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 Choice Essential (Regional PPO) | $0.00 | $3,500 | No Rx Coverage | R5287 -002 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 AARP MedicareComplete Choice Essential (Regional PPO) | $0.00 | $6,700 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 AARP MedicareComplete Choice Plan 2 (Regional PPO) | $0.00 | $4,900 | $0 | No additional gap coverage, only the Donut Hole Discount | R5287 -001 -0 | $0.00 | $6.00 | $45.00 | $45.00 | 3,825 2013 Formulary | ||
2014 AARP MedicareComplete Choice Plan 2 (Regional PPO) | $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 AARP MedicareComplete Plus (HMO-POS) | $0.00 | $4,500 | $0 | No additional gap coverage, only the Donut Hole Discount | H9011 -019 -0 | $0.00 | $0.00 | $30.00 | $30.00 | 3,825 2013 Formulary | ||
2014 AARP MedicareComplete Plus (HMO-POS) | $0.00 | $5,500 | $0 | Few Generics | $0.00 | $0.00 | $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 Aetna Medicare Value Plan (HMO) | $0.00 | $3,600 | $0 | No additional gap coverage, only the Donut Hole Discount | H5414 -019 -0 | $7.00 | $33.00 | $45.00 | $45.00 | 3,323 2013 Formulary | ||
2014 Aetna Medicare Value Plan (HMO) | $0.00 | $6,700 | $0 | Few Generics | $10.00 | $45.00 | $95.00 | $95.00 | 3,134 2014 Formulary | |||
2013 Amerivantage Classic+ Rx Plan (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H8991 -028 -0 | $2.00 | $4.00 | $35.00 | $35.00 | 2,941 2013 Formulary | ||
2014 Amerivantage Classic+ Rx Plan (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $45.00 | $45.00 | 2,885 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H1016 -021 -0 | |||||||||||
2014 AvMed Medicare Choice (HMO) | $0.00 | $5,000 | $0 | Many Generics | $0.00 | $4.00 | $35.00 | $35.00 | 3,599 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 BlueMedicare HMO (HMO) | $0.00 | $5,000 | $0 | All Generics | H1026 -040 -0 | $0.00 | $0.00 | $45.00 | $45.00 | 3,729 2013 Formulary | ||
2014 BlueMedicare HMO LifeTime (HMO) | $0.00 | $4,900 | $0 | Many Generics | $0.00 | $0.00 | $35.00 | $35.00 | 3,663 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H1026 -054 -0 | |||||||||||
2014 BlueMedicare HMO PrimeTime (HMO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $5.00 | $40.00 | $40.00 | 3,663 2014 Formulary | |||
2013 BlueMedicare Regional PPO (Regional PPO) | $0.00 | $5,900 | $0 | No additional gap coverage, only the Donut Hole Discount | R3332 -001 -0 | $6.00 | $10.00 | $45.00 | $45.00 | 3,729 2013 Formulary | ||
2014 BlueMedicare Regional PPO (Regional PPO) | $0.00 | $6,700 | $30 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $33.00 | $45.00 | $45.00 | 3,663 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 CareDirect (HMO SNP) | $0.00 | n/a | $0 | Many Generics, Few Brands |
H1019 -032 -0 | $0.00 | $0.00 | $10.00 | $10.00 | 5,233 2013 Formulary | ||
2014 CareDirect (HMO SNP) | $0.00 | n/a | $0 | Some Generics, Few Brands | $0.00 | $0.00 | $20.00 | $20.00 | 3,696 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H1019 -068 -0 | |||||||||||
2014 CareFree PLUS (HMO) | $0.00 | $5,000 | $0 | Few Generics, Few Brands | $0.00 | $10.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 CareHeart (HMO SNP) | $0.00 | n/a | $0 | Many Generics, Few Brands |
H1019 -062 -0 | $0.00 | $0.00 | $10.00 | $10.00 | 5,233 2013 Formulary | ||
