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 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. | ||||||||
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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-- This plan not offered in 2013 -- |
H2012 -094 -0 | |||||||||||
2014 Humana Gold Plus H2012-094 (HMO) | $49.00 | $6,100 | $290 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $6.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 Community HealthFirst MA Pharmacy Plan (HMO) | $61.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H5826 -009 -0 | $10.00 | $50.00 | 33% | 3,102 2013 Formulary | |||
2014 Community HealthFirst MA Pharmacy Plan (HMO) | $77.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $50.00 | 33% | 3,124 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. | ||||||||
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 Options Clear Care Prestige (PPO) | $103.00 | $3,200 | $325 | No additional gap coverage, only the Donut Hole Discount | H2810 -001 -0 | $3.00 | $10.00 | $14.00 | $14.00 | 5,235 2013 Formulary | ||
2014 Group Health Options Clear Care Prestige (PPO) | $135.00 | $3,200 | $310 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $10.00 | $11.00 | $11.00 | 5,215 2014 Formulary | |||
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 Gold Plus SNP-DE H5416-014 (HMO SNP) | $34.10 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5416 -014 -0 | 25% | 25% | 25% | 25% | 3,906 2013 Formulary | ||
-- Members will be assigned to Humana Gold Plus SNP-DE H2012-095 (HMO SNP) H2012-0095 -- | ||||||||||||
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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2013 Humana Gold Plus H5416-009 (HMO) | $38.00 | $5,200 | $0 | Few Generics, Few Brands |
H5416 -009 -0 | $6.00 | $40.00 | $80.00 | $80.00 | 3,906 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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