||||||||
2013 Triple-S Medicare Optimo Basic (PPO) | $0.00 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | H4005 -005 -0 | 25% | 25% | 25% | 25% | 3,492 2013 Formulary | ||
-- This plan not offered in 2014 -- |
||||||||||||
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 MAPFRE Medicare Excel Advance (HMO) | $0.00 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | H5821 -021 -0 | 25% | 25% | 25% | 25% | 2,899 2013 Formulary | ||
-- This plan not offered in 2014 -- |
||||||||||||
2013 MAPFRE Medicare Excel Complete Care (HMO-POS) | $64.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H5821 -022 -0 | 0% | $5.00 | $18.00 | $18.00 | 2,899 2013 Formulary | ||
-- This plan not offered in 2014 -- |
||||||||||||
2013 Humana Gold Plus SNP-DB H4007-014 (HMO SNP) | $0.00 | n/a | $0 | Few Generics, Few Brands |
H4007 -014 -0 | $0.00 | $5.00 | $20.00 | $20.00 | 3,906 2013 Formulary | ||
-- This plan not offered in 2014 -- |
||||||||||||
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