2014 CareHeart (HMO SNP) | $0.00 | n/a | $0 | Some Generics, Few Brands | $0.00 | $0.00 | $20.00 | $20.00 | 3,696 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 CareOne (HMO) | $0.00 | $5,000 | $0 | Many Generics, Few Brands |
H1019 -001 -0 | $0.00 | $0.00 | $7.00 | $7.00 | 5,233 2013 Formulary | ||
2014 CareOne (HMO) | $0.00 | $3,400 | $0 | Some Generics, Few Brands | $0.00 | $0.00 | $20.00 | $20.00 | 3,696 2014 Formulary | |||
2013 Clear Skies (HMO SNP) | $0.00 | n/a | $0 | All Generics | H4199 -015 -0 | $0.00 | $10.00 | $40.00 | $40.00 | 2,887 2013 Formulary | ||
-- | ||||||||||||
2014 Clear Skies (HMO SNP) | $0.00 | n/a | $0 | All Generics | $0.00 | $10.00 | $40.00 | $40.00 | 2,918 2014 Formulary | |||
2013 Coventry Summit Ideal (HMO-POS) | $0.00 | $3,000 | $0 | Many Generics | H5850 -003 -0 | $0.00 | $10.00 | $40.00 | $40.00 | 3,282 2013 Formulary | ||
2014 Coventry Summit Ideal (HMO) | $0.00 | $5,300 | $0 | Many Generics | $0.00 | $15.00 | $45.00 | $45.00 | 3,228 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 Coventry Vista Ideal (HMO) | $0.00 | $6,700 | $0 | Many Generics | H1013 -021 -0 | $0.00 | $30.00 | $75.00 | $75.00 | 3,282 2013 Formulary | ||
2014 Coventry Vista Ideal (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $35.00 | $75.00 | $75.00 | 3,228 2014 Formulary | |||
2013 Day Break (HMO) | $68.00 | $3,400 | $0 | All Generics | H4199 -013 -0 | $0.00 | $20.00 | $60.00 | $60.00 | 2,887 2013 Formulary | ||
-- | ||||||||||||
2014 Day Break (HMO) | $0.00 | $3,400 | $0 | All Generics | $0.00 | $20.00 | $60.00 | $60.00 | 2,918 2014 Formulary | |||
2013 Day Light (HMO) | $0.00 | $3,400 | No Rx Coverage | H4199 -014 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- | ||||||||||||
2014 Day Light (HMO) | $0.00 | $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 |
||||||
2013 Freedom Medicare Plan Rx (HMO) | $0.00 | $3,400 | $0 | Many Generics | H5427 -060 -0 | $0.00 | $20.00 | $60.00 | $60.00 | 2,768 2013 Formulary | ||
2014 Freedom Medicare Plan Rx (HMO) | $0.00 | $3,400 | $0 | Many Generics | $0.00 | $30.00 | $80.00 | $80.00 | 2,770 2014 Formulary | |||
2013 Freedom VIP Savings (HMO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H5427 -082 -0 | $0.00 | $20.00 | $60.00 | $60.00 | 2,768 2013 Formulary | ||
2014 Freedom VIP Savings (HMO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $30.00 | $80.00 | $80.00 | 2,770 2014 Formulary | |||
2013 Freedom VIP Savings COPD (HMO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H5427 -083 -0 | $0.00 | $20.00 | $60.00 | $60.00 | 2,768 2013 Formulary | ||
2014 Freedom VIP Savings COPD (HMO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $30.00 | $80.00 | $80.00 | 2,770 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 |
||||||
-- This plan not offered in 2013 -- |
H5431 -009 -0 | |||||||||||
-- | -- | |||||||||||
2014 Healthy Advantage Plan (HMO) | $0.00 | $3,400 | $0 | Many Generics | $0.00 | $0.00 | 25% | 25% | 3,003 2014 Formulary | |||
2013 Humana Gold Plus H1036-053A (HMO) | $0.00 | $5,000 | No Rx Coverage | H1036 -053 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Humana Gold Plus H1036-053A (HMO) | $0.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Humana Gold Plus H1036-065C (HMO) | $0.00 | $5,000 | $0 | Many Generics, Few Brands |
H1036 -065 -0 | $0.00 | $0.00 | $7.00 | $7.00 | 5,233 2013 Formulary | ||
2014 Humana Gold Plus H1036-065C (HMO) | $0.00 | $3,400 | $0 | Some Generics, Few Brands | $0.00 | $0.00 | $20.00 | $20.00 | 3,696 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 |
