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 Essential (HMO) | $0.00 | $6,700 | No Rx Coverage | H3107 -008 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 AARP MedicareComplete Essential (HMO) | $0.00 | $6,700 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 AARP MedicareComplete Plan 1 (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H3107 -004 -0 | $3.00 | $6.00 | $45.00 | $45.00 | 3,825 2013 Formulary | ||
2014 AARP MedicareComplete Plan 1 (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $8.00 | $45.00 | $45.00 | 3,604 2014 Formulary | |||
2013 Aetna Medicare Basic Plan (HMO) | $0.00 | $6,700 | No Rx Coverage | H3152 -045 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Aetna Medicare Basic Plan (HMO) | $0.00 | $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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-- This plan not offered in 2013 -- |
H3156 -033 -0 | |||||||||||
-- | -- | |||||||||||
2014 AmeriHealth 65 Preferred Medical Only (HMO) | $30.00 | $6,700 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 UnitedHealthcare Nursing Home Plan (HMO SNP) | $34.50 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H3113 -001 -0 | 25% | 25% | 25% | 25% | 3,825 2013 Formulary | ||
-- | -- | |||||||||||
2014 UnitedHealthcare Nursing Home Plan (HMO SNP) | $30.10 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,604 2014 Formulary | |||
2013 Healthfirst NJ Maximum Plan (HMO SNP) | $37.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H7015 -004 -0 | 25% | 25% | 25% | 25% | 4,885 2013 Formulary | ||
2014 Healthfirst NJ Maximum Plan (HMO SNP) | $37.00 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 0% | 0% | 0% | 0% | 2,885 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 Amerivantage Specialty + Rx (HMO SNP) | $37.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H3240 -013 -0 | 25% | 25% | 25% | 25% | 2,941 2013 Formulary | ||
2014 Amerivantage Specialty + Rx (HMO SNP) | $37.10 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 0% | 0% | 0% | 0% | 2,885 2014 Formulary | |||
2013 Horizon Medicare Blue TotalCare (HMO SNP) | $37.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H3154 -020 -0 | 25% | 25% | 25% | 25% | 3,095 2013 Formulary | ||
2014 Horizon Medicare Blue TotalCare (HMO SNP) | $37.10 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 0% | 0% | 0% | 0% | 2,839 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H3156 -034 -0 | |||||||||||
-- | -- | |||||||||||
2014 AmeriHealth 65 Preferred Rx (HMO) | $69.00 | $6,700 | $295 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $9.00 | $45.00 | $45.00 | 3,833 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 Aetna Medicare Premier Plan (HMO) | $125.00 | $6,700 | $0 | Some Generics | H3152 -048 -0 | $6.00 | $33.00 | $45.00 | $45.00 | 3,323 2013 Formulary | ||
2014 Aetna Medicare Premier Plan (HMO) | $145.00 | $6,700 | $0 | Few Generics | $8.00 | $45.00 | $95.00 | $95.00 | 3,134 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H3154 -022 -0 | |||||||||||
2014 Horizon Medicare Blue Choice w/Rx (HMO) | $153.70 | $6,700 | $310 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $42.00 | $42.00 | 2,839 2014 Formulary | |||
2013 Horizon Medicare Blue Access (HMO-POS) | $71.80 | $6,700 | No Rx Coverage | H3154 -005 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- Members will be assigned to Horizon Medicare Blue Value (HMO) H3154-0013 -- | ||||||||||||
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 Amerivantage Balance + Rx (HMO) | $0.00 | $3,400 | $325 | Some Generics | H3240 -010 -0 | $0.00 | $4.00 | 25% | 25% | 2,941 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 Horizon Medicare Blue Access w/ Rx Standard (HMO-POS) | $134.10 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | H3154 -012 -0 | $0.00 | $4.00 | $42.00 | $42.00 | 3,095 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 Horizon Medicare Blue Access w/Rx Enhanced (HMO-POS) | $175.80 | $6,700 | $0 | Many Generics | H3154 -006 -0 | $0.00 | $5.00 | $40.00 | $40.00 | 3,095 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 Horizon Medicare Blue Value (HMO) | $0.00 | $6,700 | No Rx Coverage | H3154 -013 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- This plan not offered in 2014 -- |
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2013 Horizon Medicare Blue Value w/ Rx Enhanced (HMO) | $110.80 | $6,700 | $0 | Many Generics | H3154 -016 -0 | $0.00 | $6.00 | $42.00 | $42.00 | 3,095 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 Horizon Medicare Blue Value w/ Rx Standard (HMO) | $0.00 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | H3154 -004 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,095 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 UnitedHealthcare Dual Complete (HMO SNP) | $37.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H3164 -003 -0 | 25% | 25% | 25% | 25% | 3,825 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 Aetna Medicare Value Plan (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H3152 -046 -0 | $6.00 | $33.00 | $45.00 | $45.00 | 3,323 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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