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 -- |
H6528 -016 -0 | |||||||||||
2014 Care Improvement Plus Gold Rx (PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $9.00 | $45.00 | $45.00 | 3,604 2014 Formulary | |||
2013 Care Improvement Plus Gold Rx (Regional PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | R9896 -009 -0 | $8.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | ||
2014 Care Improvement Plus Gold Rx (Regional PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $9.00 | $45.00 | $45.00 | 3,604 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H6528 -006 -0 | |||||||||||
2014 Care Improvement Plus Medicare Advantage (PPO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $10.00 | 25% | 25% | 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 Care Improvement Plus Medicare Advantage (Regional PPO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | R9896 -012 -0 | $8.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | ||
2014 Care Improvement Plus Medicare Advantage (Regional PPO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $10.00 | $45.00 | $45.00 | 3,604 2014 Formulary | |||
2013 HumanaChoice R5826-064 (Regional PPO) | $0.00 | $4,900 | No Rx Coverage | R5826 -064 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 HumanaChoice R5826-064 (Regional PPO) | $0.00 | $5,900 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Care Improvement Plus Silver Rx (Regional PPO SNP) | $36.30 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | R9896 -008 -0 | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | ||
2014 Care Improvement Plus Silver Rx (Regional PPO SNP) | $14.60 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 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 Care Improvement Plus Dual Advantage (Regional PPO SNP) | $36.50 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | R9896 -021 -0 | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | ||
2014 Care Improvement Plus Dual Advantage (Regional PPO SNP) | $31.50 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 0% | 0% | 0% | 0% | 3,604 2014 Formulary | |||
2013 Medicare Blue (PPO) | $31.00 | $6,700 | $195 | No additional gap coverage, only the Donut Hole Discount | H4209 -003 -0 | $9.00 | $45.00 | $85.00 | $85.00 | 2,941 2013 Formulary | ||
2014 Medicare Blue (PPO) | $38.50 | $6,700 | $195 | Many Generics | $2.00 | $15.00 | $45.00 | $45.00 | 2,839 2014 Formulary | |||
2013 Medicare Blue Saver (PPO) | $45.00 | $6,700 | No Rx Coverage | H4209 -008 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Medicare Blue Saver (PPO) | $45.00 | $6,700 | 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 |
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2013 HumanaChoice R5826-077 (Regional PPO) | $79.00 | $6,200 | $150 | No additional gap coverage, only the Donut Hole Discount | R5826 -077 -0 | $4.00 | $12.00 | $45.00 | $45.00 | 3,906 2013 Formulary | ||
2014 HumanaChoice R5826-077 (Regional PPO) | $77.00 | $6,700 | $150 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $12.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 Care Improvement Plus Dual Advantage (PPO SNP) | $38.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H6528 -020 -0 | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | ||
-- Members will be assigned to Care Improvement Plus Dual Advantage (Regional PPO SNP) R9896-0021 -- | ||||||||||||
2013 Care Improvement Plus Gold Rx (PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H6528 -019 -0 | $6.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | ||
-- Members will be assigned to Care Improvement Plus Gold Rx (PPO SNP) H6528-0016 -- | ||||||||||||
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 Care Improvement Plus Medicare Advantage (PPO) | $0.00 | $5,900 | $0 | No additional gap coverage, only the Donut Hole Discount | H6528 -007 -0 | $6.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | ||
-- Members will be assigned to Care Improvement Plus Medicare Advantage (PPO) H6528-006 -- | ||||||||||||
2013 Care Improvement Plus Silver Rx (PPO SNP) | $38.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H6528 -018 -0 | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | ||
-- Members will be assigned to Care Improvement Plus Silver Rx (Regional PPO SNP) R9896-008 -- | ||||||||||||
2013 Windsor Medicare Extra Diamond Plan (HMO) | $138.00 | $4,500 | $0 | Some Generics | H5698 -160 -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 Emerald Plan (HMO) | $0.00 | $6,700 | $0 | Some Generics | H5698 -159 -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) | $40.00 | $3,400 | $0 | Some Generics | H5698 -157 -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 Silver Plan (HMO) | $0.00 | $3,400 | No Rx Coverage | H5698 -035 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- 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 Diabetes Plan (HMO SNP) | $78.00 | n/a | $0 | Some Generics | H5698 -163 -0 | $4.00 | $10.00 | $40.00 | $40.00 | 2,715 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 Windsor Medicare Extra Comp Plus Plan (HMO SNP) | $37.50 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5698 -158 -0 | 25% | 25% | 25% | 25% | 2,715 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 Care Improvement Plus Chrome RX (PPO SNP) | $38.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H6528 -027 -0 | 25% | 25% | 25% | 25% | 3,401 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 |
||||||
2013 Care Improvement Plus Copper RX (PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H6528 -028 -0 | $6.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 Care Improvement Plus Chrome RX (Regional PPO SNP) | $36.50 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | R9896 -022 -0 | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 Care Improvement Plus Copper RX (Regional PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | R9896 -023 -0 | $8.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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