There are 84 Medicare Advantage plans meeting your criteria.
2019 / 2020 Medicare Advantage Plan Information
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Plan Name |
Monthly Premium |
Part A&B Maximum Out-Of Pocket |
Part D Deduct- ible |
(Donut Hole) Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Parts A&B MOOP Limit |
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2019 AARP MedicareComplete SecureHorizons Essential (HMO)
| $0.00 |
$4,900 |
No Rx Coverage |
H0543 -121 -0 | This plan does NOT include Prescription Drug coverage. | $4900 |
|
|
|
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2020 AARP Medicare Advantage SecureHorizons Essential (HMO)
| $0.00 |
$4,900 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | $4900 |
|
2019 AARP MedicareComplete SecureHorizons Focus (HMO)
| $0.00 |
$1,500 |
$0 | Yes, some additional gap coverage. |
H0543 -169 -0 | $0.00 | $9.00 | $47.00 | $47.00 | $1500
2019 Formulary |
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2020 AARP Medicare Advantage SecureHorizons Focus (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $9.00 | $47.00 | $47.00 | $1000 2020 Formulary |
|
2019 AARP MedicareComplete SecureHorizons Plan 2 (HMO)
| $0.00 |
$2,200 |
$0 | Yes, some additional gap coverage. |
H0543 -138 -0 | $0.00 | $12.00 | $47.00 | $47.00 | $2200
2019 Formulary |
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2020 AARP Medicare Advantage SecureHorizons Plan 2 (HMO)
| $0.00 |
$2,200 |
$0 | Yes, some additional gap coverage. | $0.00 | $14.00 | $47.00 | $47.00 | $2200 2020 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
MOOP Lmt. |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2019 --
|
H4982 -001 -0 | | | | | |
new |
new |
|
|
2020 Aetna Medicare Plus Plan (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $42.00 | $42.00 | $999 2020 Formulary |
|
2019 Aetna Medicare Prime Plan (HMO)
| $0.00 |
$2,200 |
$0 | Yes, some additional gap coverage. |
H0523 -061 -0 | $0.00 | $0.00 | $47.00 | $47.00 | $2200
2019 Formulary |
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2020 Aetna Medicare Prime Plan (HMO)
| $0.00 |
$2,200 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | $2200 2020 Formulary |
|
2019 Aetna Medicare Select Plan (HMO)
| $0.00 |
$2,000 |
$0 | Yes, some additional gap coverage. |
H0523 -002 -0 | $0.00 | $0.00 | $47.00 | $47.00 | $2000
2019 Formulary |
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2020 Aetna Medicare Select Plan (HMO)
| $0.00 |
$2,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | $2000 2020 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
MOOP Lmt. |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2019 Alignment Health Plan Heart & Diabetes (HMO SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H3815 -010 -0 | $0.00 | $5.00 | $30.00 | $30.00 | n/a
2019 Formulary |
|
|
|
|
2020 Alignment Health Plan Heart & Diabetes (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $30.00 | $30.00 | tbd 2020 Formulary |
|
2019 Alignment Health Plan My Choice (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H3815 -001 -0 | $1.00 | $5.00 | $30.00 | $30.00 | $3400
2019 Formulary |
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|
|
2020 Alignment Health Plan My Choice (HMO)
| $0.00 |
$3,200 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $30.00 | $30.00 | $3200 2020 Formulary |
|
2019 Alignment Health Plan Platinum (HMO)
| $0.00 |
$1,499 |
$0 | Yes, some additional gap coverage. |
H3815 -008 -0 | $0.00 | $3.00 | $30.00 | $30.00 | $1499
2019 Formulary |
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2020 Alignment Health Plan Platinum (HMO)
| $0.00 |
