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 SecureHorizons Essential (HMO) | $0.00 | $4,900 | No Rx Coverage | H0543 -121 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 AARP MedicareComplete SecureHorizons Essential (HMO) | $0.00 | $4,900 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 AARP MedicareComplete SecureHorizons Plan 4 (HMO) | $0.00 | $5,900 | $0 | Some Generics | H0543 -152 -0 | $4.00 | $7.00 | $45.00 | $45.00 | 3,825 2013 Formulary | ||
2014 AARP MedicareComplete SecureHorizons Plan 4 (HMO) | $0.00 | $6,700 | $0 | Some Generics | $5.00 | $9.00 | $45.00 | $45.00 | 3,604 2014 Formulary | |||
2013 Aetna Medicare Select Plan (HMO) | $0.00 | $2,900 | $0 | Some Generics | H0523 -052 -0 | $7.00 | $33.00 | $45.00 | $45.00 | 3,323 2013 Formulary | ||
2014 Aetna Medicare Select Plan (HMO) | $0.00 | $4,900 | $0 | Few Generics | $10.00 | 25% | 50% | 50% | 3,134 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 Blue Shield 65 Plus (HMO) | $0.00 | $3,000 | $0 | Many Generics | H0504 -028 -0 | $5.00 | $45.00 | $85.00 | $85.00 | 3,331 2013 Formulary | ||
2014 Blue Shield 65 Plus (HMO) | $0.00 | $3,000 | $0 | Many Generics | $5.00 | $45.00 | $85.00 | $85.00 | 3,231 2014 Formulary | |||
2013 Care1st AdvantageOptimum Plan (HMO) | $0.00 | $3,400 | $0 | Many Generics | H5928 -010 -0 | $0.00 | $5.00 | $30.00 | $30.00 | 2,752 2013 Formulary | ||
2014 Care1st AdvantageOptimum Plan (HMO) | $0.00 | $3,400 | $0 | Many Generics | $0.00 | $7.00 | $35.00 | $35.00 | 2,743 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H5087 -012 -0 | |||||||||||
-- | ||||||||||||
2014 Easy Choice Best Plan (HMO) | $0.00 | $6,700 | $0 | Many Generics | $0.00 | $10.00 | $45.00 | $45.00 | 3,267 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 Health Net Healthy Heart (HMO) | $0.00 | $5,000 | $0 | Many Generics | H0562 -012 -0 | $3.00 | $10.00 | $45.00 | $45.00 | 4,263 2013 Formulary | ||
2014 Health Net Healthy Heart (HMO) | $0.00 | $5,000 | $0 | Many Generics, Few Brands | $3.00 | $10.00 | $45.00 | $45.00 | 4,187 2014 Formulary | |||
2013 Health Net Seniority Plus Green (HMO) | $0.00 | $3,400 | No Rx Coverage | H0562 -044 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Health Net Seniority Plus Green (HMO) | $0.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Humana Gold Plus H0108-008 (HMO) | $0.00 | $3,400 | $0 | Some Generics, Few Brands |
H0108 -008 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,906 2013 Formulary | ||
2014 Humana Gold Plus H0108-008 (HMO) | $0.00 | $3,400 | $0 | Some Generics, Few Brands | $0.00 | $10.00 | $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 Humana Gold Plus H0108-029 (HMO) | $0.00 | $1,000 | No Rx Coverage | H0108 -029 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Humana Gold Plus H0108-029 (HMO) | $0.00 | $6,700 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Kaiser Permanente Senior Advantage San Diego (HMO) | $0.00 | $3,400 | $0 | All Generics, Few Brands |
H0524 -037 -0 | $5.00 | $10.00 | $45.00 | $45.00 | 5,250 2013 Formulary | ||
2014 Kaiser Permanente Senior Advantage San Diego (HMO) | $0.00 | $5,900 | $0 | All Generics, Few Brands | $5.00 | $12.00 | $45.00 | $45.00 | 5,237 2014 Formulary | |||
2013 SCAN Classic (HMO) | $0.00 | $3,400 | $0 | Many Generics | H5425 -005 -0 | $3.00 | $8.00 | $40.00 | $40.00 | 2,703 2013 Formulary | ||
