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Medicare.gov Tutorial

Find a 2013 Medicare Advantage Plan (Health and Health w/Rx Plans)

Not sure where to begin? Just select your state below to get started:
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. . . Or . . . enter your preferences in the MA-Finder chart below and click "Search".

Choose Your Medicare Advantage Plan Preferences

ZIP Code:*
Selected County:*	SANDOVAL, New Mexico
Partial Plan Name:	1:	2:
Other Options:	5-star rated plans Only Plans with MOOP ≤ $3,400 Limit Search to 10 Plans
Maximum Premium:	$	max: $342
Maximum Deductible:	$	max: $325
Type of Health Coverage
Special Needs Plans (SNP) Options:	Only show SNPs -- All Three Types OR Only: Dual-Eligible Chronic Condition Institutional
Max. Co-pay Tier 1 (Generics):	$	Ex: enter 0 to show plans with a $0 Tier 1 Co-pay
Prescription Drug Coverage:
Type of Gap Coverage:
Additional Info:
Sort Results by:
*required Scroll down to see plans meeting your needs.

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2013 PDP-DrugFinder (Formulary Search)

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Archive: 2012 | 2011 | 2010

: : Link to This Chart

There are 28 Medicare Advantage Plans in 2013 meeting your criteria.

Click below to access enrollment options (including online, and telephone).

2013 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips
Plan Name			County	Monthly Prem. (incl. Part C & D)	Deduct- ible	(Donut Hole) Gap Coverage	Plan ID	Preferred Pharmacy Copay/ Coinsurance 30-Day Supply	MOOP for Part A & B Benefits
Cust. Service Rating	Member Plan Exper.	RxCost Info Rating
Amerivantage Classic + Rx (HMO)			Sandoval	$0.00	$325	Some Generics	H5746 -012	Preferred Generic: $0.00 Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25%	$6,700 Browse Formulary

Blue Medicare Advantage (HMO)			Sandoval	$0.00	$325	No Gap Coverage	H3822 -002	Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%	$3,000 Browse Formulary
new	new	new
Care Improvement Plus Copper RX (PPO SNP)			Sandoval	$0.00	$0	No Gap Coverage	H0084 -066	Generic: $4.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33%	tbd Browse Formulary

Care Improvement Plus Gold Rx (PPO SNP)			Sandoval	$0.00	$0	No Gap Coverage	H0084 -065	Generic: $4.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33%	tbd Browse Formulary

Care Improvement Plus Medicare Advantage (PPO)			Sandoval	$0.00	$0	No Gap Coverage	H0084 -064	Generic: $4.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33%	$3,500 Browse Formulary

Plan Name			County	Monthly Prem.	Deduct- ible	Gap Coverage	Plan ID	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Service	Exper.	CostInfo
Humana Gold Plus H3028-001 (HMO)			Sandoval	$0.00	$0	Few Generics and Few Brands	H3028 -001	Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $70.00 Specialty Tier: 33%	$3,900 Browse Formulary

HumanaChoice H6411-008 (PPO)			Sandoval	$0.00	No Rx Coverage		H6411 -008	This Plan does NOT include Prescription Drug coverage.	$3,400

Lovelace Medicare Plan $0 (HMO)			Sandoval	$0.00	$0	Many Generics	H3251 -002	Preferred Generic: $0.00 Non-Preferred Generic: $4.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: Lesser of $350 or : 33%	$2,500 Browse Formulary

Lovelace Medicare Plan Deluxe (HMO)			Sandoval	$0.00	$325	No Gap Coverage	H3251 -027	Preferred Generic: $0.00 Non-Preferred Generic: $6.50 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%	$6,700 Browse Formulary

Lovelace Medicare Plan Plus (HMO)			Sandoval	$0.00	$0	Many Generics	H3251 -026	Preferred Generic: $0.00 Non-Preferred Generic: $4.00 Preferred Brand: $36.00 Non-Preferred Brand: $75.00 Specialty Tier: 33%	$3,400 Browse Formulary

Presbyterian Senior Care Plan 1 (HMO)			Sandoval	$0.00	No Rx Coverage		H3204 -008	This Plan does NOT include Prescription Drug coverage.	$2,500