$1,499 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $30.00 | $30.00 | $1499 2020 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
MOOP Lmt. |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2019 Anthem Breathe (HMO SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0544 -014 -0 | $0.00 | $7.50 | $37.50 | $37.50 | n/a
2019 Formulary |
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|
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2020 Anthem MediBlue Breathe (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $37.50 | $37.50 | tbd 2020 Formulary |
|
2019 Anthem Care On Site (HMO SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0544 -005 -0 | $0.00 | $9.50 | $37.50 | $37.50 | n/a
2019 Formulary |
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2020 Anthem MediBlue Care On Site (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $9.50 | $37.50 | $37.50 | tbd 2020 Formulary |
|
2019 Anthem Diabetes (HMO SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0544 -004 -0 | $0.00 | $7.50 | $37.50 | $37.50 | n/a
2019 Formulary |
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2020 Anthem MediBlue Diabetes (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $37.50 | $37.50 | tbd 2020 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
MOOP Lmt. |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2019 Anthem ESRD (HMO SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0544 -015 -0 | $0.00 | $7.50 | $37.50 | $37.50 | n/a
2019 Formulary |
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2020 Anthem MediBlue ESRD (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $37.50 | $37.50 | tbd 2020 Formulary |
|
2019 Anthem Heart (HMO SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0544 -013 -0 | $0.00 | $7.50 | $37.50 | $37.50 | n/a
2019 Formulary |
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2020 Anthem MediBlue Heart (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $37.50 | $37.50 | tbd 2020 Formulary |
|
2019 Anthem MediBlue Plus (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H0544 -061 -0 | $7.00 | $15.00 | $42.00 | $42.00 | $6700
2019 Formulary |
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2020 Anthem MediBlue Plus (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $7.00 | $15.00 | $42.00 | $42.00 | $6700 2020 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
MOOP Lmt. |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2019 Anthem MediBlue Select (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. |
H0544 -059 -0 | $0.00 | $5.00 | $42.00 | $42.00 | $1000
2019 Formulary |
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2020 Anthem MediBlue Select (HMO)
| $0.00 |
$900 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | $900 2020 Formulary |
|
2019 Anthem StartSmart Plus (HMO)
| $0.00 |
$3,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H0544 -007 -0 | $5.00 | $14.50 | $45.00 | $45.00 | $3000
2019 Formulary |
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2020 Anthem MediBlue StartSmart Plus (HMO)
| $0.00 |
$3,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $14.50 | $45.00 | $45.00 | $3000 2020 Formulary |
|
2019 Anthem Value Plus (HMO)
| $0.00 |
$1,500 |
$0 | Yes, some additional gap coverage. |
H0544 -002 -0 | $0.00 | $9.50 | $37.50 | $37.50 | $1500
2019 Formulary |
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|
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2020 Anthem MediBlue Value Plus (HMO)
| $0.00 |
$900 |
$0 | Yes, some additional gap coverage. | $0.00 | $9.50 | $37.50 | $37.50 | $900 2020 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
MOOP Lmt. |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2019 Blue Shield 65 Plus (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. |