||||||
-- This plan not offered in 2013 -- |
H1036 -224 -0 | |||||||||||
2014 Humana Gold Plus H1036-224 (HMO) | $0.00 | $6,700 | $0 | Few Generics, Few Brands | $0.00 | $10.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 Humana Gold Plus SNP-CVD/CHF H1036-186 (HMO SNP) | $0.00 | n/a | $0 | Many Generics, Few Brands |
H1036 -186 -0 | $0.00 | $0.00 | $10.00 | $10.00 | 5,233 2013 Formulary | ||
2014 Humana Gold Plus SNP-CVD/CHF H1036-186 (HMO SNP) | $0.00 | n/a | $0 | Some Generics, Few Brands | $0.00 | $0.00 | $20.00 | $20.00 | 3,696 2014 Formulary | |||
2013 Humana Gold Plus SNP-DB H1036-121C (HMO SNP) | $0.00 | n/a | $0 | Many Generics, Few Brands |
H1036 -121 -0 | $0.00 | $0.00 | $10.00 | $10.00 | 5,233 2013 Formulary | ||
2014 Humana Gold Plus SNP-DB H1036-121C (HMO SNP) | $0.00 | n/a | $0 | Some Generics, Few Brands | $0.00 | $0.00 | $20.00 | $20.00 | 3,696 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 R5826-018 (Regional PPO) | $0.00 | $4,000 | No Rx Coverage | R5826 -018 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 HumanaChoice R5826-018 (Regional PPO) | $0.00 | $4,000 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Humana Reader's Digest Healthy Living Plan (Regional PPO) | $0.00 | $4,950 | $0 | Few Generics, Few Brands |
R5826 -074 -0 | $6.00 | $15.00 | $45.00 | $45.00 | 3,906 2013 Formulary | ||
2014 HumanaChoice R5826-074 (Regional PPO) | $0.00 | $5,900 | $150 | Few Generics, Few Brands | $6.00 | $15.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 Medica HealthCare Plans MedicareMax (HMO) | $0.00 | $3,400 | $0 | Many Generics | H5420 -003 -0 | $0.00 | $30.00 | $50.00 | $50.00 | 4,137 2013 Formulary | ||
2014 Medica HealthCare Plans MedicareMax (HMO) | $0.00 | $4,500 | $0 | Many Generics | $0.00 | $30.00 | $89.00 | $89.00 | 3,596 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 Optimum Gold Rewards Plan (HMO-POS) | $0.00 | $3,400 | $0 | Many Generics | H5594 -001 -0 | $0.00 | $20.00 | $69.00 | $69.00 | 2,768 2013 Formulary | ||
2014 Optimum Gold Rewards Plan (HMO-POS) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $30.00 | $80.00 | $80.00 | 2,770 2014 Formulary | |||
2013 Optimum Platinum Plan (HMO-POS) | $0.00 | $3,400 | $0 | Many Generics | H5594 -002 -0 | $0.00 | $5.00 | $60.00 | $60.00 | 2,768 2013 Formulary | ||
2014 Optimum Platinum Plan (HMO-POS) | $0.00 | $3,400 | $0 | Many Generics | $0.00 | $5.00 | $69.00 | $69.00 | 2,770 2014 Formulary | |||
2013 Positive Healthcare Partners (HMO SNP) | $0.00 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H3132 -001 -0 | 25% | 25% | 25% | 2,532 2013 Formulary | |||
-- | ||||||||||||
2014 PHP (HMO SNP) | $0.00 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 2,474 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 Preferred Choice Broward (HMO) | $0.00 | $3,400 | $0 | Many Generics, Few Brands |
H1045 -005 -0 | $0.00 | $15.00 | $30.00 | $30.00 | 2,742 2013 Formulary | ||
-- | ||||||||||||
2014 Preferred Choice Broward (HMO) | $0.00 | $3,400 | $0 | Many Generics | $0.00 | $20.00 | $40.00 | $40.00 | 3,596 2014 Formulary | |||
2013 PUP EASY (HMO) | $0.00 | $3,400 | $0 | Many Generics | H5696 -041 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,542 2013 Formulary | ||
2014 PUP EASY (HMO) | $0.00 | $3,400 | $0 | Many Generics | $0.00 | $10.00 | $45.00 | $45.00 | 3,267 2014 Formulary | |||
