There are 65 Medicare Advantage plans meeting your criteria.
2018 / 2019 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 |
-- This plan not offered in 2018 --
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H1924 -003 -0 | | | | | |
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2019 Lasso Healthcare (MSA)
| $0.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2018 --
|
H3959 -033 -0 | | | | | |
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2019 Advantra Silver (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,744 2019 Formulary |
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-- This plan not offered in 2018 --
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H3959 -052 -0 | | | | | |
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2019 Advantra Southeast Prime (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,744 2019 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 |
2018 AdvantraOne (PPO)
| $19.00 |
$6,700 |
$195 | Yes, some additional gap coverage. |
H5522 -017 -0 | $2.00 | $5.00 | $42.00 | $42.00 | 5,223
2018 Formulary |
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2019 AdvantraOne (PPO)
| $0.00 |
$6,700 |
$395 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,744 2019 Formulary |
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-- This plan not offered in 2018 --
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H3931 -055 -0 | | | | | |
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2019 Aetna Medicare Basic Plan (HMO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2018 Aetna Medicare Choice Plan (HMO)
| $0.00 |
$6,700 |
$150 | Yes, some additional gap coverage. |
H3931 -112 -0 | $2.00 | $5.00 | $42.00 | $42.00 | 5,223
2018 Formulary |
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2019 Aetna Medicare Choice Plan (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $2.00 | $5.00 | $47.00 | $47.00 | 3,744 2019 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 |
2018 Aetna Medicare Main Line Health Prime Plan (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H3931 -105 -0 | $2.00 | $5.00 | $42.00 | $42.00 | 5,223
2018 Formulary |
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|
|
2019 Aetna Medicare Main Line Health Prime Plan (HMO)
| $0.00 |
$6,200 |
$0 | Yes, some additional gap coverage. | $2.00 | $5.00 | $47.00 | $47.00 | 3,744 2019 Formulary |
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-- This plan not offered in 2018 --
|
H5521 -263 -0 | | | | | |
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2019 Aetna Medicare Silver (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $2.00 | $5.00 | $47.00 | $47.00 | 3,744 2019 Formulary |
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-- This plan not offered in 2018 --
|
H2915 -006 -0 | | | | | |
new |
new |
new |
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2019 Allwell Medicare (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,811 2019 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 |
2018 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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2019 Cigna-HealthSpring Advantage (HMO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2018 --
|
H3949 -031 -0 | | | | | |
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2019 Cigna-HealthSpring Alliance (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $1.00 | $10.00 | $42.00 | $42.00 | 3,346 2019 Formulary |
|
2018 Humana Gold Plus H6622-037 (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H6622 -037 -0 | $7.00 | $17.00 | $47.00 | $47.00 | 3,666
2018 Formulary |
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2019 Humana Gold Plus H6622-037 (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $15.00 | $47.00 | $47.00 | 3,368 2019 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 |
2018 Humana Gold Plus H6622-039 (HMO)
| $0.00 |
$6,700 |
$350 | No additional gap coverage, only the Donut Hole Discount |
H6622 -039 -0 | $9.00 | $19.00 | $47.00 | $47.00 | 3,192
2018 Formulary |
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2019 Humana Gold Plus H6622-039 (HMO)
| $0.00 |
$6,700 |
$350 | No additional gap coverage, only the Donut Hole Discount | $9.00 | $19.00 | $47.00 | $47.00 | 3,098 2019 Formulary |
|
2018 HumanaChoice H5216-116 (PPO)
| $0.00 |