Plan Name			County	Monthly Prem.	Deduct- ible	Gap Coverage	Plan ID	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Service	Exper.	CostInfo
Presbyterian Senior Care Plan 2 with Rx (HMO)			Sandoval	$0.00	$0	No Gap Coverage	H3204 -001	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33%	$3,000 Browse Formulary

UnitedHealthcare Dual Complete (PPO SNP)			Sandoval	$21.70	$325	No Gap Coverage	H3209 -002	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25%	tbd Browse Formulary

Amerivantage Specialty + Rx (HMO SNP)			Sandoval	$22.50	$325	Many Generics and Few Brands	H5746 -006	Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25%	tbd Browse Formulary

Care Improvement Plus Chrome RX (PPO SNP)			Sandoval	$22.50	$325	No Gap Coverage	H0084 -036	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	tbd Browse Formulary

Care Improvement Plus Dual Advantage (PPO SNP)			Sandoval	$22.50	$325	No Gap Coverage	H0084 -035	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	tbd Browse Formulary

Care Improvement Plus Silver Rx (PPO SNP)			Sandoval	$22.50	$325	No Gap Coverage	H0084 -018	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	tbd Browse Formulary

Plan Name			County	Monthly Prem.	Deduct- ible	Gap Coverage	Plan ID	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Service	Exper.	CostInfo
Molina Medicare Options Plus (HMO SNP)			Sandoval	$22.50	$325	No Gap Coverage	H9082 -007	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	tbd Browse Formulary

HumanaChoice H6411-007 (PPO)			Sandoval	$23.00	$0	Few Generics and Few Brands	H6411 -007	Preferred Generic: $6.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $75.00 Specialty Tier: 33%	$5,000 Browse Formulary

Molina Medicare Options (HMO)			Sandoval	$40.00	$0	No Gap Coverage	H9082 -002	Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $60.00 Specialty Tier: 33%	$2,800 Browse Formulary

Humana Gold Choice H8145-078 (PFFS)			Sandoval	$46.00	$0	Few Generics and Few Brands	H8145 -078	Preferred Generic: $7.00 Non-Preferred Generic: $12.00 Preferred Brand: $42.00 Non-Preferred Brand: $83.00 Specialty Tier: 33%	$0 Browse Formulary

Presbyterian MediCare PPO Plan 1 (PPO)			Sandoval	$52.00	No Rx Coverage		H3206 -003	This Plan does NOT include Prescription Drug coverage.	$3,000

Lovelace Medicare Plan Enhanced (HMO-POS)			Sandoval	$55.90	$0	Many Generics	H3251 -021	Preferred Generic: $0.00 Non-Preferred Generic: $7.00 Preferred Brand: $36.00 Non-Preferred Brand: $70.00 Specialty Tier: Lesser of $350 or : 33%	$3,350 Browse Formulary

Plan Name			County	Monthly Prem.	Deduct- ible	Gap Coverage	Plan ID	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Service	Exper.	CostInfo
Presbyterian Senior Care Plan 3 with Rx (HMO)			Sandoval	$63.00	$0	Many Generics	H3204 -007	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33%	$2,500 Browse Formulary

Lovelace Medicare Plan Classic (PPO)			Sandoval	$70.80	$0	No Gap Coverage	H3511 -001	Preferred Generic: $4.00 Non-Preferred Generic: $4.00 Preferred Brand: $36.00 Non-Preferred Brand: $75.00 Specialty Tier: 33%	$3,350 Browse Formulary
new	new	new
Presbyterian MediCare PPO Plan 2 with Rx (PPO)			Sandoval	$90.00	$0	No Gap Coverage	H3206 -001	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33%	$3,400 Browse Formulary

Presbyterian MediCare PPO Plan 3 with Rx (PPO)			Sandoval	$118.00	$0	Many Generics	H3206 -002	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33%	$3,000 Browse Formulary

Lovelace Medicare Plan Premier (PPO)			Sandoval	$153.60	$0	No Gap Coverage	H3511 -002	Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $36.00 Non-Preferred Brand: $75.00 Specialty Tier: 33%	$3,350 Browse Formulary
new	new	new

A few notes to help with the understanding of the 2013 Medicare Part D Prescription Drug Plan chart above and Search Tips to help you narrow down your list of plans to those that best meet your needs.