2013 PUP REWARDS (HMO) | $0.00 | $4,600 | $0 | No additional gap coverage, only the Donut Hole Discount | H5696 -028 -0 | $0.00 | $15.00 | $90.00 | $90.00 | 3,542 2013 Formulary | ||
2014 PUP REWARDS (HMO) | $0.00 | $4,600 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $90.00 | $90.00 | 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 |
||||||
-- This plan not offered in 2013 -- |
H5471 -025 -0 | |||||||||||
-- | ||||||||||||
2014 Simply Clear (HMO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,786 2014 Formulary | |||
2013 Simply Extra (HMO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H5471 -016 -0 | $0.00 | $0.00 | $45.00 | $45.00 | 3,401 2013 Formulary | ||
-- | ||||||||||||
2014 Simply Extra (HMO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $45.00 | $45.00 | 3,561 2014 Formulary | |||
2013 Simply Level (HMO SNP) | $0.00 | n/a | $0 | Many Generics | H5471 -019 -0 | $0.00 | $0.00 | $5.00 | $5.00 | 3,401 2013 Formulary | ||
-- | ||||||||||||
2014 Simply Level (HMO SNP) | $0.00 | n/a | $0 | Many Generics, Few Brands | $0.00 | $0.00 | $5.00 | $5.00 | 3,561 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 Simply More (HMO) | $0.00 | $3,400 | $0 | Many Generics | H5471 -014 -0 | $0.00 | $0.00 | $5.00 | $5.00 | 3,401 2013 Formulary | ||
-- | ||||||||||||
2014 Simply More (HMO) | $0.00 | $3,400 | $0 | Many Generics | $0.00 | $0.00 | $5.00 | $5.00 | 3,561 2014 Formulary | |||
2013 Simply Options (HMO-POS) | $0.00 | $3,400 | $0 | Many Generics | H5471 -015 -0 | $0.00 | $0.00 | $20.00 | $20.00 | 3,401 2013 Formulary | ||
-- | ||||||||||||
2014 Simply Options (HMO-POS) | $0.00 | $3,400 | $0 | Many Generics | $0.00 | $0.00 | $20.00 | $20.00 | 3,561 2014 Formulary | |||
2013 SunPlus Advantage Plan (HMO) | $0.00 | $3,400 | $0 | All Generics, All Brands |
H5431 -002 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,026 2013 Formulary | ||
-- | -- | |||||||||||
2014 SunPlus Advantage Plan (HMO) | $0.00 | $3,400 | $0 | All Generics, All Brands | $0.00 | $0.00 | $0.00 | $0.00 | 3,003 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 SunPlus Diabetes Special Needs Plan (HMO SNP) | $0.00 | n/a | $0 | All Generics, All Brands |
H5431 -008 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,026 2013 Formulary | ||
-- | -- | |||||||||||
2014 SunPlus Diabetes Special Needs Plan (HMO SNP) | $0.00 | n/a | $0 | All Generics, All Brands | $0.00 | $0.00 | $0.00 | $0.00 | 3,003 2014 Formulary | |||
2013 Sunrise (HMO) | $0.00 | $3,400 | $0 | All Generics | H4199 -012 -0 | $0.00 | $10.00 | $40.00 | $40.00 | 2,887 2013 Formulary | ||
-- | ||||||||||||
2014 Sunrise (HMO) | $0.00 | $3,400 | $0 | All Generics | $0.00 | $10.00 | $40.00 | $40.00 | 2,918 2014 Formulary | |||
2013 WellCare Advance (HMO) | $0.00 | $3,400 | No Rx Coverage | H1032 -037 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 WellCare Advance (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 |
||||||
2013 WellCare Dividend (HMO) | $0.00 | $5,500 | $0 | All Generics | H1032 -179 -0 | $3.00 | $39.00 | $75.00 | $75.00 | 2,835 2013 Formulary | ||
2014 WellCare Dividend (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $10.00 | $35.00 | $35.00 | 2,844 2014 Formulary | |||
2013 WellCare Essential (HMO) | $0.00 | $3,400 | $0 | All Generics | H1032 -133 -0 | $0.00 | $39.00 | $79.00 | $79.00 | 2,835 2013 Formulary | ||
2014 WellCare Essential (HMO-POS) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $35.00 | $35.00 | 2,844 2014 Formulary | |||
