There are 53 Medicare Advantage plans meeting your criteria.
2016 / 2017 Medicare Advantage Plan Information
Click here to jump to the Chart Legend |
Plan Name |
Monthly Premium |
Part A&B Maximum Out-Of Pocket |
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 |
2016 Advantra Silver (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3959 -033 -0 | $7.00 | $15.00 | $47.00 | $47.00 | 3,417
2016 Formulary |
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|
|
|
2017 Advantra Silver (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $2.00 | $5.00 | $47.00 | $47.00 | 3,670 2017 Formulary |
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-- This plan not offered in 2016 --
|
H3931 -112 -0 | | | | | |
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-- |
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2017 Aetna Medicare Choice Plan (HMO)
| $0.00 |
$6,700 |
$275 | Yes, some additional gap coverage. | $2.00 | $5.00 | $47.00 | $47.00 | 3,670 2017 Formulary |
|
2016 Cigna-HealthSpring Advantage (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H3949 -026 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
|
2017 Cigna-HealthSpring Advantage (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 |
2016 Cigna-HealthSpring PreventiveCare (HMO)
| $0.00 |
$6,700 |
$280 | No additional gap coverage, only the Donut Hole Discount |
H3949 -028 -0 | $4.00 | $10.00 | $47.00 | $47.00 | 3,253
2016 Formulary |
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|
|
|
2017 Cigna-HealthSpring PreventiveCare (HMO)
| $0.00 |
$6,700 |
$280 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $42.00 | $42.00 | 3,420 2017 Formulary |
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-- This plan not offered in 2016 --
|
H5932 -010 -0 | | | | | |
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|
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2017 Gateway Health Medicare Assured Select (HMO)
| $0.00 |
$6,700 |
$400 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $47.00 | $47.00 | 3,021 2017 Formulary |
|
2016 Health Partners Medicare Basic (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H9207 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
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2017 Health Partners Medicare Basic (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 |
-- This plan not offered in 2016 --
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H9207 -008 -0 | | | | | |
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|
|
2017 Health Partners Medicare Value (HMO)
| $0.00 |
$6,700 |
$350 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $20.00 | $47.00 | $47.00 | 3,713 2017 Formulary |
|
2016 Humana Gold Plus H6859-004 (HMO)
| $0.00 |
$6,700 |
$360 | Yes, some additional gap coverage. |
H6859 -004 -0 | $7.00 | $17.00 | $47.00 | $47.00 | 3,615
2016 Formulary |
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-- |
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2017 Humana Gold Plus H6859-004 (HMO)
| $0.00 |
$6,700 |
$360 | Yes, some additional gap coverage. | $7.00 | $17.00 | $47.00 | $47.00 | 3,820 2017 Formulary |
|
2016 HumanaChoice R5826-062 (Regional PPO)
| $0.00 |
$4,500 |
No Rx Coverage |
R5826 -062 -0 | This plan does NOT include Prescription Drug coverage. | |
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2017 HumanaChoice R5826-062 (Regional PPO)
| $0.00 |
$4,500 |
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 |
2016 Keystone 65 Focus Rx (HMO)
| $0.00 |
$5,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3952 -053 -0 | $2.00 | $15.00 | $47.00 | $47.00 | 3,309
2016 Formulary |
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|
|
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2017 Keystone 65 Focus Rx (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $47.00 | $47.00 | 3,653 2017 Formulary |
|
2016 UnitedHealthcare Assisted Living Plan (PPO SNP)
| $25.70 |
n/a |
$50 | No additional gap coverage, only the Donut Hole Discount |
H0710 -018 -0 | $2.00 | $11.00 | $47.00 | $47.00 | 3,529
2016 Formulary |
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-- |
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2017 UnitedHealthcare Assisted Living Plan (PPO SNP)
| $19.00 |
n/a |
$50 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $12.00 | $47.00 | $47.00 | 3,683 2017 Formulary |
|
2016 Cigna-HealthSpring Preferred (HMO)
| $20.00 |
$6,700 |
$280 | No additional gap coverage, only the Donut Hole Discount |
H3949 -030 -0 | $4.00 | $12.00 | $47.00 | $47.00 | 3,253
2016 Formulary |
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|
|
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2017 Cigna-HealthSpring Preferred (HMO)
| $20.00 |
$6,700 |