2014 SCAN Classic (HMO) | $0.00 | $3,400 | $0 | Some Generics | $3.00 | $8.00 | $45.00 | $45.00 | 2,747 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 Sharp SecureHorizons Plan by UnitedHealthcare (HMO) | $0.00 | $4,900 | $0 | Some Generics | H0543 -145 -0 | $3.00 | $6.00 | $45.00 | $45.00 | 3,825 2013 Formulary | ||
2014 Sharp SecureHorizons Plan by UnitedHealthcare (HMO) | $0.00 | $5,700 | $0 | Some Generics | $4.00 | $8.00 | $45.00 | $45.00 | 3,604 2014 Formulary | |||
2013 Senior Advantage Medicare Medi-Cal Plan South (HMO SNP) | $11.40 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H0524 -029 -0 | $10.00 | $10.00 | $45.00 | $45.00 | 5,250 2013 Formulary | ||
2014 Senior Advantage Medicare Medi-Cal Plan South (HMO SNP) | $14.40 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $12.00 | $45.00 | $45.00 | 5,237 2014 Formulary | |||
2013 Molina Medicare Options Plus (HMO SNP) | $29.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5810 -001 -0 | $0.00 | $45.00 | $95.00 | $95.00 | 2,941 2013 Formulary | ||
2014 Molina Medicare Options Plus (HMO SNP) | $21.60 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $45.00 | $95.00 | $95.00 | 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 |
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2013 AARP MedicareComplete SecureHorizons Value (HMO) | $25.00 | $4,700 | $0 | Some Generics | H0543 -013 -0 | $3.00 | $6.00 | $45.00 | $45.00 | 3,825 2013 Formulary | ||
2014 AARP MedicareComplete SecureHorizons Value (HMO) | $25.00 | $5,300 | $0 | Some Generics | $4.00 | $8.00 | $45.00 | $45.00 | 3,604 2014 Formulary | |||
2013 SCAN Plus (HMO) | $27.50 | $3,000 | $325 | No additional gap coverage, only the Donut Hole Discount | H5425 -040 -0 | $0.00 | $0.00 | 25% | 25% | 2,703 2013 Formulary | ||
2014 SCAN Plus (HMO) | $25.40 | $6,700 | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 2,747 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H5928 -037 -0 | |||||||||||
2014 Coordinated Choice Plan (HMO) | $26.30 | $3,400 | $310 | Few Generics | $0.00 | 25% | 25% | 25% | 2,743 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 Care1st TotalDual Plan (HMO SNP) | $29.80 | n/a | $325 | Few Generics | H5928 -009 -0 | $0.00 | 25% | 25% | 25% | 2,752 2013 Formulary | ||
2014 Care1st TotalDual Plan (HMO SNP) | $26.90 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 15% | 15% | 2,743 2014 Formulary | |||
2013 CommuniCare Advantage (HMO SNP) | $29.90 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H7086 -001 -0 | $0.00 | $60.00 | 3,285 2013 Formulary | ||||
2014 CommuniCare Advantage (HMO SNP) | $28.10 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $60.00 | 3,192 2014 Formulary | |||||
2013 Easy Choice Plus Plan (HMO) | $29.90 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | H5087 -002 -0 | 25% | 25% | 25% | 25% | 3,458 2013 Formulary | ||
-- | ||||||||||||
2014 Easy Choice Plus Plan (HMO) | $28.10 | $6,700 | $310 | Call plan for details | $0.00 | 25% | 25% | 25% | 3,267 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 Health Net Seniority Plus Amber II (HMO SNP) | $29.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H0562 -070 -0 | 25% | 25% | 25% | 25% | 4,263 2013 Formulary | ||
2014 Health Net Seniority Plus Amber II (HMO SNP) | $28.10 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $13.00 | $45.00 | $45.00 | 4,195 2014 Formulary | |||
2013 Humana Gold Plus H0108-009 (HMO-POS) | $39.00 | $5,000 | $0 | Few Generics, Few Brands |