Plan Name: This is the official plan name from CMS. The same plan name generally has a different plan id in each state. (Search Tip: If you would like to reduce the plans shown to just plans for one or two specific carriers, you can select the carrier name in the "Plan Family" fields 1 and 2. Select the empty (blank) option at the top of the list to remove the criteria. You can also click the "National Plans" checkbox to limit your search to just national plans.)

CMS Plan Ratings: these are found under the Plan Name at the left side of the chart.

This is a 1 to 5 star rating system with five (5) stars as excellent, four (4) stars as very good, three (3) stars as good, two (2) stars as fair and one (1) star as poor.

Cust. Service Rating - Drug Plan Customer Service - Medicare and members rate the drug plan and how well a drug plan provides customer service.

This category includes measures of how drug plans rate on the following areas:
- Time on Hold When Customer and Pharmacist Calls Drug Plan.
- Calls Disconnected When Customer and Pharmacist Calls Drug Plan.
- Drug Plan’s Timeliness in Giving a Decision for Members Who Make an Appeal.
- Fairness of Drug Plan’s Denials to a Member’s Appeal, Based on an Independent Reviewer.

Member Plan Exper. - Member Experience with Drug Plan - This category shows how well drug plans make prescription drugs available to their members.

This category includes measures of how drug plans rate on the following areas:
- Drug Plan Provides Information or Help When Members Need It.
- Members’ Overall Rating of Drug Plan.
- Members’ Ability to Get Prescriptions Filled Easily When Using the Drug Plan.

RxCost Info Rating - This category shows how well drug plans are doing with pricing prescriptions and providing information on the Medicare website.

This category includes measures of how drug plans rate on the following areas:
- Completeness of the Drug Plan’s Information on Members Who Need Extra Help.
- Drug Plan Provides Current Information on Costs and Coverage for Medicare’s Website (the same data is used on this Q1Medicare.com).
- Drug Plan’s Prices that Did Not Increase More Than Expected During the Year.
- Drug Plan’s Prices on Medicare’s Website (and this website) Are Similar to the Prices Members Pay at the Pharmacy.
- Drug Plan’s Members 65 and Older Who Received Prescriptions for Certain Drugs with a High Risk of Side Effects, when There May Be Safer Drug Choices.

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County: Medicare Advantage Plans are only available in specific county and in some cases on in part of a county. This field will note the county where the plan is available or in some cases, "Statewide" if the plan is available in every county. (Search Tip: You must enter your 5 digit ZIP Code in the criteria field to begin your search. We will determine your county from your ZIP code and only show appropriate plans.)
Monthly Premium: This is the amount you must pay each month to use the plan. For the Medicare Advantage Plans shown above, this premium includes Medicare Part C AND Part D (if the plan has prescription drug coverage). This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase. (Search Tip: If you would like to reduce the plans shown to just plans under a certain premium, enter this value in the "Maximum Premium" field.)
Deductible: This is the $325 deductible that was presented in the CMS Standard Plan. Many provider’s plans do not have a deductible, however the premium may be higher. (Search Tip: If you would like to reduce the plans shown to just plans with a deductible under a certain value, enter this value in the "Maximum Deductible field" field.)