$4,500 |
No Rx Coverage |
H5216 -116 -0 | This plan does NOT include Prescription Drug coverage. | |
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2019 HumanaChoice H5216-116 (PPO)
| $0.00 |
$4,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2018 --
|
H5525 -038 -0 | | | | | |
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2019 HumanaChoice H5525-038 (PPO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $17.00 | $47.00 | $47.00 | 3,368 2019 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 |
2018 HumanaChoice R0923-001 (Regional PPO)
| $0.00 |
$4,500 |
No Rx Coverage |
R0923 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
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2019 HumanaChoice R0923-001 (Regional PPO)
| $0.00 |
$4,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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2018 Keystone 65 Basic Rx (HMO)
| $0.00 |
$6,700 |
$300 | No additional gap coverage, only the Donut Hole Discount |
H3952 -056 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,737
2018 Formulary |
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|
|
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2019 Keystone 65 Basic Rx (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $10.00 | $47.00 | $47.00 | 3,897 2019 Formulary |
|
2018 UPMC for Life HMO Deductible with Rx (HMO)
| $0.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3907 -044 -0 | $0.00 | $10.00 | $42.00 | $42.00 | 3,762
2018 Formulary |
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|
|
2019 UPMC for Life HMO Deductible with Rx (HMO)
| $0.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $42.00 | $42.00 | 3,417 2019 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 |
2018 Cigna-HealthSpring Preferred (HMO)
| $23.00 |
$6,700 |
$280 | No additional gap coverage, only the Donut Hole Discount |
H3949 -030 -0 | $1.00 | $10.00 | $42.00 | $42.00 | 3,508
2018 Formulary |
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|
|
|
2019 Cigna-HealthSpring Preferred (HMO)
| $15.00 |
$6,700 |
$280 | No additional gap coverage, only the Donut Hole Discount | $1.00 | $10.00 | $42.00 | $42.00 | 3,346 2019 Formulary |
|
2018 Cigna-HealthSpring Achieve (HMO SNP)
| $58.00 |
n/a |
$280 | No additional gap coverage, only the Donut Hole Discount |
H3949 -024 -0 | $1.00 | $10.00 | $42.00 | $42.00 | 3,508
2018 Formulary |
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|
|
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2019 Cigna-HealthSpring Achieve (HMO SNP)
| $29.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $1.00 | $5.00 | $42.00 | $42.00 | 3,346 2019 Formulary |
|
2018 Humana Gold Plus SNP-DE H6622-038 (HMO SNP)
| $25.00 |
n/a |
$230 | No additional gap coverage, only the Donut Hole Discount |
H6622 -038 -0 | $0.00 | $19.00 | $47.00 | $47.00 | 3,666
2018 Formulary |
|
|
|
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2019 Humana Gold Plus SNP-DE H6622-038 (HMO SNP)
| $31.40 |
n/a |
$300 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $19.00 | $47.00 | $47.00 | 3,368 2019 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 |
2018 Erickson Advantage Guardian (HMO-POS SNP)
| $32.80 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5652 -003 -0 | $0.00 | $0.00 | $28.00 | $28.00 | 3,779
2018 Formulary |
|
|
|
|
2019 Erickson Advantage Guardian (HMO-POS SNP)
| $33.10 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $28.00 | $28.00 | 3,516 2019 Formulary |
|
2018 Cigna-HealthSpring TotalCare (HMO SNP)
| $29.90 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H3949 -009 -0 | | | | | 3,508
2018 Formulary |
|
|
|
|
2019 Cigna-HealthSpring TotalCare (HMO SNP)
| $33.50 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 15% | 15% | 3,346 2019 Formulary |
|
2018 Keystone 65 Focus Rx (HMO)
| $35.00 |
$6,700 |
$200 | No additional gap coverage, only the Donut Hole Discount |
H3952 -054 -0 | $2.00 | $15.00 | $47.00 | $47.00 | 3,737
2018 Formulary |
|
|
|
|
2019 Keystone 65 Focus Rx (HMO-POS)
| $35.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $10.00 | $47.00 | $47.00 | 3,897 2019 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 |
2018 Advantra Cares (HMO SNP)
| $27.80 |
n/a |
$125 | No additional gap coverage, only the Donut Hole Discount |
H3959 -035 -0 | $10.00 | $15.00 | $47.00 | $47.00 | 5,223