H0504 -015 -0 | $0.00 | $5.00 | $40.00 | $40.00 | $999
2019 Formulary |
|
|
|
|
2020 Blue Shield 65 Plus (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $38.00 | $38.00 | $999 2020 Formulary |
|
2019 Blue Shield 65 Plus Choice Plan (HMO)
| $0.00 |
$1,899 |
$0 | Yes, some additional gap coverage. |
H0504 -021 -0 | $3.00 | $10.00 | $40.00 | $40.00 | $1899
2019 Formulary |
|
|
|
|
2020 Blue Shield 65 Plus Choice Plan (HMO)
| $0.00 |
$1,899 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $40.00 | $40.00 | $1899 2020 Formulary |
|
-- This plan not offered in 2019 --
|
H0504 -043 -0 | | | | | |
|
|
|
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2020 Blue Shield Inspire (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $35.00 | $35.00 | $999 2020 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
MOOP Lmt. |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2019 Blue Shield Promise AdvantageOptimum Plan (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. |
H5928 -004 -0 | $0.00 | $5.00 | $40.00 | $40.00 | $999
2019 Formulary |
|
|
|
|
2020 Blue Shield Promise AdvantageOptimum Plan (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $40.00 | $40.00 | $999 2020 Formulary |
|
-- This plan not offered in 2019 --
|
H0504 -044 -0 | | | | | |
|
|
|
|
2020 Blue Shield Vital (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $40.00 | $40.00 | $3400 2020 Formulary |
|
2019 Brand New Day Bridges Care Plan (HMO SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0838 -028 -0 | $0.00 | $8.00 | $45.00 | $45.00 | n/a
2019 Formulary |
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|
|
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2020 Brand New Day Bridges Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $9.00 | $45.00 | $45.00 | tbd |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
MOOP Lmt. |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2019 Brand New Day Classic Care I Plan (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H0838 -025 -0 | $0.00 | $8.00 | $45.00 | $45.00 | $3400
2019 Formulary |
|
|
|
|
2020 Brand New Day Classic Care I Plan (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $9.00 | $47.00 | $47.00 | $999 |
|
2019 Brand New Day Classic Care II Plan (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H0838 -037 -0 | $0.00 | $10.00 | $45.00 | $45.00 | $3400
2019 Formulary |
|
|
|
|
2020 Brand New Day Classic Care II Plan (HMO)
| $0.00 |
$999 |
$125 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | $999 |
|
2019 Brand New Day Embrace Care Plan (HMO SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0838 -039 -1 | $0.00 | $8.00 | $45.00 | $45.00 | n/a
2019 Formulary |
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|
|
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2020 Brand New Day Embrace Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | tbd |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
MOOP Lmt. |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2019 Brand New Day Harmony Care Plan (HMO SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0838 -032 -0 | $0.00 | $9.00 | $45.00 | $45.00 | n/a
2019 Formulary |
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|
|
|
2020 Brand New Day Harmony Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$100 | Yes, some additional gap coverage. | $0.00 | $10.00 | $45.00 | $45.00 | tbd |
|
2019 Central Health Focus Plan (HMO SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5649 -006 -0 | $0.00 | $5.00 | $35.00 | $35.00 | n/a
2019 Formulary |
|
-- |
|
|
2020 Central Health Focus Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | tbd 2020 Formulary |
