2013 / 2014 Medicare Advantage Plan Information Click here to jump to the Chart Legend | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
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 |
||||||
2013 PacificSource Medicare Explorer 6 (PPO) | $0.00 | $2,500 | No Rx Coverage | H4754 -006 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 PacificSource Medicare Explorer 6 (PPO) | $19.00 | $3,000 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 True Blue (HMO) | $30.00 | $3,000 | No Rx Coverage | H1350 -006 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 True Blue (HMO) | $30.00 | $3,000 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Secure Blue (PPO) | $40.00 | $3,400 | No Rx Coverage | H1302 -004 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 Secure Blue (PPO) | $42.00 | $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 PacificSource Medicare Explorer Rx 2 (PPO) | $36.00 | $2,500 | $0 | No additional gap coverage, only the Donut Hole Discount | H4754 -002 -0 | $5.00 | $40.00 | $80.00 | $80.00 | 4,762 2013 Formulary | ||
2014 PacificSource Medicare Explorer Rx 2 (PPO) | $72.00 | $2,500 | $0 | Few Generics | $4.00 | $10.00 | $45.00 | $45.00 | 3,887 2014 Formulary | |||
2013 True Blue Rx Option II (HMO) | $121.00 | $3,000 | $300 | No additional gap coverage, only the Donut Hole Discount | H1350 -010 -0 | $6.00 | $31.00 | $70.00 | $70.00 | 5,002 2013 Formulary | ||
2014 True Blue Rx Option II (HMO) | $74.00 | $3,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $7.00 | $31.00 | $31.00 | 4,779 2014 Formulary | |||
2013 Secure Blue (PPO) | $93.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | H1302 -001 -0 | $8.00 | $43.00 | $93.00 | $93.00 | 5,002 2013 Formulary | ||
2014 Secure Blue Idaho (PPO) | $98.00 | $3,400 | $200 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $7.00 | $43.00 | $43.00 | 4,779 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 True Blue Rx Option I (HMO) | $142.00 | $3,000 | $0 | Many Generics | H1350 -001 -0 | $6.00 | $31.00 | $70.00 | $70.00 | 5,002 2013 Formulary | ||
2014 True Blue Rx Option I (HMO) | $144.00 | $3,000 | $0 | Many Generics, Few Brands | $4.00 | $7.00 | $31.00 | $31.00 | 4,779 2014 Formulary | |||
2013 True Blue Special Needs Plan (HMO SNP) | $176.40 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H1350 -009 -0 | 25% | 25% | 25% | 25% | 5,002 2013 Formulary | ||
2014 True Blue Special Needs Plan (HMO SNP) | $184.70 | n/a | $310 | No additional gap coverage, only the Donut Hole Discount | 0% | 0% | 0% | 0% | 4,779 2014 Formulary | |||
2013 UnitedHealthcare MedicareDirect Essential (PFFS) | $0.00 | n/a | No Rx Coverage | H5435 -001 -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 UnitedHealthcare MedicareDirect Rx (PFFS) | $28.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H5435 -014 -0 | $4.00 | $10.00 | $44.00 | $44.00 | 3,825 2013 Formulary | ||
-- This plan not offered in 2014 -- |
||||||||||||
2013 Today's Options Premier Plus 350A (PFFS) | $144.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H5421 -067 -0 | $2.00 | $7.00 | $40.00 | $40.00 | 4,885 2013 Formulary | ||
-- This plan not offered in 2014 -- |
||||||||||||
2013 Today's Options Premier 600 (PFFS) | $60.00 | n/a | No Rx Coverage | H5421 -049 -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 Today's Options Premier Plus 650H (PFFS) | $87.00 | n/a | $87 | No additional gap coverage, only the Donut Hole Discount | H5421 -073 -0 | $5.00 | $12.00 | $45.00 | $45.00 | 4,885 2013 Formulary | ||
-- This plan not offered in 2014 -- |
||||||||||||
2013 Today's Options Premier 300 (PFFS) | $95.00 | n/a | No Rx Coverage | H5421 -209 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
-- This plan not offered in 2014 -- |
||||||||||||
|