H0108 -009 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,906 2013 Formulary | ||
2014 Humana Gold Plus H0108-009 (HMO-POS) | $42.00 | $5,000 | $0 | Some Generics, Few Brands | $0.00 | $10.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 AARP MedicareComplete SecureHorizons Premier (HMO) | $69.00 | $3,700 | $0 | Some Generics | H0543 -060 -0 | $3.00 | $6.00 | $42.00 | $42.00 | 3,825 2013 Formulary | ||
2014 AARP MedicareComplete SecureHorizons Premier (HMO) | $69.00 | $4,300 | $0 | Some Generics | $4.00 | $8.00 | $42.00 | $42.00 | 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 |
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2013 SCAN Signature (HMO) | $69.00 | $4,000 | $0 | Many Generics | H5425 -004 -0 | $3.00 | $8.00 | $34.00 | $34.00 | 2,703 2013 Formulary | ||
2014 SCAN Signature (HMO) | $70.00 | $4,000 | $0 | Many Generics | $3.00 | $8.00 | $40.00 | $40.00 | 2,747 2014 Formulary | |||
2013 Health Net Violet (PPO) | $82.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H5439 -001 -0 | $7.00 | $25.00 | $45.00 | $45.00 | 4,263 2013 Formulary | ||
2014 Health Net Violet (PPO) | $92.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $25.00 | $45.00 | $45.00 | 4,195 2014 Formulary | |||
2013 Anthem Medicare Preferred Standard (PPO) | $70.00 | $4,500 | $95 | No additional gap coverage, only the Donut Hole Discount | H8552 -006 -0 | $4.00 | $12.00 | $39.00 | $39.00 | 2,838 2013 Formulary | ||
2014 Anthem Medicare Preferred Standard (PPO) | $106.00 | $4,500 | $173 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $16.00 | $36.00 | $36.00 | 2,880 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 Health Net Seniority Plus Ruby Plan 2 (HMO) | $69.00 | $5,000 | $0 | Many Generics | H0562 -040 -0 | $5.00 | $15.00 | $45.00 | $45.00 | 4,263 2013 Formulary | ||
2014 Health Net Seniority Plus Ruby (HMO) | $129.00 | $5,000 | $0 | Many Generics, Few Brands | $5.00 | $15.00 | $45.00 | $45.00 | 4,187 2014 Formulary | |||
2013 Health Net Seniority Plus Ruby (HMO) | $182.00 | $5,000 | $0 | No additional gap coverage, only the Donut Hole Discount | H0562 -017 -0 | $3.00 | $10.00 | $45.00 | $45.00 | 4,263 2013 Formulary | ||
-- Members will be assigned to Health Net Seniority Plus Ruby (HMO) H0562-0098 -- | ||||||||||||
2013 Blue Cross Senior Secure Plan I (HMO) | $0.00 | $4,000 | $0 | Many Generics | H0564 -047 -0 | $7.00 | $15.00 | $45.00 | $45.00 | 4,173 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 Easy Choice Best Plan (HMO) | $0.00 | $6,700 | $0 | Many Generics | H5087 -005 -0 | $0.00 | $10.00 | $40.00 | $40.00 | 3,458 2013 Formulary | ||
-- | ||||||||||||
-- This plan not offered in 2014 -- |
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2013 Freedom VIP Care (HMO SNP) | $0.00 | n/a | $0 | Many Generics | H5087 -007 -0 | $0.00 | $10.00 | $40.00 | $40.00 | 3,458 2013 Formulary | ||
-- | ||||||||||||
-- This plan not offered in 2014 -- |
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2013 Freedom VIP Care COPD (HMO SNP) | $0.00 | n/a | $0 | Many Generics | H5087 -008 -0 | $0.00 | $10.00 | $40.00 | $40.00 | 3,458 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 Kaiser Permanente Senior Advantage B Only South (HMO) | $0.00 | n/a | $0 | n/a | H0524 -002 -0 | $5.00 | $8.00 | $45.00 | $45.00 | 5,250 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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