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 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 HealthSpring Advantage (PPO) | $0.00 | $3,400 | No Rx Coverage | H7787 -002 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Cigna-HealthSpring Advantage (PPO) | $0.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2013 -- |
H4510 -032 -0 | |||||||||||
2014 Humana Gold Plus H4510-032 (HMO) | $0.00 | $3,900 | $0 | Few Generics, Few Brands | $1.00 | $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 |
||||||
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. | ||||||||
2013 SeniorCare Sr Select-Medical Only (Cost) | $0.00 | $6,700 | No Rx Coverage | H4564 -012 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- | ||||||||||||
2014 SeniorCare Sr Select-Medical Only (Cost) | $0.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- 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 |
||||||
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 HealthSpring Preferred (HMO) | $0.00 | $3,400 | $0 | Many Generics | H2165 -018 -0 | $3.00 | $8.00 | $35.00 | $35.00 | 3,056 2013 Formulary | ||
2014 Cigna-HealthSpring Preferred (HMO) | $20.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $8.00 | $35.00 | $35.00 | 2,946 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 HealthSpring TotalCare (HMO SNP) | $31.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H2165 -019 -0 | 25% | 3,025 2013 Formulary | |||||
2014 Cigna-HealthSpring TotalCare (HMO SNP) | $24.30 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 2,946 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 SeniorCare Sr Select - Value Rx (Cost) | $46.80 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | H4564 -015 -0 | 25% | 25% | 25% | 25% | 2,880 2013 Formulary | ||
-- | ||||||||||||
2014 SeniorCare Sr Select - Value Rx (Cost) | $43.70 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $20.00 | $45.00 | $45.00 | 2,878 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 SeniorCare Sr Select - Basic Rx (Cost) | $44.50 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H4564 -003 -0 | $7.00 | $35.00 | $64.00 | $64.00 | 2,880 2013 Formulary | ||
-- | ||||||||||||
2014 SeniorCare Sr Select - Basic Rx (Cost) | $48.60 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $35.00 | $35.00 | 2,878 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 | |||
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 | |||
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 HealthSpring Preferred (PPO) | $35.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H7787 -001 -0 | $0.00 | $4.00 | $30.00 | $30.00 | 3,056 2013 Formulary | ||
2014 Cigna-HealthSpring Preferred (PPO) | $67.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $8.00 | $35.00 | $35.00 | 2,946 2014 Formulary | |||
2013 SeniorCare Sr Select - Enhanced Rx (Cost) | $98.00 | $6,700 | $0 | Many Generics | H4564 -006 -0 | $2.00 | $35.00 | $65.00 | $65.00 | 2,880 2013 Formulary | ||
-- | ||||||||||||
2014 SeniorCare Sr Select - Enhanced Rx (Cost) | $81.50 | n/a | $0 | Some Generics | $0.00 | $8.00 | $35.00 | $35.00 | 2,878 2014 Formulary | |||
2013 Today's Options Advantage Plus 650B (PPO) | $64.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H5378 -184 -0 | $5.00 | $12.00 | $45.00 | $45.00 | 4,885 2013 Formulary | ||
2014 Today's Options Advantage Plus 950E (PPO) | $86.00 | $6,700 | $110 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $12.00 | $45.00 | $45.00 | 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 |
||||||
2013 SeniorCare Sr Preferred-Medical Only (Cost) | $87.00 | $3,400 | No Rx Coverage | H4564 -011 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- | ||||||||||||
2014 SeniorCare Sr Preferred-Medical Only (Cost) | $87.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
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 SeniorCare Sr Preferred - Value Rx (Cost) | $133.90 | $3,400 | $325 | No additional gap coverage, only the Donut Hole Discount | H4564 -014 -0 | 25% | 25% | 25% | 25% | 2,880 2013 Formulary | ||
-- | ||||||||||||
2014 SeniorCare Sr Preferred - Value Rx (Cost) | $130.70 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $20.00 | $45.00 | $45.00 | 2,878 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 SeniorCare Sr Preferred - Basic Rx (Cost) | $131.60 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H4564 -002 -0 | $7.00 | $35.00 | $64.00 | $64.00 | 2,880 2013 Formulary | ||
-- | ||||||||||||
2014 SeniorCare Sr Preferred - Basic Rx (Cost) | $135.60 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $35.00 | $35.00 | 2,878 2014 Formulary | |||
2013 SeniorCare Sr VIP - Medical Only (Cost) | $147.00 | $3,400 | No Rx Coverage | H4564 -016 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- | ||||||||||||
2014 SeniorCare Sr VIP - Medical Only (Cost) | $147.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 SeniorCare Sr MedOption - Medical Only (Cost) | $167.00 | $3,400 | No Rx Coverage | H4564 -020 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- | ||||||||||||