|
2019 Central Health Medicare Plan (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H5649 -001 -0 | $0.00 | $5.00 | $35.00 | $35.00 | $3400
2019 Formulary |
|
-- |
|
|
2020 Central Health Medicare Plan (HMO)
| $0.00 |
$2,995 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | $2995 2020 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
MOOP Lmt. |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2019 --
|
H2241 -013 -0 | | | | | |
|
|
|
|
2020 Connected Care (HMO)
| $0.00 |
$1,499 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $45.00 | $45.00 | $1499 2020 Formulary |
|
-- This plan not offered in 2019 --
|
H2241 -019 -0 | | | | | |
|
|
|
|
2020 Connected Care Select (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $45.00 | $45.00 | tbd 2020 Formulary |
|
2019 Health Net Gold Select (HMO)
| $0.00 |
$2,000 |
$0 | Yes, some additional gap coverage. |
H0562 -101 -1 | $0.00 | $10.00 | $37.00 | $37.00 | $2000
2019 Formulary |
|
|
|
|
2020 Health Net Gold Select (HMO)
| $0.00 |
$899 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $37.00 | $37.00 | $899 2020 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
MOOP Lmt. |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2019 Health Net Jade (HMO SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0562 -092 -0 | $0.00 | $10.00 | $37.00 | $37.00 | n/a
2019 Formulary |
|
|
|
|
2020 Health Net Jade (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $37.00 | $37.00 | tbd 2020 Formulary |
|
-- This plan not offered in 2019 --
|
H0562 -122 -0 | | | | | |
|
|
|
|
2020 Health Net Seniority Plus Sapphire (HMO)
| $0.00 |
$4,500 |
$370 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | $4500 2020 Formulary |
|
2019 Humana Gold Plus H5619-021 (HMO)
| $0.00 |
$1,300 |
$0 | Yes, some additional gap coverage. |
H5619 -021 -0 | $0.00 | $0.00 | $35.00 | $35.00 | $1300
2019 Formulary |
|
|
|
|
2020 Humana Gold Plus H5619-021 (HMO)
| $0.00 |
$990 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | $990 2020 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
MOOP Lmt. |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2019 --
|
H5619 -120 -0 | | | | | |
|
|
|
|
2020 Humana Honor (HMO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | $6700 |
|
-- This plan not offered in 2019 --
|
H5496 -005 -0 | | | | | |
-- |
-- |
|
|
2020 Imperial Senior Value (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | tbd 2020 Formulary |
|
-- This plan not offered in 2019 --
|
H5496 -007 -0 | | | | | |
-- |
-- |
|
|
2020 Imperial Traditional (HMO) (HMO)
| $0.00 |
$4,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | $4000 2020 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
MOOP Lmt. |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2019 Inter Valley Health Plan Service To Seniors (HMO)
| $0.00 |
$2,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H0545 -001 -0 | $5.00 | $12.00 | $47.00 | $47.00 | $2000
2019 Formulary |
|
|
|
|
2020 Inter Valley Health Plan Service To Seniors (HMO)
| $0.00 |
$2,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | $2000 2020 Formulary |
|
2019 Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
| $0.00 |
$4,900 |
$0 | Yes, some additional gap coverage. |
H0524 -003 -0 | $5.00 | $15.00 | $47.00 | $47.00 | $4900
2019 Formulary |
|
|
|
|
2020 Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
| $0.00 |
$4,000 |
$0 | Yes, some additional gap coverage. | $3.00 | $15.00 | $47.00 | $47.00 | $4000 2020 Formulary |
|
2019 OneCare Connect (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H8016 -001 -0 | 0% | 0% | 0% | | n/a
2019 Formulary |
-- |
-- |
|
|