$280 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $42.00 | $42.00 | 3,420 2017 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 |
2016 AdvantraOne (PPO)
| $23.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5522 -017 -0 | $8.00 | $15.00 | $47.00 | $47.00 | 3,279
2016 Formulary |
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|
|
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2017 AdvantraOne (PPO)
| $23.00 |
$6,700 |
$400 | Yes, some additional gap coverage. | $2.00 | $5.00 | $47.00 | $47.00 | 3,670 2017 Formulary |
|
2016 Advantra Cares (HMO SNP)
| $5.70 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3959 -035 -0 | | | | | 3,090
2016 Formulary |
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2017 Advantra Cares (HMO SNP)
| $25.60 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,670 2017 Formulary |
|
2016 AARP MedicareComplete (HMO)
| $29.00 |
$6,700 |
$230 | No additional gap coverage, only the Donut Hole Discount |
H1944 -009 -0 | $2.00 | $8.00 | $45.00 | $45.00 | 3,529
2016 Formulary |
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-- |
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2017 AARP MedicareComplete (HMO)
| $26.00 |
$6,700 |
$230 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $45.00 | $45.00 | 3,683 2017 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 |
2016 Cigna-HealthSpring TotalCare (HMO SNP)
| $35.10 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3949 -009 -0 | | | | | 3,253
2016 Formulary |
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2017 Cigna-HealthSpring TotalCare (HMO SNP)
| $28.80 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | tbd |
|
2016 UnitedHealthcare Nursing Home Plan (PPO SNP)
| $35.30 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H0710 -017 -0 | | | | | 3,529
2016 Formulary |
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-- |
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2017 UnitedHealthcare Nursing Home Plan (PPO SNP)
| $29.80 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,683 2017 Formulary |
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2016 Keystone 65 Select Medical Only (HMO)
| $12.00 |
$5,500 |
No Rx Coverage |
H3952 -048 -0 | This plan does NOT include Prescription Drug coverage. | |
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2017 Keystone 65 Select Medical Only (HMO)
| $32.00 |
$5,500 |
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 |
-- This plan not offered in 2016 --
|
H3113 -009 -0 | | | | | |
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-- |
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2017 UnitedHealthcare Dual Complete (HMO SNP)
| $34.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,683 2017 Formulary |
|
-- This plan not offered in 2016 --
|
H6859 -008 -0 | | | | | |
|
-- |
|
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2017 Humana Gold Plus SNP-DE H6859-008 (HMO SNP)
| $34.90 |
n/a |
$150 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $19.00 | $47.00 | $47.00 | 3,820 2017 Formulary |
|
-- This plan not offered in 2016 --
|
H3113 -012 -0 | | | | | |
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-- |
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2017 UnitedHealthcare Dual Complete ONE (HMO SNP)
| $35.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,683 2017 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 2016 --
|
H4093 -001 -0 | | | | | |
new |
new |
new |
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2017 Provider Partners Pennsylvania Advantage Plan (HMO SNP)
| $35.30 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,244 2017 Formulary |
|
2016 Erickson Advantage Guardian (HMO-POS SNP)
| $29.10 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5652 -003 -0 | $0.00 | $4.00 | $28.00 | $28.00 | 3,529
2016 Formulary |
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|
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2017 Erickson Advantage Guardian (HMO-POS SNP)
| $35.80 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $28.00 | $28.00 | 3,683 2017 Formulary |
|
2016 Cigna-HealthSpring Traditions (HMO SNP)
| $35.30 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H3949 -016 -0 | | | | | 3,253
2016 Formulary |
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|
|
|
2017 Cigna-HealthSpring Traditions (HMO SNP)
| $39.40 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | tbd |
|
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 |
2016 Gateway Health Medicare Assured Diamond (HMO SNP)
| $35.30 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H5932 -001 -0 | | | | | 2,902
2016 Formulary |
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|
|
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2017 Gateway Health Medicare Assured Diamond (HMO SNP)
