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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-- This plan not offered in 2013 -- |
H0084 -004 -0 | |||||||||||
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 | |||
-- This plan not offered in 2013 -- |
H0084 -001 -0 | |||||||||||
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 | |||
2013 Gold Advantage (HMO) | $0.00 | $2,225 | $0 | No additional gap coverage, only the Donut Hole Discount | H2663 -005 -0 | $3.00 | $30.00 | $65.00 | $65.00 | 3,224 2013 Formulary | ||
2014 Gold Advantage (HMO) | $0.00 | $2,300 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $30.00 | $30.00 | 3,177 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 HumanaChoice R5826-023 (Regional PPO) | $0.00 | $4,500 | No Rx Coverage | R5826 -023 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
2014 HumanaChoice R5826-023 P (Regional PPO) | $0.00 | $4,500 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
2013 Advantra Option 1 (HMO) | $29.00 | $3,350 | $0 | No additional gap coverage, only the Donut Hole Discount | H2663 -006 -0 | $7.00 | $40.00 | $80.00 | $80.00 | 3,224 2013 Formulary | ||
2014 Advantra Option 1 (HMO) | $30.00 | $4,500 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $4.00 | $30.00 | $30.00 | 3,177 2014 Formulary | |||
-- This plan not offered in 2013 -- |
H2611 -001 -0 | |||||||||||
2014 Advantra (PPO) | $36.00 | $3,400 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $4.00 | $30.00 | $30.00 | 3,177 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 Advantra Option 2 (HMO-POS) | $94.00 | $2,675 | $0 | No additional gap coverage, only the Donut Hole Discount | H2663 -002 -0 | $7.00 | $40.00 | $80.00 | $80.00 | 3,224 2013 Formulary | ||
2014 Advantra Option 2 (HMO-POS) | $96.00 | $2,900 | $0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $8.00 | $30.00 | $30.00 | 3,177 2014 Formulary | |||
2013 HumanaChoice R5826-009 (Regional PPO) | $89.00 | $6,700 | $325 | No additional gap coverage, only the Donut Hole Discount | R5826 -009 -0 | 25% | 25% | 25% | 25% | 3,906 2013 Formulary | ||
2014 HumanaChoice R5826-009 P (Regional PPO) | $112.00 | $6,700 | $310 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,711 2014 Formulary | |||
2013 Care Improvement Plus Gold Rx (PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H0084 -007 -0 | $8.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | ||
-- Members will be assigned to Care Improvement Plus Gold Rx (PPO SNP) H0084-004 -- | ||||||||||||
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 Care Improvement Plus Medicare Advantage (PPO) | $0.00 | $5,900 | $0 | No additional gap coverage, only the Donut Hole Discount | H0084 -009 -0 | $10.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | ||
-- Members will be assigned to Care Improvement Plus Medicare Advantage (PPO) H0084-001 -- | ||||||||||||
2013 Care Improvement Plus Silver Rx (PPO SNP) | $30.90 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H0084 -006 -0 | 25% | 25% | 25% | 25% | 3,401 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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2013 Care Improvement Plus Chrome RX (PPO SNP) | $30.90 | n/a | $325 | No additional gap coverage, only the Donut Hole Discount | H0084 -029 -0 | 25% | 25% | 25% | 25% | 3,401 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 |
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2013 Care Improvement Plus Copper RX (PPO SNP) | $0.00 | n/a | $0 | No additional gap coverage, only the Donut Hole Discount | H0084 -030 -0 | $8.00 | $45.00 | $95.00 | $95.00 | 3,401 2013 Formulary | ||
-- This plan not offered in 2014 -- |
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