2014 SeniorCare Sr MedOption - Medical Only (Cost) | $167.00 | 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 |
||||||
2013 SeniorCare Sr Preferred - Enhanced Rx (Cost) | $185.00 | $3,400 | $0 | Many Generics | H4564 -005 -0 | $2.00 | $35.00 | $65.00 | $65.00 | 2,880 2013 Formulary | ||
-- | ||||||||||||
2014 SeniorCare Sr Preferred - Enhanced Rx (Cost) | $168.40 | n/a | $0 | Some Generics | $0.00 | $8.00 | $35.00 | $35.00 | 2,878 2014 Formulary | |||
2013 SeniorCare Sr Premium-Medical Only (Cost) | $187.00 | $3,400 | No Rx Coverage | H4564 -010 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- | ||||||||||||
2014 SeniorCare Sr Premium-Medical Only (Cost) | $187.00 | n/a | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 SeniorCare Sr VIP - Value Rx (Cost) | $193.90 | $3,400 | $325 | No additional gap coverage, only the Donut Hole Discount | H4564 -019 -0 | 25% | 25% | 25% | 25% | 2,880 2013 Formulary | ||
-- | ||||||||||||
2014 SeniorCare Sr VIP - Value Rx (Cost) | $190.70 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $20.00 | $45.00 | $45.00 | 2,878 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 SeniorCare Sr VIP - Basic Rx (Cost) | $191.60 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H4564 -017 -0 | $7.00 | $35.00 | $64.00 | $64.00 | 2,880 2013 Formulary | ||
-- | ||||||||||||
2014 SeniorCare Sr VIP - Basic Rx (Cost) | $195.60 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $35.00 | $35.00 | 2,878 2014 Formulary | |||
2013 SeniorCare Sr MedOption - Value Rx (Cost) | $213.90 | $3,400 | $325 | No additional gap coverage, only the Donut Hole Discount | H4564 -023 -0 | 25% | 25% | 25% | 25% | 2,880 2013 Formulary | ||
-- | ||||||||||||
2014 SeniorCare Sr MedOption - Value Rx (Cost) | $210.70 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $20.00 | $45.00 | $45.00 | 2,878 2014 Formulary | |||
2013 SeniorCare Sr MedOption - Basic Rx (Cost) | $211.50 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H4564 -021 -0 | $7.00 | $35.00 | $64.00 | $64.00 | 2,880 2013 Formulary | ||
-- | ||||||||||||
2014 SeniorCare Sr MedOption - Basic Rx (Cost) | $215.60 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $35.00 | $35.00 | 2,878 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 SeniorCare Sr VIP - Enhanced Rx (Cost) | $244.90 | $3,400 | $0 | Many Generics | H4564 -018 -0 | $2.00 | $35.00 | $65.00 | $65.00 | 2,880 2013 Formulary | ||
-- | ||||||||||||
2014 SeniorCare Sr VIP - Enhanced Rx (Cost) | $228.40 | n/a | $0 | Some Generics | $0.00 | $8.00 | $35.00 | $35.00 | 2,878 2014 Formulary | |||
2013 SeniorCare Sr Premium - Value Rx (Cost) | $233.80 | $3,400 | $325 | No additional gap coverage, only the Donut Hole Discount | H4564 -013 -0 | 25% | 25% | 25% | 25% | 2,880 2013 Formulary | ||
-- | ||||||||||||
2014 SeniorCare Sr Premium - Value Rx (Cost) | $230.70 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $20.00 | $45.00 | $45.00 | 2,878 2014 Formulary | |||
2013 SeniorCare Sr Premium - Basic Rx (Cost) | $231.50 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H4564 -001 -0 | $7.00 | $35.00 | $64.00 | $64.00 | 2,880 2013 Formulary | ||
-- | ||||||||||||
2014 SeniorCare Sr Premium - Basic Rx (Cost) | $235.70 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $35.00 | $35.00 | 2,878 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 SeniorCare Sr MedOption - Enhanced Rx (Cost) | $264.90 | $3,400 | $0 | Many Generics | H4564 -022 -0 | $2.00 | $35.00 | $65.00 | $65.00 | 2,880 2013 Formulary | ||
-- | ||||||||||||
2014 SeniorCare Sr MedOption - Enhanced Rx (Cost) | $248.40 | n/a | $0 | Some Generics | $0.00 | $8.00 | $35.00 | $35.00 | 2,878 2014 Formulary | |||
2013 SeniorCare Sr Premium - Enhanced Rx (Cost) | $284.90 | $3,400 | $0 | Many Generics | H4564 -004 -0 | $2.00 | $35.00 | $65.00 | $65.00 | 2,880 2013 Formulary | ||
-- | ||||||||||||
2014 SeniorCare Sr Premium - Enhanced Rx (Cost) | $268.50 | n/a | $0 | Some Generics | $0.00 | $8.00 | $35.00 | $35.00 | 2,878 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 |
||||||
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 Humana Gold Plus H4529-014 (HMO) | $0.00 | $3,400 | $0 | Few Generics, Few Brands |
H4529 -014 -0 | $7.00 | $11.00 | $40.00 | $40.00 | 3,906 2013 Formulary | ||
-- Members will be assigned to Humana Gold Plus H4510-032 (HMO) H4510-0032 -- | ||||||||||||
2013 Today's Options Advantage Plus 350A (PPO) | $127.00 | $3,250 | $0 | No additional gap coverage, only the Donut Hole Discount | H5378 -200 -0 | $2.00 | $7.00 | $40.00 | $40.00 | 4,885 2013 Formulary | ||
-- Members will be assigned to Today's Options Advantage Plus 950E (PPO) H5378-00184 -- | ||||||||||||
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 (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 -- |
||||||||||||
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 -- |
||||||||||||
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 -- |
||||||||||||
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 (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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