| $39.40 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,021 2017 Formulary |
|
2016 Gateway Health Medicare Assured Ruby (HMO SNP)
| $35.30 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H5932 -009 -0 | | | | | 2,902
2016 Formulary |
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|
|
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2017 Gateway Health Medicare Assured Ruby (HMO SNP)
| $39.40 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,021 2017 Formulary |
|
2016 Health Partners Medicare Prime (HMO)
| $35.00 |
$6,700 |
$300 | No additional gap coverage, only the Donut Hole Discount |
H9207 -005 -0 | $7.00 | $45.00 | $95.00 | $95.00 | 3,503
2016 Formulary |
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|
|
|
2017 Health Partners Medicare Prime (HMO)
| $39.40 |
$6,700 |
$350 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $20.00 | $47.00 | $47.00 | 3,713 2017 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 |
2016 Health Partners Medicare Special (HMO SNP)
| $0.00 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H9207 -004 -0 | | | | | 3,379
2016 Formulary |
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|
|
|
2017 Health Partners Medicare Special (HMO SNP)
| $39.40 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,603 2017 Formulary |
|
2016 Keystone VIP Choice (HMO SNP)
| $35.30 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H4227 -001 -0 | $4.00 | $13.00 | $47.00 | $47.00 | 3,316
2016 Formulary |
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|
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2017 Keystone VIP Choice (HMO SNP)
| $39.40 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $16.00 | $47.00 | $47.00 | 3,201 2017 Formulary |
|
2016 Aetna Medicare Basic Plan (HMO)
| $42.00 |
$6,700 |
No Rx Coverage |
H3931 -055 -0 | This plan does NOT include Prescription Drug coverage. | |
|
-- |
|
|
2017 Aetna Medicare Basic Plan (HMO)
| $42.00 |
$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 |
2016 Erickson Advantage Freedom (HMO-POS)
| $49.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5652 -006 -0 | $5.00 | $10.00 | $45.00 | $45.00 | 3,529
2016 Formulary |
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|
|
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2017 Erickson Advantage Freedom (HMO-POS)
| $46.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $10.00 | $45.00 | $45.00 | 3,683 2017 Formulary |
|
2016 Keystone 65 Select Rx (HMO)
| $36.00 |
$5,500 |
$320 | No additional gap coverage, only the Donut Hole Discount |
H3952 -049 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,860
2016 Formulary |
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|
|
|
2017 Keystone 65 Select Rx (HMO)
| $56.00 |
$5,500 |
$350 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 4,006 2017 Formulary |
|
2016 Cigna-HealthSpring Achieve (HMO SNP)
| $58.50 |
n/a |
$280 | No additional gap coverage, only the Donut Hole Discount |
H3949 -024 -0 | $4.00 | $10.00 | $47.00 | $47.00 | 3,253
2016 Formulary |
|
|
|
|
2017 Cigna-HealthSpring Achieve (HMO SNP)
| $58.50 |
n/a |
$280 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $42.00 | $42.00 | tbd |
|
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 |
2016 HumanaChoice H5525-005 (PPO)
| $73.00 |
$6,700 |
$360 | Yes, some additional gap coverage. |
H5525 -005 -0 | $7.00 | $17.00 | $47.00 | $47.00 | 3,615
2016 Formulary |
|
|
|
|
2017 HumanaChoice H5525-005 (PPO)
| $77.00 |
$6,700 |
$250 | Yes, some additional gap coverage. | $7.00 | $17.00 | $47.00 | $47.00 | 3,820 2017 Formulary |
|
2016 HumanaChoice R5826-002 (Regional PPO)
| $99.00 |
$6,700 |
$360 | No additional gap coverage, only the Donut Hole Discount |
R5826 -002 -0 | $9.00 | $20.00 | $47.00 | $47.00 | n/a |
|
|
|
|
2017 HumanaChoice R5826-002 (Regional PPO)
| $97.00 |
$6,700 |
$250 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $20.00 | $47.00 | $47.00 | tbd |
|
2016 Aetna Medicare Standard Plan (HMO)
| $79.00 |
$6,700 |
$150 | No additional gap coverage, only the Donut Hole Discount |
H3931 -064 -0 | $2.00 | $12.00 | $47.00 | $47.00 | 3,417
2016 Formulary |
|
-- |
|
|
2017 Aetna Medicare Standard Plan (HMO)
| $99.00 |
$6,700 |
$225 | Yes, some additional gap coverage. | $2.00 | $5.00 | $47.00 | $47.00 | 3,670 2017 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 2016 --
|
H5522 -014 -0 | | | | | |
|
|
|
|
2017 Advantra Gold (PPO)
| $113.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $2.00 | $5.00 | $47.00 | $47.00 | 3,670 2017 Formulary |
|
2016 Erickson Advantage Signature without Drugs (HMO-POS)
| $149.00 |
$5,000 |
No Rx Coverage |
H5652 -002 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2017 Erickson Advantage Signature without Drugs (HMO-POS)