2020 OneCare Connect (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | 0% | 0% | 0% | | tbd 2020 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
MOOP Lmt. |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2019 SCAN Balance (HMO SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5425 -034 -0 | $0.00 | $2.00 | $30.00 | $30.00 | n/a
2019 Formulary |
|
|
|
|
2020 SCAN Balance (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $2.00 | $30.00 | $30.00 | tbd 2020 Formulary |
|
2019 SCAN Classic (HMO)
| $0.00 |
$1,500 |
$0 | Yes, some additional gap coverage. |
H5425 -007 -0 | $0.00 | $5.00 | $42.00 | $42.00 | $1500
2019 Formulary |
|
|
|
|
2020 SCAN Classic (HMO)
| $0.00 |
$899 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | $899 2020 Formulary |
|
2019 SCAN Healthy at Home (HMO SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H9104 -006 -0 | $0.00 | $5.00 | $42.00 | $42.00 | n/a
2019 Formulary |
-- |
-- |
|
|
2020 SCAN Healthy at Home (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | tbd 2020 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
MOOP Lmt. |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2019 Heart First (HMO SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5425 -028 -0 | $0.00 | $2.00 | $42.00 | $42.00 | n/a
2019 Formulary |
|
|
|
|
2020 SCAN Heart First (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $2.00 | $42.00 | $42.00 | tbd 2020 Formulary |
|
2019 Easy Choice Best Plan (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. |
H5087 -005 -0 | $0.00 | $0.00 | $47.00 | $47.00 | $2500
2019 Formulary |
|
-- |
|
|
2020 WellCare Best (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $25.00 | $25.00 | $2500 2020 Formulary |
|
-- This plan not offered in 2019 --
|
H5087 -025 -0 | | | | | |
|
-- |
|
|
2020 WellCare Dividend (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | $3400 2020 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
MOOP Lmt. |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2019 Easy Choice Plus Plan (HMO)
| $25.00 |
$2,500 |
$415 | No additional gap coverage, only the Donut Hole Discount |
H5087 -002 -0 | $0.00 | $20.00 | $47.00 | $47.00 | $2500
2019 Formulary |
|
-- |
|
|
2020 WellCare Plus (HMO)
| $0.00 |
$2,500 |
$435 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | $2500 2020 Formulary |
|
-- This plan not offered in 2019 --
|
H0544 -081 -0 | | | | | |
|
|
|
|
2020 Anthem MediBlue Extra (HMO)
| $14.40 |
$900 |
$435 | Yes, some additional gap coverage. | $0.00 | $2.00 | $47.00 | $47.00 | $900 2020 Formulary |
|
2019 UnitedHealthcare MedicareComplete Assure (HMO)
| $16.10 |
$6,700 |
$415 | No additional gap coverage, only the Donut Hole Discount |
H0543 -153 -0 | 25% | 25% | 25% | 25% | $6700
2019 Formulary |
|
|
|
|
2020 UnitedHealthcare Medicare Advantage Assure (HMO)
| $14.90 |
$6,700 |
$435 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | $6700 2020 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
MOOP Lmt. |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2019 Health Net Healthy Heart (HMO)
| $16.00 |
$2,400 |
$0 | Yes, some additional gap coverage. |
H0562 -100 -1 | $5.00 | $10.00 | $37.00 | $37.00 | $2400
2019 Formulary |
|
|
|
|
2020 Health Net Healthy Heart (HMO)
| $16.00 |
$2,400 |
$0 | Yes, some additional gap coverage. | $5.00 | $10.00 | $37.00 | $37.00 | $2400 2020 Formulary |
|
2019 Humana Value Plus H5619-037 (HMO)
| $33.30 |
$6,700 |
$415 | No additional gap coverage, only the Donut Hole Discount |
H5619 -037 -0 | $0.00 | $19.00 | $47.00 | $47.00 | $6700
2019 Formulary |
|
|
|
|
2020 Humana Value Plus H5619-037 (HMO)
| $16.80 |
$6,700 |
$435 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $19.00 | $47.00 | $47.00 | $6700 2020 Formulary |
|