2018 Formulary |
|
|
|
|
2019 Advantra Cares (HMO SNP)
| $35.50 |
n/a |
$270 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $5.00 | $47.00 | $47.00 | 3,744 2019 Formulary |
|
2018 Allwell Dual Medicare (HMO SNP)
| $37.10 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H2915 -002 -0 | | | | | 3,470
2018 Formulary |
new |
new |
new |
|
2019 Allwell Dual Medicare (HMO SNP)
| $37.00 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | $0.00 | | | | 3,297 2019 Formulary |
|
2018 Cigna-HealthSpring Traditions (HMO SNP)
| $37.20 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H3949 -016 -0 | | | | | 3,508
2018 Formulary |
|
|
|
|
2019 Cigna-HealthSpring Traditions (HMO SNP)
| $37.00 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,346 2019 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 |
2018 Gateway Health Medicare Assured Diamond (HMO SNP)
| $37.20 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H5932 -001 -0 | | | | | 3,150
2018 Formulary |
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|
|
|
2019 Gateway Health Medicare Assured Diamond (HMO SNP)
| $37.00 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,113 2019 Formulary |
|
2018 Gateway Health Medicare Assured Ruby (HMO SNP)
| $37.20 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H5932 -009 -0 | | | | | 3,150
2018 Formulary |
|
|
|
|
2019 Gateway Health Medicare Assured Ruby (HMO SNP)
| $37.00 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,113 2019 Formulary |
|
2018 Health Partners Medicare Special (HMO SNP)
| $37.00 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H9207 -004 -0 | | | | | 3,738
2018 Formulary |
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|
|
|
2019 Health Partners Medicare Special (HMO SNP)
| $37.00 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | 15% | | | | 3,557 2019 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 |
2018 Keystone First VIP Choice (HMO SNP)
| $37.20 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H4227 -001 -0 | $10.00 | $19.00 | $47.00 | $47.00 | 3,363
2018 Formulary |
|
|
|
|
2019 Keystone First VIP Choice (HMO SNP)
| $37.00 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | $6.00 | 25% | | | 3,335 2019 Formulary |
|
-- This plan not offered in 2018 --
|
H4093 -001 -0 | | | | | |
-- |
-- |
-- |
|
2019 Provider Partners Pennsylvania Advantage Plan (HMO SNP)
| $37.00 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | 25% | | | | 3,615 2019 Formulary |
|
2018 Spartan Plan PA I-SNP (HMO SNP)
| $37.10 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H4236 -001 -0 | 25% | 25% | | | 3,880
2018 Formulary |
new |
new |
new |
|
2019 Sunrise Advantage Plan I-SNP (HMO SNP)
| $37.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $15.00 | $45.00 | $45.00 | 3,930 2019 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 |
2018 UnitedHealthcare Nursing Home Plan 2 (PPO SNP)
| $32.70 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H0710 -017 -0 | | | | | 3,779
2018 Formulary |
|
-- |
|
|
2019 UnitedHealthcare Nursing Home Plan 2 (PPO SNP)
| $37.00 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,516 2019 Formulary |
|
2018 UPMC for Life Dual (HMO SNP)
| $37.10 |
n/a |
$405 | No additional gap coverage, only the Donut Hole Discount |
H4279 -001 -0 | $7.00 | $10.00 | $14.00 | $14.00 | 3,762
2018 Formulary |
|
|
|
|
2019 UPMC for Life Dual (HMO SNP)
| $37.00 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $6.00 | $10.00 | $10.00 | 3,360 2019 Formulary |
|
2018 Spartan Plan PA (HMO)
| $39.00 |
$5,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H4236 -003 -0 | 25% | 25% | | | 3,880
2018 Formulary |
new |
new |
new |
|
2019 Sunrise Advantage Plan (HMO)
| $39.00 |
$5,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $15.00 | $45.00 | $45.00 | 3,930 2019 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 |
2018 HumanaChoice H5525-005 (PPO)
| $77.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5525 -005 -0 | $7.00 | $17.00 | $47.00 | $47.00 | 3,666
2018 Formulary |
|
|
|
|
2019 HumanaChoice H5525-005 (PPO)
| $45.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $47.00 | $47.00 | 3,368 2019 Formulary |
|
2018 Aetna Medicare Silver Plan (HMO)
| $56.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H3931 -070 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 5,223