2013 WellCare Value (HMO-POS) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H1032 -073 -0 | $0.00 | $30.00 | $79.00 | $79.00 | 2,835 2013 Formulary | ||
2014 WellCare Value (HMO) | $0.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $35.00 | $35.00 | 2,844 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 Plus SNP-I H1036-185 (HMO SNP) | $20.10 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H1036 -185 -0 | $0.00 | $0.00 | $45.00 | $45.00 | 5,233 2013 Formulary | ||
2014 Humana Gold Plus SNP-I H1036-185 (HMO SNP) | $7.70 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $45.00 | $45.00 | 3,696 2014 Formulary | |||
2013 Humana Gold Plus SNP-DE H1036-103A (HMO SNP) | $12.20 | n/a | $325 | n/a | H1036 -103 -0 | $0.00 | $0.00 | $45.00 | $45.00 | 5,233 2013 Formulary | ||
2014 Humana Gold Plus SNP-DE H1036-103A (HMO SNP) | $8.00 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $45.00 | $45.00 | 3,696 2014 Formulary | |||
2013 WellCare Liberty (HMO SNP) | $8.70 | n/a | $325 | n/a | H1032 -124 -0 | $0.00 | $45.00 | $95.00 | $95.00 | 2,835 2013 Formulary | ||
2014 WellCare Liberty (HMO SNP) | $9.40 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $4.00 | $35.00 | $35.00 | 2,844 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 PUP EXTRA (HMO SNP) | $4.90 | n/a | $0 | n/a | H5696 -021 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,542 2013 Formulary | ||
2014 PUP EXTRA (HMO SNP) | $9.90 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 3,267 2014 Formulary | |||
2013 WellCare Access (HMO SNP) | $12.10 | n/a | $325 | n/a | H1032 -175 -0 | $0.00 | $45.00 | $95.00 | $95.00 | 2,835 2013 Formulary | ||
2014 WellCare Access (HMO SNP) | $10.40 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $7.00 | $35.00 | $35.00 | 2,844 2014 Formulary | |||
2013 Humana Gold Plus SNP-DE H1036-162 (HMO SNP) | $20.60 | n/a | $325 | n/a | H1036 -162 -0 | $0.00 | $0.00 | $45.00 | $45.00 | 5,233 2013 Formulary | ||
2014 Humana Gold Plus SNP-DE H1036-162 (HMO SNP) | $10.50 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $45.00 | $45.00 | 3,696 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 WellCare Select (HMO-POS SNP) | $8.50 | n/a | $325 | n/a | H1032 -061 -0 | $0.00 | $45.00 | $95.00 | $95.00 | 2,835 2013 Formulary | ||
2014 WellCare Select (HMO SNP) | $11.60 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $4.00 | $35.00 | $35.00 | 2,844 2014 Formulary | |||
2013 CareNeeds PLUS (HMO SNP) | $23.20 | n/a | $325 | n/a | H1019 -047 -0 | $0.00 | $0.00 | $45.00 | $45.00 | 5,233 2013 Formulary | ||
2014 CareNeeds PLUS (HMO SNP) | $11.70 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $45.00 | $45.00 | 3,696 2014 Formulary | |||
2013 CareNeeds (HMO SNP) | $24.80 | n/a | $325 | n/a | H1019 -023 -0 | $0.00 | $0.00 | $45.00 | $45.00 | 5,233 2013 Formulary | ||
2014 CareNeeds (HMO SNP) | $17.00 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $45.00 | $45.00 | 3,696 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 Coventry Summit Maximum (HMO SNP) | $18.20 | n/a | $0 | n/a | H5850 -002 -0 | $0.00 | $40.00 | $76.00 | $76.00 | 3,282 2013 Formulary | ||
2014 Coventry Summit Maximum (HMO SNP) | $18.90 | n/a | $0 | Many Generics | $0.00 | $45.00 | $76.00 | $76.00 | 3,228 2014 Formulary | |||
2013 UnitedHealthcare Nursing Home Plan (PPO SNP) | $23.80 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H5417 -001 -0 | 25% | 25% | 25% | 25% | 3,825 2013 Formulary | ||