2019 Anthem Connect Plus (HMO)
| $34.70 |
$6,700 |
$415 | No additional gap coverage, only the Donut Hole Discount |
H0544 -049 -0 | 25% | 25% | 25% | 25% | $6700
2019 Formulary |
|
|
|
|
2020 Anthem MediBlue Connect Plus (HMO)
| $20.20 |
$6,700 |
$435 | Yes, some additional gap coverage. | 25% | 25% | 25% | 25% | $6700 2020 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
MOOP Lmt. |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2019 Anthem MediBlue Coordination Plus (HMO)
| $34.80 |
$6,700 |
$415 | Yes, some additional gap coverage. |
H0544 -072 -0 | $0.00 | $9.00 | $47.00 | $47.00 | $6700
2019 Formulary |
|
|
|
|
2020 Anthem MediBlue Coordination Plus (HMO)
| $25.30 |
$6,700 |
$435 | Yes, some additional gap coverage. | $0.00 | $15.00 | $47.00 | $47.00 | $6700 2020 Formulary |
|
2019 AARP MedicareComplete SecureHorizons Premier (HMO)
| $25.20 |
$1,500 |
$0 | Yes, some additional gap coverage. |
H0543 -165 -0 | $0.00 | $9.00 | $47.00 | $47.00 | $1500
2019 Formulary |
|
|
|
|
2020 AARP Medicare Advantage SecureHorizons Premier (HMO)
| $26.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $9.00 | $47.00 | $47.00 | $1000 2020 Formulary |
|
2019 SCAN Prime (HMO)
| $26.00 |
$1,500 |
$0 | Yes, some additional gap coverage. |
H5425 -066 -0 | $0.00 | $5.00 | $42.00 | $42.00 | $1500
2019 Formulary |
|
|
|
|
2020 SCAN Prime (HMO)
| $26.00 |
$800 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | $800 2020 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
MOOP Lmt. |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2019 Alignment Health Plan CalPlus (HMO)
| $30.50 |
$6,700 |
$415 | No additional gap coverage, only the Donut Hole Discount |
H3815 -009 -0 | $5.00 | $10.00 | 25% | 25% | $6700
2019 Formulary |
|
|
|
|
2020 Alignment Health Plan CalPlus (HMO)
| $27.30 |
$6,700 |
$435 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $14.00 | 25% | 25% | $6700 2020 Formulary |
|
2019 Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
| $34.80 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H0524 -029 -0 | $5.00 | $17.00 | $47.00 | $47.00 | n/a
2019 Formulary |
|
|
|
|
2020 Senior Advantage Medicare Medi-Cal Plan South (HMO D-SNP)
| $31.10 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount | 15% | 15% | 15% | 15% | tbd 2020 Formulary |
|
2019 Blue Shield Promise Coordinated Choice Plan (HMO)
| $34.80 |
$6,700 |
$415 | Yes, some additional gap coverage. |
H5928 -037 -0 | $0.00 | 25% | 25% | 25% | $6700
2019 Formulary |
|
|
|
|
2020 Blue Shield Promise Coordinated Choice Plan (HMO)
| $32.00 |
$6,700 |
$435 | Yes, some additional gap coverage. | $0.00 | 25% | 25% | 25% | $6700 2020 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
MOOP Lmt. |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2019 Blue Shield Promise TotalDual Plan (HMO SNP)
| $34.80 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount |
H5928 -005 -0 | 15% | 15% | 15% | 15% | n/a
2019 Formulary |
|
|
|
|
2020 Blue Shield Promise TotalDual Plan (HMO D-SNP)
| $32.00 |
n/a |
$435 | Yes, some additional gap coverage. | $0.00 | 25% | 25% | 25% | tbd 2020 Formulary |
|
2019 Brand New Day Bridges Choice Medi-Medi Plan (HMO SNP)
| $34.80 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount |
H0838 -029 -0 | 0% | 25% | 25% | 25% | n/a
2019 Formulary |
|
|
|
|
2020 Brand New Day Bridges Choice Plan (HMO C-SNP)
| $32.00 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount | 0% | 25% | 25% | 25% | tbd |
|
2019 Brand New Day Classic Choice Medi-Medi Plan (HMO)
| $34.80 |
$6,700 |
$415 | No additional gap coverage, only the Donut Hole Discount |
H0838 -033 -0 | 0% | 25% | 25% | 25% | $6700
2019 Formulary |
|
|
|
|
2020 Brand New Day Classic Choice Plan (HMO)
