There are 56 Medicare Advantage plans meeting your criteria.
2014 / 2015 Medicare Advantage Plan Information
Click here to jump to the Chart Legend |
Plan Name |
Monthly Premium |
Part A&B Maximum Out-Of Pocket |
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 |
2014 AHM Basic (HMO)
| $0.00 |
$3,000 |
No Rx Coverage |
H5774 -003 -0 | This plan does NOT include Prescription Drug coverage. | |
-- |
|
|
|
2015 AHM Basic (HMO)
| $0.00 |
$3,000 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2014 AHM Classic (HMO)
| $0.00 |
$3,400 |
$0 | All Generics |
H5774 -008 -0 | $6.00 | $15.00 | $40.00 | $40.00 | 2,927
2014 Formulary |
-- |
|
|
|
2015 AHM Classic (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $6.00 | $15.00 | $40.00 | $40.00 | 2,824 2015 Formulary |
|
2014 AHM Platino Plus (HMO SNP)
| $0.00 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H5774 -019 -0 | 15% | 15% | 15% | 15% | 2,912
2014 Formulary |
-- |
|
|
|
2015 AHM Platino Optimum (HMO SNP)
| $0.00 |
$2,500 |
$320 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 2,809 2015 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 |
2014 AHM Standard (HMO)
| $0.00 |
$3,000 |
$0 | All Generics |
H5774 -005 -0 | $3.00 | $8.00 | $35.00 | $35.00 | 2,927
2014 Formulary |
-- |
|
|
|
2015 AHM Royal (HMO)
| $0.00 |
$3,000 |
$0 | Yes, some additional gap coverage. | $5.00 | $10.00 | $35.00 | $35.00 | 2,824 2015 Formulary |
|
2014 AHM Classic Plus (HMO SNP)
| $0.00 |
n/a |
$0 | All Generics |
H5774 -009 -0 | $3.00 | $8.00 | $35.00 | $35.00 | 2,927
2014 Formulary |
-- |
|
|
|
2015 AHM Vital (HMO SNP)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $5.00 | $10.00 | $35.00 | $35.00 | 2,824 2015 Formulary |
|
-- This plan not offered in 2014 --
|
H5774 -022 -0 | | | | | |
-- |
|
|
|
2015 AHM Vital Plus (HMO SNP)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $5.00 | $10.00 | $35.00 | $35.00 | 2,824 2015 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 |
2014 Apollo - Constellation Health (HMO)
| $0.00 |
$3,400 |
$0 | Many Generics, Few Brands |
H8266 -001 -0 | $5.00 | $30.00 | $60.00 | $60.00 | 3,447
2014 Formulary |
-- |
-- |
-- |
|
2015 Apollo - Constellation Health (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $5.00 | $45.00 | $75.00 | $75.00 | 3,631 2015 Formulary |
|
2014 First Care+Plus (HMO)
| $0.00 |
$6,700 |
$0 | All Generics |
H5887 -001 -0 | $5.00 | $10.00 | $25.00 | $25.00 | 3,156
2014 Formulary |
-- |
|
|
|
2015 First Care+Plus (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $6.00 | $12.00 | $40.00 | $40.00 | 3,049 2015 Formulary |
|
2014 First+Plus Advantage (PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
H4011 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
-- |
|
|
|
2015 First+Plus Advantage (PPO)
| $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 |
2014 First+Plus Advantage Plus (PPO)
| $0.00 |
$6,700 |
$0 | All Generics |
H4011 -003 -0 | $6.00 | $12.00 | $35.00 | $35.00 | 3,156
2014 Formulary |
-- |
|
|
|
2015 First+Plus Advantage Plus (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $6.00 | $14.00 | $40.00 | $40.00 | 3,049 2015 Formulary |
|
2014 First+Plus Complete (HMO SNP)
| $0.00 |
n/a |
$0 | All Generics |
H5887 -007 -0 | $6.00 | $12.00 | $30.00 | $30.00 | 3,156
2014 Formulary |
-- |
|
|
|
2015 First+Plus Complete (HMO SNP)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $7.00 | $14.00 | $40.00 | $40.00 | 3,049 2015 Formulary |