| $138.00 |
$5,000 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2016 Cigna-HealthSpring Preferred Plus (HMO)
| $141.00 |
$6,700 |
$200 | No additional gap coverage, only the Donut Hole Discount |
H3949 -013 -0 | $4.00 | $8.00 | $40.00 | $40.00 | 3,253
2016 Formulary |
|
|
|
|
2017 Cigna-HealthSpring Preferred Plus (HMO)
| $140.00 |
$6,700 |
$280 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $42.00 | $42.00 | 3,420 2017 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 2016 --
|
H5521 -122 -0 | | | | | |
|
|
|
|
2017 Aetna Medicare Gold Plan (PPO)
| $159.00 |
$4,500 |
$0 | Yes, some additional gap coverage. | $2.00 | $5.00 | $47.00 | $47.00 | 3,670 2017 Formulary |
|
2016 Keystone 65 Preferred Medical Only (HMO)
| $145.00 |
$4,000 |
No Rx Coverage |
H3952 -008 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2017 Keystone 65 Preferred Medical Only (HMO)
| $173.00 |
$4,000 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2016 Erickson Advantage Champion (HMO-POS SNP)
| $190.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5652 -004 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,529
2016 Formulary |
|
|
|
|
2017 Erickson Advantage Champion (HMO-POS SNP)
| $176.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $45.00 | $45.00 | 3,683 2017 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 |
2016 Erickson Advantage Signature with Drugs (HMO-POS)
| $190.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5652 -001 -0 | $5.00 | $10.00 | $45.00 | $45.00 | 3,529
2016 Formulary |
|
|
|
|
2017 Erickson Advantage Signature with Drugs (HMO-POS)
| $176.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $10.00 | $45.00 | $45.00 | 3,683 2017 Formulary |
|
2016 Humana Gold Choice H8145-053 (PFFS)
| $195.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H8145 -053 -0 | $7.00 | $17.00 | $47.00 | $47.00 | 3,615
2016 Formulary |
|
|
|
|
2017 Humana Gold Choice H8145-053 (PFFS)
| $193.00 |
n/a |
$0 | Yes, some additional gap coverage. | $7.00 | $17.00 | $47.00 | $47.00 | 3,820 2017 Formulary |
|
2016 Personal Choice 65 Medical Only (PPO)
| $165.00 |
$6,200 |
No Rx Coverage |
H3909 -007 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2017 Personal Choice 65 Medical Only (PPO)
| $194.00 |
$6,200 |
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 |
2016 Aetna Medicare Premier Plan (HMO)
| $177.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3931 -004 -0 | $2.00 | $12.00 | $47.00 | $47.00 | 3,417
2016 Formulary |
|
-- |
|
|
2017 Aetna Medicare Premier Plan (HMO)
| $199.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $2.00 | $5.00 | $47.00 | $47.00 | 3,894 2017 Formulary |
|
2016 Keystone 65 Preferred Rx (HMO)
| $199.00 |
$4,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3952 -020 -0 | $2.00 | $8.00 | $45.00 | $45.00 | 3,860
2016 Formulary |
|
|
|
|
2017 Keystone 65 Preferred Rx (HMO)
| $227.00 |
$4,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $10.00 | $47.00 | $47.00 | 4,006 2017 Formulary |
|
2016 Personal Choice 65 Rx (PPO)
| $251.00 |
$6,200 |
$320 | No additional gap coverage, only the Donut Hole Discount |
H3909 -001 -0 | $3.00 | $9.00 | $47.00 | $47.00 | 3,860
2016 Formulary |
|
|
|
|
2017 Personal Choice 65 Rx (PPO)
| $280.00 |
$6,200 |
$400 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 4,006 2017 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 |
2016 Advantra Gold (PPO)
| $123.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5522 -015 -0 | $2.00 | $47.00 | 50% | 50% | 3,543
2016 Formulary |
|
|
|
|
-- Members will be assigned to Advantra Gold (PPO) H5522-014 --
| | | | | |
|
2016 Cigna-HealthSpring Premier (HMO-POS)
| $39.50 |
$6,700 |
$280 | No additional gap coverage, only the Donut Hole Discount |
H3949 -027 -0 | $7.00 | $10.00 | $40.00 | $40.00 | 3,253
2016 Formulary |
|
|
|
|
-- Members will be assigned to Cigna-HealthSpring Preferred (HMO) H3949-030 --
| | | | | |
|
2016 Health Partners Medicare PrimePlus (HMO)
| $110.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H9207 -006 -0 | $7.00 | $45.00 | $95.00 | $95.00 | 3,503
2016 Formulary |
|
|
|
|
-- Members will be assigned to Health Partners Medicare Prime (HMO) H9207-005 --
| | | | | |
|
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 |
2016 Gateway Health Medicare Assured Gold (HMO SNP)
| $67.00 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H5932 -007 -0 | $4.00 | $10.00 | $45.00 | $45.00 | 2,902
2016 Formulary |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|
2016 Gateway Health Medicare Assured Platinum (HMO SNP)
| $97.00 |
n/a |
$250 | No additional gap coverage, only the Donut Hole Discount |
H5932 -008 -0 | $4.00 | $10.00 | $45.00 | $45.00 | 2,902
2016 Formulary |
|
|
|
|
-- This plan not offered in 2017 --
|
| | | | |
|