| $32.00 |
$6,700 |
$435 | No additional gap coverage, only the Donut Hole Discount | 0% | 25% | 25% | 25% | $6700 |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
MOOP Lmt. |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2019 Brand New Day Dual Access Plan (HMO SNP)
| $34.80 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount |
H0838 -024 -0 | 0% | 0% | 25% | 25% | n/a
2019 Formulary |
|
|
|
|
2020 Brand New Day Dual Access Plan (HMO D-SNP)
| $32.00 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount | 0% | 25% | 25% | 25% | tbd |
|
2019 Brand New Day Embrace Choice Medi-Medi Plan (HMO SNP)
| $34.80 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount |
H0838 -040 -1 | 0% | 25% | 25% | 25% | n/a
2019 Formulary |
|
|
|
|
2020 Brand New Day Embrace Choice Plan (HMO C-SNP)
| $32.00 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount | 0% | 25% | 25% | 25% | tbd |
|
2019 Brand New Day Harmony Choice Plan (HMO SNP)
| $34.80 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount |
H0838 -020 -0 | 0% | 25% | 25% | 25% | n/a
2019 Formulary |
|
|
|
|
2020 Brand New Day Harmony Choice Plan (HMO C-SNP)
| $32.00 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount | 0% | 25% | 25% | 25% | tbd |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
MOOP Lmt. |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2019 Brand New Day Select Care Plan (HMO SNP)
| $34.80 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount |
H0838 -041 -0 | 0% | 25% | 25% | 25% | n/a
2019 Formulary |
|
|
|
|
2020 Brand New Day Select Care Plan (HMO I-SNP)
| $32.00 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount | 0% | 25% | 25% | 25% | tbd |
|
2019 Central Health Premier Plan (HMO)
| $34.80 |
$6,700 |
$415 | Yes, some additional gap coverage. |
H5649 -004 -0 | $0.00 | $0.00 | 25% | 25% | $6700
2019 Formulary |
|
-- |
|
|
2020 Central Health Premier Plan (HMO)
| $32.00 |
$6,700 |
$435 | Yes, some additional gap coverage. | $0.00 | $0.00 | 25% | 25% | $6700 2020 Formulary |
|
2019 Health Net Seniority Plus Amber I (HMO SNP)
| $34.80 |
n/a |
$320 | No additional gap coverage, only the Donut Hole Discount |
H0562 -055 -0 | $0.00 | $20.00 | $47.00 | $47.00 | n/a
2019 Formulary |
|
|
|
|
2020 Health Net Seniority Plus Amber I (HMO D-SNP)
| $32.00 |
n/a |
$350 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | tbd 2020 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
MOOP Lmt. |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2019 --
|
H0562 -121 -0 | | | | | |
|
|
|
|
2020 Health Net Seniority Plus Amber II (HMO D-SNP)
| $32.00 |
n/a |
$350 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | tbd 2020 Formulary |
|
2019 Health Net Seniority Plus Sapphire Premier (HMO)
| $34.80 |
$6,700 |
$285 | No additional gap coverage, only the Donut Hole Discount |
H3561 -002 -0 | $0.00 | $20.00 | $47.00 | $47.00 | $6700
2019 Formulary |
|
|
|
|
2020 Health Net Seniority Plus Sapphire Premier (HMO)
| $32.00 |
$6,700 |
$370 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | $6700 2020 Formulary |
|
2019 Health Net Seniority Plus Sapphire Premier II (HMO)
| $34.80 |
$6,700 |
$280 | No additional gap coverage, only the Donut Hole Discount |
H3561 -005 -0 | $0.00 | $20.00 | $47.00 | $47.00 | $6700
2019 Formulary |
|
|
|
|
2020 Health Net Seniority Plus Sapphire Premier II (HMO)
| $32.00 |
$6,700 |
$410 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | $6700 2020 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
MOOP Lmt. |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2019 --
|
H5496 -009 -0 | | | | | |
-- |
-- |
|
|
2020 Imperial Traditional Plus (HMO) (HMO)
| $32.00 |
$4,000 |