-- | ||||||||||||
2014 UnitedHealthcare Nursing Home Plan (PPO SNP) | $19.80 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,604 2014 Formulary | |||
2013 Medica HealthCare Plans MedicareMax Plus (HMO SNP) | $23.40 | n/a | $325 | n/a | H5420 -006 -0 | $0.00 | 25% | 35% | 35% | 4,137 2013 Formulary | ||
2014 Medica HealthCare Plans MedicareMax Plus (HMO-POS SNP) | $20.60 | n/a | $0 | Many Generics | $0.00 | 25% | 25% | 25% | 3,596 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 |
||||||
-- This plan not offered in 2013 -- |
H5190 -003 -0 | |||||||||||
-- | -- | -- | ||||||||||
2014 Advantage by Sunshine Health (HMO SNP) | $21.00 | n/a | $310 | Many Generics | $0.00 | $45.00 | $95.00 | $95.00 | 2,966 2014 Formulary | |||
2013 Preferred Medicare Assist (HMO-POS SNP) | $4.50 | n/a | $0 | n/a | H1045 -012 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 2,742 2013 Formulary | ||
-- | ||||||||||||
2014 Preferred Medicare Assist (HMO-POS SNP) | $21.20 | n/a | $0 | Many Generics | $0.00 | $0.00 | 25% | 25% | 3,596 2014 Formulary | |||
-- This plan not offered in 2013 -- |
R5287 -003 -0 | |||||||||||
2014 UnitedHealthcare Dual Complete RP (Regional PPO SNP) | $21.80 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 15% | 15% | 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 Molina Medicare Options Plus (HMO SNP) | $18.70 | n/a | $325 | n/a | H8130 -001 -0 | $0.00 | $0.00 | $95.00 | $95.00 | 2,941 2013 Formulary | ||
-- | ||||||||||||
2014 Molina Medicare Options Plus (HMO SNP) | $22.00 | n/a | $310 | Many Generics, Few Brands | $0.00 | $0.00 | $95.00 | $95.00 | 2,885 2014 Formulary | |||
2013 Amerivantage Specialty + Rx (HMO SNP) | $24.70 | n/a | $325 | Some Generics | H8991 -017 -0 | $0.00 | 25% | 25% | 25% | 2,941 2013 Formulary | ||
2014 Amerivantage Specialty + Rx (HMO SNP) | $22.10 | n/a | $310 | Some Generics | $0.00 | 25% | 25% | 25% | 2,885 2014 Formulary | |||
2013 Coventry Vista Maximum Choice (HMO SNP) | $25.50 | n/a | $0 | n/a | H1076 -011 -0 | $0.00 | $45.00 | $76.00 | $76.00 | 3,282 2013 Formulary | ||
2014 Coventry Vista Maximum Choice (HMO SNP) | $22.10 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $45.00 | $76.00 | $76.00 | 3,228 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 Freedom Medi-Medi Full (HMO SNP) | $23.10 | n/a | $325 | n/a | H5427 -087 -0 | 25% | 2,764 2013 Formulary | |||||
2014 Freedom Medi-Medi Full (HMO SNP) | $22.10 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 0% | 2,770 2014 Formulary | ||||||
2013 Freedom Medi-Medi Partial (HMO SNP) | $24.70 | n/a | $325 | n/a | H5427 -078 -0 | 25% | 2,764 2013 Formulary | |||||
2014 Freedom Medi-Medi Partial (HMO SNP) | $22.10 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 2,770 2014 Formulary | ||||||
2013 MediMax (HMO) | $24.70 | $3,400 | $325 | No additional gap coverage, only the Donut Hole Discount | H5431 -006 -0 | 25% | 25% | 25% | 25% | 3,026 2013 Formulary | ||
-- | -- | |||||||||||
2014 MediMax (HMO) | $22.10 | $3,400 | $310 | Call plan for details | 25% | 25% | 25% | 25% | 3,003 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 Optimum Emerald Full (HMO SNP) | $24.80 | n/a | $325 | n/a | H5594 -017 -0 | 25% | 2,764 2013 Formulary | |||||
2014 Optimum Emerald Full (HMO SNP) | $22.10 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 0% | 2,770 2014 Formulary | ||||||
2013 Optimum Emerald Partial (HMO SNP) | $24.80 | n/a | $325 | n/a | H5594 -016 -0 | 25% | 2,764 2013 Formulary | |||||