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Gap Coverage: the Donut Hole: In the CMS Standard Plan, the beneficiary must pay the next $3763.75 in drug costs (the Donut Hole). The Healthcare Reform provides that for Plan Year 2013, ALL formulary generics will have at least a 21% discount and ALL brand drugs will have at least a 52.5% discount in the coverage gap. The Gap Coverage Types discussed in this section are in addition to the Healthcare Reform mandated discounts. In our chart, you will see one of the following:
- No Rx Cov.: This plan does not include prescription drug coverage. You are 100% responsible for your medication costs. If you would like to see ONLY those plans that do include some type of prescription coverage, please select ":Show only plans WITH Drug Coverage" in the "Prescription Drug Coverage" selector above (this is the default setting);
- No Gap Coverage: you must pay the $3763.75;
- All Generics and All Brands: All formulary generics and all formulary Brand drugs are covered through the donut hole. This gap coverage option is available in Los Angeles and Orange counties in CA on the CareMore Value Plus (HMO) plan and in Dade county, FL on the Medica HealthCare Plans MedicareMax(PSO) plan;
- All Generics and Some Brands: All formulary generics and a some (10% to 65%) of formulary Brands are covered through the donut hole; Plans available in Riverside, CA, Many counties in LA, and Washoe, NV.
- All Generics and Few Brands: All formulary generics and a few (less than 10%) of formulary Brands are covered through the donut hole; Plans available in Los Angeles, Orange and San Bernadino, CA and many counties in NY.
- All Generics: All formulary generics and no Brands are covered through the donut hole. You must pay for Brand Drugs up to $3763.75;
- Many Generics and Some Brands: Many formulary generics (65% to 100%) and a some (10% to 65%) formulary Brands are covered through the donut hole;
- Many Generics and Few Brands: Many formulary generics (65% to 100%) and a few (less than 10%) formulary Brands are covered through the donut hole;
- Many Generics: 65% to 100% of formulary generics are covered, but you must pay for Brand Drugs up to $3763.75;
- Some Generics and Few Brands: Some formulary generics (10% to 65%) and a few (less than 10%) formulary Brands are covered through the donut hole;
- Some Generics: 10% to 65% of formulary generics are covered, but you must pay for Brand Drugs up to $3763.75;
- Few Generics and Few Brands: Less than 10% of formulary generics and a few (less than 10%) formulary Brands are covered through the donut hole;
- Few Generics: Less than 10% of formulary generics and no Brands are covered through the donut hole. You must pay for Brand Drugs up to $3763.75;
Plan ID: This is the unique id for this particular plan.

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Copay / Coinsurance - Cost Sharing - These figures apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in "tiers". Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on which tier the drug is in. Plans can form their own tiers, so you should contact the plan or reference it’s summary of benefits to find out what copays and limitations are associated with each tier. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. (Search Tip: If you would like to reduce the plans shown to just plans that have a tier 1 (Generics) co-pay of up to a certain value (ex: $0 co-pay), enter the value (ex: 0) in the "Max. Co-pay Tier 1 (Generics)" field.)

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Additional Information Fields:
You can select one of the following additional pieces of plan information to display (Search Tip: to change the type of information shown in the last column of the chart, select the data to be shown in the "Additional Info" field.)

Total Formulary Drugs (default) - This is the total number of medications on the plans formulary or drug list. This total drug count does not include "Bonus Drugs". These are non-Medicare Part D drugs which are covered by the plan, however they do not count toward your plan deductible, retail drug cost, or TrOOP.
Offers Mail Order - "Yes" is displayed if this plan offers mail order on any medications. It does NOT mean that ALL medications are available through mail order.
Members in This State (updated: April 2013 figures) - This is the total number of members in this plan for this CMS Region. For regions which contain more than one state, this is the total for all of those states combined. We are showing the latest Medicare Advantage plan enrollment figures. We update this figure as new enrollment statistics are released by Medicare.

MOOP for Part A & B Benefits - MOOP is the Maximum Out-of-Pocket limit set by the Medicare Advantage Plan. The figure shown is the beneficiaries yearly maximum out of pocket cost-sharing expenditure (co-payments / co-insurance) for Medicare Parts A & B (NOT Part D - prescription drug cost-sharing) . N/A That this plan does not actually offer health cost-sharing benefits. Example: a Medicare Savings Account (MSA).
Health Plan Type - This the organization type for the Medicare Advantage Plan. This could be Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), etc. (Search Tip: If you would like to limit your search to a specific type of Medicare Advantage Plans, please select the health plan type in the "Type of Health Coverage" field.);
SNP Eligibility Requirements - Special Needs Plans (SNPs) have an eligibility requirement whereas all other Medicare Advantage plans do not. (Search Tip: If you would like to limit your search to specific types of Special Needs Medicare Advantage Plans, please check the appropriate boxes in the "Special Needs Plans (SNP) Options" field.)

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(Chart Source: various files provided by the Centers for Medicare and Medicaid Services along with data from the Medicare.gov website plan finder.)

Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, we cannot guarantee the accuracy of this information.

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