|
2014 First+Plus Platino (HMO SNP)
| $0.00 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H5887 -010 -0 | 15% | 15% | 15% | 15% | 3,147
2014 Formulary |
-- |
|
|
|
2015 First+Plus Platino (HMO SNP)
| $0.00 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 2,903 2015 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 |
2014 First+Plus Smart Premium (HMO)
| $0.00 |
$6,700 |
$0 | All Generics |
H5887 -012 -0 | $5.00 | $10.00 | $35.00 | $35.00 | 3,156
2014 Formulary |
-- |
|
|
|
2015 First+Plus Smart Premium (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $7.00 | $15.00 | $45.00 | $45.00 | 3,049 2015 Formulary |
|
2014 First+Plus Smart Value (HMO)
| $0.00 |
$6,700 |
$0 | All Generics |
H5887 -013 -0 | $7.00 | $15.00 | $40.00 | $40.00 | 3,156
2014 Formulary |
-- |
|
|
|
2015 First+Plus Smart Value (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $7.00 | $15.00 | $45.00 | $45.00 | 3,049 2015 Formulary |
|
2014 Genesis - Constellation Health (HMO SNP)
| $0.00 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3054 -001 -0 | 15% | 15% | 15% | 15% | 2,491
2014 Formulary |
-- |
-- |
-- |
|
2015 Genesis - Constellation Health (HMO SNP)
| $0.00 |
$3,400 |
$320 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 2,622 2015 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 |
2014 Humana Gold Plus H4007-012 (HMO)
| $0.00 |
$3,500 |
$310 | Few Generics, Few Brands |
H4007 -012 -0 | $0.00 | $15.00 | $30.00 | $30.00 | 3,711
2014 Formulary |
-- |
|
|
|
2015 Humana Gold Plus H4007-012 (HMO)
| $0.00 |
$3,500 |
$320 | Yes, some additional gap coverage. | $0.00 | $15.00 | $30.00 | $30.00 | 3,630 2015 Formulary |
|
2014 Humana Gold Plus H4007-013 (HMO)
| $0.00 |
$5,000 |
$0 | Few Generics |
H4007 -013 -0 | $0.00 | $25.00 | $45.00 | | 3,294
2014 Formulary |
-- |
|
|
|
2015 Humana Gold Plus H4007-013 (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $29.00 | $29.00 | 3,651 2015 Formulary |
|
2014 Humana Gold Plus SNP-DE H4007-005 (HMO SNP)
| $0.00 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H4007 -005 -0 | 25% | 25% | 25% | | 3,294
2014 Formulary |
-- |
|
|
|
2015 Humana Gold Plus SNP-DE H4007-005 (HMO SNP)
| $0.00 |
$3,400 |
$320 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 3,651 2015 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 |
2014 Humana Gold Plus SNP-DE H4007-016 (HMO SNP)
| $0.00 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H4007 -016 -0 | 25% | 25% | 25% | | 3,294
2014 Formulary |
-- |
|
|
|
2015 Humana Gold Plus SNP-DE H4007-016 (HMO SNP)
| $0.00 |
$3,400 |
$320 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 3,651 2015 Formulary |
|
2014 MCS Classicare Essential (HMO-POS)
| $0.00 |
$3,400 |
$0 | Many Generics |
H5577 -008 -0 | $4.00 | $5.00 | $29.00 | $29.00 | 3,129
2014 Formulary |
-- |
|
|
|
2015 MCS Classicare Essential (HMO-POS)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $6.00 | $9.00 | $41.00 | $41.00 | 3,112 2015 Formulary |
|
2014 MCS Classicare InteliCare (HMO)
| $0.00 |
$3,400 |
$0 | Many Generics |
H5577 -005 -0 | $4.00 | $5.00 | $29.00 | $29.00 | 3,129
2014 Formulary |
-- |
|
|
|
2015 MCS Classicare InteliCare (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $5.00 | $35.00 | $55.00 | $55.00 | 2,852 2015 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 |