2018 Formulary |
|
|
|
|
2019 Aetna Medicare Silver Plan (HMO)
| $47.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,864 2019 Formulary |
|
2018 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 | 3,779
2018 Formulary |
|
|
|
|
2019 Erickson Advantage Freedom (HMO-POS)
| $48.00 |
$3,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $10.00 | $45.00 | $45.00 | 3,516 2019 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 |
2018 Spartan Plan PA C-SNP (HMO SNP)
| $49.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H4236 -002 -0 | 25% | 25% | | | 3,880
2018 Formulary |
new |
new |
new |
|
2019 Sunrise Advantage Plan C-SNP (HMO SNP)
| $49.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $15.00 | $45.00 | $45.00 | 3,930 2019 Formulary |
|
2018 Keystone 65 Select Medical Only (HMO)
| $66.00 |
$5,500 |
No Rx Coverage |
H3952 -050 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2019 Keystone 65 Select Medical Only (HMO)
| $66.00 |
$5,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2018 Advantra Gold (PPO)
| $136.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H5522 -014 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 5,215
2018 Formulary |
|
|
|
|
2019 Advantra Gold (PPO)
| $67.00 |
$6,600 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,864 2019 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 |
2018 Health Partners Medicare Prime (HMO)
| $37.00 |
$6,700 |
$350 | No additional gap coverage, only the Donut Hole Discount |
H9207 -005 -0 | $7.00 | $20.00 | $47.00 | $47.00 | 3,814
2018 Formulary |
|
|
|
|
2019 Health Partners Medicare Prime (HMO)
| $71.00 |
$6,700 |
$350 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $20.00 | $47.00 | $47.00 | 3,639 2019 Formulary |
|
2018 Aetna Medicare Standard Plan (HMO)
| $102.00 |
$6,700 |
$75 | Yes, some additional gap coverage. |
H3931 -064 -0 | $2.00 | $5.00 | $42.00 | $42.00 | 5,223
2018 Formulary |
|
|
|
|
2019 Aetna Medicare Standard Plan (HMO)
| $73.00 |
$5,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,864 2019 Formulary |
|
2018 HumanaChoice R0923-002 (Regional PPO)
| $95.00 |
$6,700 |
$315 | No additional gap coverage, only the Donut Hole Discount |
R0923 -002 -0 | $10.00 | $20.00 | $47.00 | $47.00 | 3,666
2018 Formulary |
|
|
|
|
2019 HumanaChoice R0923-002 (Regional PPO)
| $75.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $20.00 | $47.00 | $47.00 | 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 |
2018 UPMC for Life HMO Rx (HMO)
| $81.00 |
$4,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3907 -048 -0 | $0.00 | $10.00 | $42.00 | $42.00 | 3,762
2018 Formulary |
|
|
|
|
2019 UPMC for Life HMO Rx (HMO)
| $81.00 |
$4,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $42.00 | $42.00 | 3,417 2019 Formulary |
|
2018 Keystone 65 Select Rx (HMO)
| $101.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3952 -051 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 4,051
2018 Formulary |
|
|
|
|
2019 Keystone 65 Select Rx (HMO)
| $98.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $1.00 | $9.00 | $47.00 | $47.00 | 3,897 2019 Formulary |
|
2018 Cigna-HealthSpring Preferred Plus (HMO)
| $139.00 |
$6,700 |
$280 | No additional gap coverage, only the Donut Hole Discount |
H3949 -013 -0 | $1.00 | $8.00 | $42.00 | $42.00 | 3,508
2018 Formulary |
|
|
|
|
2019 Cigna-HealthSpring PreferredPlus (HMO)
| $125.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $1.00 | $2.00 | $42.00 | $42.00 | 3,346 2019 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 |
2018 Aetna Medicare Gold Plan (PPO)
| $156.00 |
$4,500 |
$0 | Yes, some additional gap coverage. |
H5521 -122 -0 | $2.00 | $5.00 | $42.00 | $42.00 | 5,223
2018 Formulary |
|
|
|
|
2019 Aetna Medicare Gold Plan (PPO)
| $147.00 |
$4,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,864 2019 Formulary |
|
2018 HumanaChoice H5216-122 (PPO)
| $147.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5216 -122 -0 | $5.00 | $15.00 | $47.00 | $47.00 | 3,666
2018 Formulary |
|
|
|
|
2019 HumanaChoice H5216-122 (PPO)
| $147.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $47.00 | $47.00 | 3,368 2019 Formulary |
|
2018 Erickson Advantage Signature without Drugs (HMO-POS)
| $160.00 |
$5,000 |
No Rx Coverage |
H5652 -002 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2019 Erickson Advantage Signature without Drugs (HMO-POS)