2014 Optimum Emerald Partial (HMO SNP) | $22.10 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 15% | 2,770 2014 Formulary | ||||||
2013 Simply Care (HMO SNP) | $24.80 | n/a | $0 | Many Generics | H5471 -017 -0 | $0.00 | $0.00 | $10.00 | $10.00 | 3,401 2013 Formulary | ||
-- | ||||||||||||
2014 Simply Care (HMO SNP) | $22.10 | n/a | $0 | Many Generics | $0.00 | $0.00 | $10.00 | $10.00 | 3,561 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 Simply Comfort (HMO SNP) | $24.80 | n/a | $0 | Many Generics | H5471 -018 -0 | $0.00 | $0.00 | $10.00 | $10.00 | 3,401 2013 Formulary | ||
-- | ||||||||||||
2014 Simply Comfort (HMO SNP) | $22.10 | n/a | $0 | Many Generics | $0.00 | $0.00 | $10.00 | $10.00 | 3,561 2014 Formulary | |||
2013 Simply Complete (HMO SNP) | $24.80 | n/a | $0 | n/a | H5471 -013 -0 | $0.00 | $0.00 | $45.00 | $45.00 | 3,401 2013 Formulary | ||
-- | ||||||||||||
2014 Simply Complete (HMO SNP) | $22.10 | n/a | $310 | Many Generics | $0.00 | $0.00 | $45.00 | $45.00 | 3,561 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H8991 -029 -0 | |||||||||||
2014 Touch Institutional Special Needs Plan (HMO SNP) | $22.10 | n/a | $310 | Some Generics | $0.00 | 25% | 25% | 25% | 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 Sunny Days (HMO SNP) | $4.90 | n/a | $325 | n/a | H4199 -016 -0 | 25% | 25% | 25% | 25% | 2,887 2013 Formulary | ||
-- | ||||||||||||
2014 Sunny Days (HMO SNP) | $33.90 | n/a | $0 | All Generics | $0.00 | 25% | 25% | 25% | 2,918 2014 Formulary | |||
2013 Aetna Medicare Premier Plan (PPO) | $33.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H5521 -033 -0 | $7.00 | $33.00 | $45.00 | $45.00 | 3,323 2013 Formulary | ||
-- | ||||||||||||
2014 Aetna Medicare Premier Plan (PPO) | $35.00 | $6,700 | $310 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $45.00 | $95.00 | $95.00 | 3,134 2014 Formulary | |||
2013 HumanaChoice H5415-056 (PPO) | $42.00 | $5,000 | $0 | Few Generics, Few Brands |
H5415 -056 -0 | $6.00 | $43.00 | $80.00 | $80.00 | 3,906 2013 Formulary | ||
2014 HumanaChoice H5415-056 (PPO) | $45.00 | $5,000 | $0 | Few Generics, Few Brands | $5.00 | $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 |
||||||
2013 HumanaChoice R5826-005 (Regional PPO) | $85.00 | $4,750 | $0 | Few Generics, Few Brands |
R5826 -005 -0 | $3.00 | $8.00 | $40.00 | $40.00 | 3,906 2013 Formulary | ||
2014 HumanaChoice R5826-005 (Regional PPO) | $92.00 | $5,700 | $0 | Few Generics, Few Brands | $3.00 | $8.00 | $40.00 | $40.00 | 3,711 2014 Formulary | |||
2013 Humana Gold Choice H8145-061 (PFFS) | $102.00 | n/a | $0 | Few Generics, Few Brands |
H8145 -061 -0 | $6.00 | $15.00 | $45.00 | $45.00 | 3,906 2013 Formulary | ||
2014 Humana Gold Choice H8145-061 (PFFS) | $103.00 | n/a | $0 | Few Generics, Few Brands | $6.00 | $15.00 | $45.00 | $45.00 | 3,711 2014 Formulary | |||
2013 BlueMedicare PPO (PPO) | $152.00 | $6,700 | $0 | No additional gap coverage, only the Donut Hole Discount | H5434 -002 -0 | $10.00 | $17.00 | $45.00 | $45.00 | 3,729 2013 Formulary | ||
2014 BlueMedicare PPO (PPO) | $127.00 | $3,200 | $0 | Many Generics | $2.00 | $5.00 | $30.00 | $30.00 | 3,663 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 AARP MedicareComplete Plan 1 (HMO) | $0.00 | $3,400 | $0 | Some Generics | H9011 -018 -0 | $0.00 | $0.00 | $30.00 | $30.00 | 3,825 2013 Formulary | ||
-- Members will be assigned to AARP MedicareComplete Plus (HMO-POS) H9011-0019 -- | ||||||||||||