2014 MCS Classicare Platino Ideal (HMO SNP)
| $0.00 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H5577 -002 -0 | 15% | 15% | 15% | 15% | 2,755
2014 Formulary |
-- |
|
|
|
2015 MCS Classicare Platino Ideal (HMO SNP)
| $0.00 |
$3,400 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 2,852 2015 Formulary |
|
2014 MCS Classicare Platino M
| $0.00 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H5577 -009 -0 | 15% | 15% | 15% | 15% | 2,755
2014 Formulary |
-- |
|
|
|
2015 MCS Classicare Platino M
| $0.00 |
$3,400 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 2,852 2015 Formulary |
|
2014 MCS Classicare Platino Superior (HMO SNP)
| $0.00 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H5577 -010 -0 | 15% | 15% | 15% | 15% | 2,755
2014 Formulary |
-- |
|
|
|
2015 MCS Classicare Platino Superior (HMO SNP)
| $0.00 |
$3,400 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 2,852 2015 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 |
2014 Medicare y Mucho Mas - DIAMANTE CHOICE (HMO SNP)
| $0.00 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H4003 -017 -0 | 15% | 15% | 15% | | 2,635
2014 Formulary |
|
|
|
|
2015 Medicare y Mucho Mas - DIAMANTE CHOICE (HMO SNP)
| $0.00 |
$3,250 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 2,706 2015 Formulary |
|
-- This plan not offered in 2014 --
|
H4003 -033 -0 | | | | | |
|
|
|
|
2015 Medicare y Mucho Mas - DIAMANTE EXCEL (HMO SNP)
| $0.00 |
$3,250 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 2,706 2015 Formulary |
|
2014 Medicare y Mucho Mas - DIAMANTE EXTRA (HMO SNP)
| $0.00 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H4003 -021 -0 | 15% | 15% | 15% | | 2,635
2014 Formulary |
|
|
|
|
2015 Medicare y Mucho Mas - DIAMANTE EXTRA (HMO SNP)
| $0.00 |
$3,250 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 2,706 2015 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 |
-- This plan not offered in 2014 --
|
H4003 -031 -0 | | | | | |
|
|
|
|
2015 Medicare y Mucho Mas - ELITE EXCEL PLUS (HMO-POS)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | $0.00 | $20.00 | $40.00 | $40.00 | 2,745 2015 Formulary |
|
2014 Medicare y Mucho Mas - ELITE ULTRA (HMO-POS)
| $0.00 |
$3,250 |
$0 | Some Generics |
H4003 -027 -0 | $10.00 | $40.00 | 25% | | 2,635
2014 Formulary |
|
|
|
|
2015 Medicare y Mucho Mas - ELITE ULTRA (HMO-POS)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | $4.00 | $24.00 | 25% | | 2,706 2015 Formulary |
|
2014 Medicare y Mucho Mas - SUPREMO (HMO SNP)
| $34.00 |
n/a |
$0 | Some Generics |
H4003 -009 -0 | $3.00 | $5.00 | $45.00 | $45.00 | 2,635
2014 Formulary |
|
|
|
|
2015 Medicare y Mucho Mas - SUPREMO (HMO SNP)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | $3.00 | $7.00 | $45.00 | $45.00 | 2,706 2015 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 |
2014 Medicare y Mucho Mas - UNICO EXTRA (HMO)
| $0.00 |
$3,250 |
$0 | Some Generics |
H4003 -015 -0 | $7.00 | $40.00 | $60.00 | $60.00 | 2,683
2014 Formulary |
|
|
|
|
2015 Medicare y Mucho Mas - UNICO EXTRA (HMO)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | $5.00 | $25.00 | $60.00 | $60.00 | 2,745 2015 Formulary |
|
2014 Triple-S Medicare Optimo (PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
H4005 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
-- |
|
|
|
2015 Optimo (PPO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2014 --
|
