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 Community HealthFirst MA Extra Plan (HMO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H5826 -010 -0 | $10.00 | $50.00 | 33% | 3,102 2013 Formulary | |||
2014 Community HealthFirst MA Extra Plan (HMO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $50.00 | 33% | 3,124 2014 Formulary | ||||
2013 Community HealthFirst MA Plan (HMO) | $0.00 | $3,400 | No Rx Coverage | H5826 -006 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Community HealthFirst MA Plan (HMO) | $0.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Humana Gold Choice H8145-097 (PFFS) | $0.00 | n/a | No Rx Coverage | H8145 -097 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Humana Gold Choice H8145-097 (PFFS) | $0.00 | n/a | 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 Nursing Home Plan (HMO SNP) | $34.90 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5008 -001 -0 | 25% | 25% | 25% | 25% | 3,825 2013 Formulary | ||
2014 UnitedHealthcare Nursing Home Plan (HMO SNP) | $27.80 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,604 2014 Formulary | |||
2013 Community HealthFirst MA Pharmacy Plan (HMO) | $37.30 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H5826 -008 -0 | $10.00 | $50.00 | 33% | 3,102 2013 Formulary | |||
2014 Community HealthFirst MA Pharmacy Plan (HMO) | $34.80 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $50.00 | 33% | 3,124 2014 Formulary | ||||
2013 Community HealthFirst MA Special Needs Plan (HMO SNP) | $37.40 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5826 -005 -0 | 25% | 3,102 2013 Formulary | |||||
2014 Community HealthFirst MA Special Needs Plan (HMO SNP) | $34.80 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 3,124 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 Group Health Cooperative Clear Care Vital (HMO) | $43.00 | $3,200 | $325 | No additional gap coverage, only the Donut Hole Discount | H5050 -013 -0 | $3.00 | $9.00 | $13.00 | $13.00 | 5,235 2013 Formulary | ||
2014 Group Health Cooperative Clear Care Vital (HMO) | $78.00 | $3,500 | $310 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $20.00 | $20.00 | 5,215 2014 Formulary | |||
2013 Regence MedAdvantage Basic (PPO) | $79.00 | $3,400 | No Rx Coverage | H5009 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Regence MedAdvantage Basic (PPO) | $89.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Humana Prime Choice H6609-013 (PPO) | $64.00 | $6,700 | $0 | Few Generics, Few Brands |
H6609 -013 -0 | $6.00 | $40.00 | $80.00 | $80.00 | 3,906 2013 Formulary | ||
2014 HumanaChoice H6609-013 (PPO) | $90.00 | $6,700 | $300 | Few Generics, Few Brands | $4.00 | $6.00 | $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 Group Health Cooperative Clear Care Basic (HMO) | $59.00 | $2,500 | No Rx Coverage | H5050 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Group Health Cooperative Clear Care Basic (HMO) | $99.00 | $3,000 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Regence MedAdvantage + Rx Classic (PPO) | $99.00 | $3,400 | $205 | No additional gap coverage, only the Donut Hole Discount | H5009 -002 -0 | $7.50 | $33.00 | $45.00 | $45.00 | 3,733 2013 Formulary | ||
2014 Regence MedAdvantage + Rx Classic (PPO) | $137.00 | $3,400 | $235 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $33.00 | $45.00 | $45.00 | 3,414 2014 Formulary | |||
2013 Humana Prime Choice H6609-073 (PPO) | $202.00 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | H6609 -073 -0 | 25% | 25% | 25% | 25% | 3,906 2013 Formulary | ||
2014 HumanaChoice H6609-073 (PPO) | $205.00 | $6,700 | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 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 Group Health Cooperative Clear Care Essential (HMO) | $153.00 | $2,500 | $250 | No additional gap coverage, only the Donut Hole Discount | H5050 -009 -0 | $4.00 | $18.00 | $20.00 | $20.00 | 5,235 2013 Formulary | ||
2014 Group Health Cooperative Clear Care Essential (HMO) | $207.00 | $3,000 | $250 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $15.00 | $22.00 | $22.00 | 5,215 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H5050 -014 -0 | |||||||||||
2014 Group Health Cooperative Clear Care Key (HMO) | $294.00 | $2,500 | $200 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $23.00 | $23.00 | 5,215 2014 Formulary | |||
2013 Group Health Cooperative Clear Care Optimal (HMO) | $254.00 | $1,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H5050 -004 -0 | $4.00 | $20.00 | $25.00 | $25.00 | 5,235 2013 Formulary | ||
2014 Group Health Cooperative Clear Care Optimal (HMO) | $328.00 | $2,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $20.00 | $25.00 | $25.00 | 5,215 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 Regence MedAdvantage + Rx Enhanced (PPO) | $241.00 | $2,800 | $0 | Many Generics | H5009 -004 -0 | $5.00 | $33.00 | $45.00 | $45.00 | 3,733 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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