| $160.00 |
$2,900 |
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 |
2018 Personal Choice 65 Rx (PPO)
| $160.00 |
$6,200 |
$400 | No additional gap coverage, only the Donut Hole Discount |
H3909 -009 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 4,051
2018 Formulary |
|
|
|
|
2019 Personal Choice 65 Rx (PPO)
| $160.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $1.00 | $9.00 | $47.00 | $47.00 | 3,897 2019 Formulary |
|
2018 Aetna Medicare Premier Plan (HMO)
| $211.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H3931 -004 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 5,215
2018 Formulary |
|
|
|
|
2019 Aetna Medicare Premier Plan (HMO)
| $167.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,864 2019 Formulary |
|
-- This plan not offered in 2018 --
|
H4236 -004 -0 | | | | | |
new |
new |
new |
|
2019 Sunrise Advantage Plan Gold (HMO SNP)
| $175.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $9.00 | $45.00 | $45.00 | 3,930 2019 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 |
2018 Erickson Advantage Champion (HMO-POS SNP)
| $196.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5652 -004 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,779
2018 Formulary |
|
|
|
|
2019 Erickson Advantage Champion (HMO-POS SNP)
| $195.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $45.00 | $45.00 | 3,516 2019 Formulary |
|
2018 Erickson Advantage Signature with Drugs (HMO-POS)
| $196.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5652 -001 -0 | $5.00 | $10.00 | $45.00 | $45.00 | 3,779
2018 Formulary |
|
|
|
|
2019 Erickson Advantage Signature with Drugs (HMO-POS)
| $195.00 |
$2,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $10.00 | $45.00 | $45.00 | 3,516 2019 Formulary |
|
2018 Keystone 65 Preferred Medical Only (HMO)
| $224.00 |
$4,000 |
No Rx Coverage |
H3952 -044 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2019 Keystone 65 Preferred Medical Only (HMO)
| $224.00 |
$4,000 |
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 |
2018 Keystone 65 Preferred Rx (HMO)
| $289.00 |
$4,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3952 -045 -0 | $2.00 | $10.00 | $47.00 | $47.00 | 4,051
2018 Formulary |
|
|
|
|
2019 Keystone 65 Preferred Rx (HMO)
| $289.00 |
$4,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $1.00 | $9.00 | $47.00 | $47.00 | 3,897 2019 Formulary |
|
2018 Advantra Silver (HMO)
| $45.00 |
$6,700 |
$150 | Yes, some additional gap coverage. |
H3959 -031 -0 | $2.00 | $5.00 | $42.00 | $42.00 | 5,223
2018 Formulary |
|
|
|
|
-- Members will be assigned to Advantra Silver (HMO) H3959-033 --
| | | | | |
|
2018 Cigna-HealthSpring PreventiveCare (HMO)
| $0.00 |
$6,700 |
$310 | No additional gap coverage, only the Donut Hole Discount |
H3949 -028 -0 | $1.00 | $10.00 | $42.00 | $42.00 | 3,508
2018 Formulary |
|
|
|
|
-- Members will be assigned to Cigna-HealthSpring Preferred (HMO) H3949-030 --
| | | | | |
|
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 |
2018 UnitedHealthcare Assisted Living Plan (PPO SNP)
| $29.30 |
n/a |
$200 | No additional gap coverage, only the Donut Hole Discount |
H0710 -018 -0 | $2.00 | $12.00 | $47.00 | $47.00 | 3,779
2018 Formulary |
|
|
|
|
-- This plan not offered in 2019 --
|
| | | | |
|
2018 Health Partners Medicare Basic (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H9207 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
-- This plan not offered in 2019 --
|
| | | | |
|
2018 Gateway Health Medicare Assured Select (HMO)
| $0.00 |
$6,700 |
$405 | No additional gap coverage, only the Donut Hole Discount |
H5932 -010 -0 | $0.00 | $15.00 | $47.00 | $47.00 | 3,150
2018 Formulary |
|
|
|
|
-- This plan not offered in 2019 --
|
| | | | |
|
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 |
2018 Health Partners Medicare Value (HMO)
| $0.00 |
$6,700 |
$350 | No additional gap coverage, only the Donut Hole Discount |
H9207 -008 -0 | $4.00 | $20.00 | $47.00 | $47.00 | 3,814
2018 Formulary |
|
|
|
|
-- This plan not offered in 2019 --
|
| | | | |
|
2018 Gateway Health Medicare Assured Value (HMO-POS)
| $29.00 |
$6,700 |
$250 | No additional gap coverage, only the Donut Hole Discount |
H5932 -011 -0 | $0.00 | $15.00 | $47.00 | $47.00 | 3,150
2018 Formulary |
|
|
|
|
-- This plan not offered in 2019 --
|
| | | | |
|