H8266 -002 -0 | | | | | |
-- |
-- |
-- |
|
2015 Orion - Constellation Health (HMO)
| $0.00 |
$3,400 |
$320 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $45.00 | $95.00 | $95.00 | 2,622 2015 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 |
2014 PMC Max (HMO)
| $10.00 |
$3,250 |
$0 | Some Generics |
H4004 -050 -0 | $7.00 | $35.00 | 25% | | 2,635
2014 Formulary |
-- |
|
|
|
2015 PMC Max (HMO)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | $5.00 | $35.00 | 25% | | 2,706 2015 Formulary |
|
2014 PMC Max - EXTRA (HMO-POS)
| $0.00 |
$3,250 |
$0 | Some Generics |
H4004 -053 -0 | $10.00 | $40.00 | 25% | | 2,635
2014 Formulary |
-- |
|
|
|
2015 PMC Max - EXTRA (HMO-POS)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | $5.00 | $25.00 | 25% | | 2,706 2015 Formulary |
|
2014 Premier Preferred (HMO SNP)
| $0.00 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H4004 -048 -0 | 15% | 15% | 15% | | 2,635
2014 Formulary |
-- |
|
|
|
2015 Premier Preferred (HMO SNP)
| $0.00 |
$3,250 |
$320 | No additional gap coverage, only the Donut Hole Discount | | | | | 2,706 2015 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 |
2014 Dorado (HMO)
| $30.00 |
$3,250 |
No Rx Coverage |
H4004 -025 -0 | This plan does NOT include Prescription Drug coverage. | |
-- |
|
|
|
2015 Dorado (HMO)
| $10.00 |
$3,250 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2014 Medicare y Mucho Mas - Original (HMO)
| $30.00 |
$3,250 |
No Rx Coverage |
H4003 -018 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2015 Medicare y Mucho Mas - Original (HMO)
| $10.00 |
$3,250 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2014 Medicare y Mucho Mas - Unico (HMO)
| $25.00 |
$3,250 |
$0 | Some Generics |
H4003 -019 -0 | $4.00 | $30.00 | $60.00 | $60.00 | 2,683
2014 Formulary |
|
|
|
|
2015 Medicare y Mucho Mas - Unico (HMO)
| $18.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | $0.00 | $20.00 | $40.00 | $40.00 | 2,745 2015 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 |
2014 Elite Dorado (HMO-POS)
| $34.50 |
$3,250 |
$0 | Some Generics |
H4004 -015 -0 | $5.00 | $29.00 | $50.00 | $50.00 | 2,683
2014 Formulary |
-- |
|
|
|
2015 Elite Dorado (HMO-POS)
| $33.50 |
$3,250 |
$0 | Yes, some additional gap coverage. | $0.00 | $15.00 | $35.00 | $35.00 | 2,745 2015 Formulary |
|
2014 HumanaChoice H2029-001 (PPO)
| $45.00 |
$6,700 |
$0 | Some Generics, Few Brands |
H2029 -001 -0 | $4.00 | $10.00 | $45.00 | $45.00 | 3,711
2014 Formulary |
-- |
|
|
|
2015 HumanaChoice Value H2029-001 (PPO)
| $48.00 |
$6,700 |
$310 | Yes, some additional gap coverage. | $3.00 | $10.00 | $45.00 | $45.00 | 3,630 2015 Formulary |
|
2014 Olympus - Constellation Health (PPO)
| $51.00 |
$3,400 |
$0 | Many Generics, Few Brands |
H4876 -001 -0 | $5.00 | $25.00 | $45.00 | $45.00 | 3,447
2014 Formulary |
-- |
-- |
-- |
|
2015 Olympus - Constellation Health (PPO)
| $51.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $5.00 | $25.00 | $45.00 | $45.00 | 3,631 2015 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 |
2014 Triple-S Medicare Optimo Plus (PPO)
| $73.00 |
$6,700 |
$0 | All Generics |
H4005 -004 -0 | $5.00 | $10.00 | $20.00 | $20.00 | 3,537
2014 Formulary |
-- |
|
|
|
2015 Optimo Plus (PPO)
| $80.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $5.00 | $10.00 | $25.00 | $25.00 | 3,115 2015 Formulary |
|
2014 HumanaChoice H2029-002 (PPO)
| $103.00 |