$435 | Yes, some additional gap coverage. | 0% | 25% | 25% | 25% | $4000 2020 Formulary |
|
-- This plan not offered in 2019 --
|
H0545 -015 -0 | | | | | |
|
|
|
|
2020 Inter Valley Health Plan Vitality Plus (HMO)
| $32.00 |
$5,900 |
$435 | No additional gap coverage, only the Donut Hole Discount | $0.00 | 25% | 25% | 25% | $5900 2020 Formulary |
|
2019 OneCare (HMO SNP)
| $33.70 |
n/a |
$0 | Yes, some additional gap coverage. |
H5433 -001 -0 | $0.00 | $0.00 | | | n/a
2019 Formulary |
|
|
|
|
2020 OneCare (HMO D-SNP)
| $32.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | | | tbd 2020 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
MOOP Lmt. |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2019 SCAN Plus (HMO)
| $34.80 |
$6,700 |
$415 | No additional gap coverage, only the Donut Hole Discount |
H5425 -045 -0 | $0.00 | 25% | 25% | 25% | $6700
2019 Formulary |
|
|
|
|
2020 SCAN Plus (HMO)
| $32.00 |
$6,700 |
$435 | No additional gap coverage, only the Donut Hole Discount | $0.00 | 25% | 25% | 25% | $6700 2020 Formulary |
|
2019 VillageHealth (HMO-POS SNP)
| $34.80 |
n/a |
$415 | No additional gap coverage, only the Donut Hole Discount |
H5943 -002 -0 | $0.00 | 25% | 25% | 25% | n/a
2019 Formulary |
|
-- |
|
|
2020 VillageHealth (HMO-POS C-SNP)
| $32.00 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount | $0.00 | 25% | 25% | 25% | tbd 2020 Formulary |
|
2019 Aetna Medicare Choice Plan (PPO)
| $73.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H5521 -056 -0 | $0.00 | $0.00 | $47.00 | $47.00 | $6700
2019 Formulary |
|
|
|
|
2020 Aetna Medicare Choice Plan (PPO)
| $98.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | $6700 2020 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
MOOP Lmt. |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2019 Anthem MediBlue Access (PPO)
| $159.00 |
$6,700 |
$370 | No additional gap coverage, only the Donut Hole Discount |
H8552 -020 -0 | $4.00 | $12.00 | $42.00 | $42.00 | $6700
2019 Formulary |
|
|
|
|
2020 Anthem MediBlue Access (PPO)
| $171.00 |
$6,700 |
$370 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $8.00 | $42.00 | $42.00 | $6700 2020 Formulary |
|
2019 Health Net Seniority Plus Amber II (HMO SNP)
| $34.80 |
n/a |
$300 | No additional gap coverage, only the Donut Hole Discount |
H0562 -110 -1 | $0.00 | $20.00 | $47.00 | $47.00 | n/a
2019 Formulary |
|
|
|
|
-- Members will be assigned to Health Net Seniority Plus Amber II (HMO D-SNP) H0562-121-0 --
| | | | | |
|
2019 Health Net Seniority Plus Sapphire (HMO)
| $34.80 |
$6,700 |
$340 | No additional gap coverage, only the Donut Hole Discount |
H0562 -111 -1 | $0.00 | $20.00 | $47.00 | $47.00 | $6700
2019 Formulary |
|
|
|
|
-- Members will be assigned to Health Net Seniority Plus Sapphire (HMO) H0562-122-0 --
| | | | | |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
MOOP Lmt. |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2019 Inter Valley Health Plan Value Preferred Choice (HMO)
| $34.80 |
$5,900 |
$415 | No additional gap coverage, only the Donut Hole Discount |
H0545 -014 -0 | $0.00 | 25% | 25% | 25% | $5900
2019 Formulary |
|
|
|
|
-- Members will be assigned to Inter Valley Health Plan Service To Seniors (HMO) H0545-001-0 --
| | | | | |
|
2019 Easy Choice Rx (HMO)
| $12.00 |
$2,000 |
$415 | Yes, some additional gap coverage. |
H5087 -023 -0 | $0.00 | $20.00 | $47.00 | $47.00 | $2000
2019 Formulary |
|
-- |
|
|
-- Members will be assigned to WellCare Best (HMO) H5087-005-0 --
| | | | | |
|
2019 Golden State (HMO)
| $0.00 |
$1,499 |
$0 | Yes, some additional gap coverage. |
H2241 -007 -1 | $5.00 | $10.00 | $45.00 | $45.00 | $1499
2019 Formulary |
|
|
|
|
-- This plan not offered in 2020 --
|
| | | | |
|