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 SecureHorizons (HMO) | $0.00 | $3,400 | $0 | Some Generics | H4590 -010 -0 | $5.00 | $33.00 | $45.00 | $45.00 | 3,833 2013 Formulary | ||
2014 AARP MedicareComplete SecureHorizons (HMO) | $0.00 | $4,400 | $0 | Some Generics | $3.00 | $8.00 | $43.00 | $43.00 | 3,604 2014 Formulary | |||
2013 AARP MedicareComplete SecureHorizons Essential (HMO) | $0.00 | $3,400 | No Rx Coverage | H4590 -029 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 AARP MedicareComplete SecureHorizons Essential (HMO) | $0.00 | $3,900 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2013 -- |
H4523 -016 -0 | |||||||||||
2014 Aetna Medicare Select Plan (HMO) | $0.00 | $3,400 | $0 | Few Generics | $10.00 | 25% | 50% | 50% | 2,800 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 Gold Rx (PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H0084 -004 -0 | $6.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | ||
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 | R6801 -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 | |||
2013 Care Improvement Plus Medicare Advantage (PPO) | $0.00 | $6,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H0084 -001 -0 | $6.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | ||
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 | $45.00 | $45.00 | 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 |
||||||
2013 Care Improvement Plus Medicare Advantage (Regional PPO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | R6801 -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 Humana Gold Plus H4510-015 (HMO) | $0.00 | $4,000 | $0 | Some Generics, Few Brands |
H4510 -015 -0 | $0.00 | $20.00 | $60.00 | $60.00 | 3,906 2013 Formulary | ||
2014 Humana Gold Plus H4510-015 (HMO) | $0.00 | $4,500 | $0 | Few Generics, Few Brands | $0.00 | $20.00 | $60.00 | $60.00 | 3,711 2014 Formulary | |||
2013 HumanaChoice R5826-026 (Regional PPO) | $0.00 | $3,400 | No Rx Coverage | R5826 -026 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 HumanaChoice R5826-026 (Regional PPO) | $0.00 | $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 |
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2013 UnitedHealthcare Chronic Complete (HMO SNP) | $0.00 | n/a | $0 | Some Generics | H4590 -037 -0 | $5.00 | $32.00 | $45.00 | $45.00 | 3,833 2013 Formulary | ||
2014 UnitedHealthcare Chronic Complete (HMO SNP) | $0.00 | n/a | $0 | Some Generics | $3.00 | $8.00 | $43.00 | $43.00 | 3,604 2014 Formulary | |||
2013 UnitedHealthcare Dual Complete (HMO SNP) | $11.50 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H4590 -022 -0 | 25% | 25% | 25% | 25% | 3,825 2013 Formulary | ||
2014 UnitedHealthcare Dual Complete (HMO SNP) | $3.00 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 15% | 15% | 3,604 2014 Formulary | |||
-- This plan not offered in 2013 -- |
R5826 -091 -0 | |||||||||||
2014 HumanaChoice R5826-091 (Regional PPO) | $10.00 | $6,700 | $310 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $13.00 | $42.00 | $42.00 | 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 |
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2013 Humana Gold Choice H8145-126 (PFFS) | $10.00 | n/a | No Rx Coverage | H8145 -126 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Humana Gold Choice H8145-126 (PFFS) | $15.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Care Improvement Plus Silver Rx (Regional PPO SNP) | $31.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | R6801 -008 -0 | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | ||
2014 Care Improvement Plus Silver Rx (Regional PPO SNP) | $15.50 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,604 2014 Formulary | |||
2013 Humana Gold Plus SNP-DE H4510-024 (HMO SNP) | $30.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H4510 -024 -0 | 25% | 25% | 25% | 25% | 3,906 2013 Formulary | ||
2014 Humana Gold Plus SNP-DE H4510-024 (HMO SNP) | $23.20 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 0% | 0% | 0% | 0% | 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 |
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2013 UnitedHealthcare Nursing Home Plan (HMO SNP) | $29.20 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H4590 -039 -0 | 25% | 25% | 25% | 25% | 3,825 2013 Formulary | ||
2014 UnitedHealthcare Nursing Home Plan (HMO SNP) | $26.20 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,604 2014 Formulary | |||
2013 Care Improvement Plus Dual Advantage (Regional PPO SNP) | $31.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | R6801 -011 -0 | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | ||
2014 Care Improvement Plus Dual Advantage (Regional PPO SNP) | $26.30 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 0% | 0% | 0% | 0% | 3,604 2014 Formulary | |||
2013 HumanaChoice R5826-012 (Regional PPO) | $59.00 | $6,700 | $125 | No additional gap coverage, only the Donut Hole Discount | R5826 -012 -0 | $7.00 | $12.00 | $45.00 | $45.00 | 3,906 2013 Formulary | ||
2014 HumanaChoice R5826-012 (Regional PPO) | $65.00 | $6,700 | $0 | Few Generics, Few Brands | $7.00 | $12.00 | $45.00 | $45.00 | 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 |
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2013 Humana Prime Choice H4520-006 (PPO) | $57.00 | $4,500 | $0 | Few Generics, Few Brands |
H4520 -006 -0 | $7.00 | $12.00 | $42.00 | $42.00 | 3,906 2013 Formulary | ||
2014 HumanaChoice H4520-006 (PPO) | $66.00 | $6,600 | $0 | Few Generics, Few Brands | $7.00 | $12.00 | $42.00 | $42.00 | 3,711 2014 Formulary | |||
2013 Humana Gold Choice H8145-084 (PFFS) | $87.00 | n/a | $0 | Few Generics, Few Brands |
H8145 -084 -0 | $6.00 | $12.00 | $39.00 | $39.00 | 3,906 2013 Formulary | ||
2014 Humana Gold Choice H8145-084 (PFFS) | $89.00 | n/a | $0 | Few Generics, Few Brands | $6.00 | $12.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 Care Improvement Plus Dual Advantage (PPO SNP) | $31.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H0084 -005 -0 | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | ||
-- Members will be assigned to Care Improvement Plus Dual Advantage (Regional PPO SNP) R6801-0011 -- | ||||||||||||
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 Silver Rx (PPO SNP) | $31.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H0084 -003 -0 | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | ||
-- Members will be assigned to Care Improvement Plus Silver Rx (Regional PPO SNP) R6801-008 -- | ||||||||||||
2013 Care Improvement Plus Chrome RX (PPO SNP) | $31.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H0084 -026 -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 (PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H0084 -027 -0 | $6.00 | $45.00 | $95.00 | $95.00 | 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 Chrome RX (Regional PPO SNP) | $31.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | R6801 -021 -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 | R6801 -022 -0 | $8.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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