$3,400 |
$0 | Some Generics, Few Brands |
H2029 -002 -0 | $3.00 | $10.00 | $30.00 | $30.00 | 3,711
2014 Formulary |
-- |
|
|
|
-- Members will be assigned to HumanaChoice Value H2029-001 (PPO) H2029-001 --
| | | | | |
|
2014 MCS Classicare Premium Health (HMO)
| $0.00 |
$3,400 |
$0 | Many Generics |
H4006 -007 -0 | $4.00 | $5.00 | $29.00 | $29.00 | 3,129
2014 Formulary |
|
|
|
|
-- Members will be assigned to MCS Classicare Essential (HMO-POS) H5577-008 --
| | | | | |
|
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 |
2014 MCS Classicare Advanced Health (HMO-POS)
| $79.00 |
$3,400 |
$0 | Many Generics |
H4006 -008 -0 | $0.00 | $3.00 | $18.00 | $18.00 | 3,129
2014 Formulary |
|
|
|
|
-- Members will be assigned to MCS Classicare Essential (HMO-POS) H5577-008 --
| | | | | |
|
2014 MCS Classicare B-Max (HMO)
| $0.00 |
$6,700 |
$310 | No additional gap coverage, only the Donut Hole Discount |
H4006 -025 -0 | 25% | 25% | 25% | 25% | 3,129
2014 Formulary |
|
|
|
|
-- Members will be assigned to MCS Classicare Essential (HMO-POS) H5577-008 --
| | | | | |
|
2014 Medicare y Mucho Mas - ELITE (HMO-POS)
| $33.50 |
$3,250 |
$0 | Some Generics |
H4003 -001 -0 | $4.00 | $20.00 | $50.00 | $50.00 | 2,683
2014 Formulary |
|
|
|
|
-- Members will be assigned to Medicare y Mucho Mas - ELITE ULTRA (HMO-POS) H4003-027 --
| | | | | |
|
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 |
2014 Triple-S Medicare Selecto with Medicare Platino (HMO SNP)
| $0.00 |
n/a |
$310 | No additional gap coverage, only the Donut Hole Discount |
H4012 -003 -0 | 15% | 15% | 15% | 15% | 2,912
2014 Formulary |
|
|
|
|
-- Members will be assigned to Platino Optimum (HMO SNP) H5774-019 --
| | | | | |
|
2014 AHM Opal (HMO-POS)
| $33.00 |
$3,400 |
$0 | All Generics |
H5774 -014 -0 | $5.00 | $10.00 | $35.00 | $35.00 | 3,537
2014 Formulary |
-- |
|
|
|
-- Members will be assigned to Royal (HMO) H5774-005 --
| | | | | |
|
2014 Triple-S Medicare Optimo Premier (HMO)
| $27.00 |
$6,700 |
$0 | All Generics |
H5732 -001 -0 | $5.00 | $15.00 | $35.00 | $35.00 | 3,537
2014 Formulary |
|
|
|
|
-- Members will be assigned to Royal (HMO) H5774-005 --
| | | | | |
|
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 |
2014 Triple-S Medicare Optimo Select (HMO) (HMO)
| $0.00 |
$6,700 |
$0 | All Generics |
H4012 -008 -0 | $5.00 | $10.00 | $35.00 | $35.00 | 2,927
2014 Formulary |
|
|
|
|
-- Members will be assigned to Royal (HMO) H5774-005 --
| | | | | |
|
2014 MCS Classicare MA (HMO)
| $0.00 |
$3,400 |
No Rx Coverage |
H4006 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
-- This plan not offered in 2015 --
|
| | | | |
|
2014 Medicare y Mucho Mas - BASICO EXTRA (HMO)
| $0.00 |
$3,250 |
$310 | No additional gap coverage, only the Donut Hole Discount |
H4003 -024 -0 | 25% | 25% | 25% | | 2,635
2014 Formulary |
|
|
|
|
-- This plan not offered in 2015 --
|
| | | | |
|
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 |
2014 Medicare y Mucho Mas - ELITE EXTRA (HMO-POS)
| $76.30 |
$3,250 |
$0 | Some Generics |
H4003 -025 -0 | $2.00 | $5.00 | $25.00 | $25.00 | 2,988
2014 Formulary |
|
|
|
|
-- This plan not offered in 2015 --
|
| | | | |
|
2014 Alpha - Constellation Health (HMO SNP)
| $62.00 |
n/a |
$0 | Many Generics, Few Brands |
H3054 -002 -0 | $3.00 | $8.00 | $45.00 | $45.00 | 2,497
2014 Formulary |
-- |
-- |
-- |
|
-- This plan not offered in 2015 --
|
| | | | |
|