2013 CareFree (HMO) | $0.00 | $5,000 | $0 | Few Generics, Few Brands |
H1019 -004 -0 | $0.00 | $0.00 | $20.00 | $20.00 | 5,233 2013 Formulary | ||
-- Members will be assigned to CareOne (HMO) H1019-001 -- | ||||||||||||
2013 HumanaChoice H5415-068 (PPO) | $152.00 | $3,400 | $0 | Few Generics, Few Brands |
H5415 -068 -0 | $7.00 | $40.00 | $80.00 | $80.00 | 3,906 2013 Formulary | ||
-- Members will be assigned to HumanaChoice H5415-056 (PPO) H5415-0056 -- | ||||||||||||
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 Medica HealthCare Plans MedicareMax Value RX (HMO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H5420 -009 -0 | $0.00 | $25.00 | $40.00 | $40.00 | 4,137 2013 Formulary | ||
-- Members will be assigned to Medica HealthCare Plans MedicareMax (HMO) H5420-003 -- | ||||||||||||
2013 Coventry Vista Prime (HMO) | $0.00 | $3,400 | $0 | Many Generics | H1076 -003 -0 | $0.00 | $20.00 | $50.00 | $50.00 | 3,282 2013 Formulary | ||
-- This plan not offered in 2014 -- |
||||||||||||
2013 Coventry Vista Value (HMO) | $0.00 | $6,700 | No Rx Coverage | H1076 -010 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- 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 Coventry Summit Plus (HMO) | $0.00 | $6,700 | $0 | Many Generics | H5850 -022 -0 | $0.00 | $35.00 | $70.00 | $70.00 | 3,282 2013 Formulary | ||
-- This plan not offered in 2014 -- |
||||||||||||
2013 Freedom Savings Plan (HMO) | $0.00 | $3,400 | No Rx Coverage | H5427 -052 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- This plan not offered in 2014 -- |
||||||||||||
2013 Freedom Savings Plan Rx (HMO) | $0.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H5427 -054 -0 | $0.00 | $25.00 | $65.00 | $65.00 | 2,768 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 Medica HealthCare Plans MedicareMax Value (HMO) | $0.00 | $3,400 | No Rx Coverage | H5420 -008 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- This plan not offered in 2014 -- |
||||||||||||
2013 Coventry Vista Maximum (HMO SNP) | $24.70 | n/a | $0 | n/a | H1013 -024 -0 | $0.00 | $45.00 | $76.00 | $76.00 | 3,282 2013 Formulary | ||
-- This plan not offered in 2014 -- |
||||||||||||
2013 AvMed Medicare Choice (HMO) | $0.00 | $4,000 | $0 | Many Generics, Few Brands |
H1016 -001 -0 | $0.00 | $0.00 | $25.00 | $25.00 | 4,574 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 Coventry Summit Select (HMO-POS) | $0.00 | $6,700 | $0 | Many Generics | H5850 -024 -0 | $0.00 | $30.00 | $70.00 | $70.00 | 3,282 2013 Formulary | ||
-- This plan not offered in 2014 -- |
||||||||||||
2013 Preferred Select Care (HMO SNP) | $0.00 | n/a | $0 | Many Generics, Few Brands |
H1045 -022 -0 | $0.00 | $20.00 | $60.00 | $60.00 | 2,742 2013 Formulary | ||
-- | ||||||||||||
-- This plan not offered in 2014 -- |
||||||||||||
2013 Preferred Secure Option (HMO) | $0.00 | $6,700 | $0 | Many Generics, Few Brands |
H1045 -023 -0 | $0.00 | $40.00 | $95.00 | $95.00 | 2,742 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 Sunshine State Health Plan (HMO SNP) | $24.00 | n/a | $325 | n/a | H5190 -001 -0 | $0.00 | $45.00 | $95.00 | $95.00 | 3,010 2013 Formulary | ||
-- | -- | -- | ||||||||||
-- This plan not offered in 2014 -- |
||||||||||||
2013 UnitedHealthcare Dual Complete RP (Regional PPO SNP) | $24.80 | n/a | $325 | n/a | R5287 -003 -0 | 25% | 25% | 25% | 25% | 3,825 2013 Formulary | ||
-- This plan not offered in 2014 -- |
||||||||||||
|