There are 92 Medicare Advantage plans meeting your criteria.
2020 / 2021 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 |
Parts A&B MOOP Limit |
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H0543 -215 -0 | | | | | |
|
|
|
|
2021 AARP Medicare Advantage Freedom Plus (HMO-POS)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | $1000 2021 Formulary |
|
2020 AARP Medicare Advantage SecureHorizons Essential (HMO)
| $0.00 |
$4,900 |
No Rx Coverage |
H0543 -121 -0 | This plan does NOT include Prescription Drug coverage. | $4900 |
|
|
|
|
2021 AARP Medicare Advantage Patriot (HMO)
| $0.00 |
$4,900 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | $4900 |
|
2020 AARP Medicare Advantage SecureHorizons Focus (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. |
H0543 -169 -0 | $0.00 | $9.00 | $47.00 | $47.00 | $1000
2020 Formulary |
|
|
|
|
2021 AARP Medicare Advantage SecureHorizons Focus (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | $1000 2021 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 |
2020 AARP Medicare Advantage SecureHorizons Plan 2 (HMO)
| $0.00 |
$2,200 |
$0 | Yes, some additional gap coverage. |
H0543 -138 -0 | $0.00 | $14.00 | $47.00 | $47.00 | $2200
2020 Formulary |
|
|
|
|
2021 AARP Medicare Advantage SecureHorizons Plan 2 (HMO)
| $0.00 |
$1,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $14.00 | $47.00 | $47.00 | $1900 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H4982 -013 -0 | | | | | |
new |
new |
new |
|
2021 Aetna Medicare Eagle Plan (HMO)
| $0.00 |
$4,200 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | $4200 |
|
2020 Aetna Medicare Plus Plan (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. |
H4982 -001 -0 | $0.00 | $0.00 | $42.00 | $42.00 | $999
2020 Formulary |
new |
new |
new |
|
2021 Aetna Medicare Plus Plan (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $37.00 | $37.00 | $999 2021 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 |
2020 Aetna Medicare Prime Plan (HMO)
| $0.00 |
$2,200 |
$0 | Yes, some additional gap coverage. |
H0523 -061 -0 | $0.00 | $10.00 | $47.00 | $47.00 | $2200
2020 Formulary |
|
|
|
|
2021 Aetna Medicare Prime Plan (HMO)
| $0.00 |
$2,200 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | $2200 2021 Formulary |
|
2020 Aetna Medicare Select Plan (HMO)
| $0.00 |
$2,000 |
$0 | Yes, some additional gap coverage. |
H0523 -002 -0 | $0.00 | $10.00 | $47.00 | $47.00 | $2000
2020 Formulary |
|
|
|
|
2021 Aetna Medicare Select Plan (HMO)
| $0.00 |
$2,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | $2000 2021 Formulary |
|
2020 Anthem MediBlue Care On Site (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0544 -005 -0 | $0.00 | $9.50 | $37.50 | $37.50 | n/a
2020 Formulary |
|
|
|
|
2021 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 2021 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 |
2020 Anthem MediBlue Diabetes (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0544 -004 -0 | $0.00 | $7.50 | $37.50 | $37.50 | n/a
2020 Formulary |
|
|
|
|
2021 Anthem MediBlue Diabetes Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $37.50 | $37.50 | tbd 2021 Formulary |
|
2020 Anthem MediBlue ESRD (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0544 -015 -0 | $0.00 | $7.50 | $37.50 | $37.50 | n/a
2020 Formulary |
|
|
|
|
2021 Anthem MediBlue ESRD Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $37.50 | $37.50 | tbd 2021 Formulary |
|
2020 Anthem MediBlue Heart (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0544 -013 -0 | $0.00 | $7.50 | $37.50 | $37.50 | n/a
2020 Formulary |
|
|
|
|
2021 Anthem MediBlue Heart Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $37.50 | $37.50 | tbd 2021 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 |
2020 Anthem MediBlue Breathe (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0544 -014 -0 | $0.00 | $7.50 | $37.50 | $37.50 | n/a
2020 Formulary |
|
|
|
|
2021 Anthem MediBlue Lung Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $37.50 | $37.50 | tbd 2021 Formulary |
|
2020 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
2020 Formulary |
|
|
|
|
2021 Anthem MediBlue Plus (HMO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $15.00 | $42.00 | $42.00 | $7550 2021 Formulary |
|
2020 Anthem MediBlue Select (HMO)
| $0.00 |
$900 |
$0 | Yes, some additional gap coverage. |
H0544 -059 -0 | $0.00 | $5.00 | $42.00 | $42.00 | $900
2020 Formulary |
|
|
|
|
2021 Anthem MediBlue Select (HMO)
| $0.00 |
$900 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | $900 2021 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 |
2020 Anthem MediBlue 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
2020 Formulary |
|
|
|
|
2021 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 2021 Formulary |
|
2020 Anthem MediBlue Value Plus (HMO)
| $0.00 |
$900 |
$0 | Yes, some additional gap coverage. |
H0544 -002 -0 | $0.00 | $9.50 | $37.50 | $37.50 | $900
2020 Formulary |
|
|
|
|
2021 Anthem MediBlue Value Plus (HMO)
| $0.00 |
$900 |
$0 | Yes, some additional gap coverage. | $0.00 | $9.50 | $37.50 | $37.50 | $900 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H1993 -001 -0 | | | | | |
new |
new |
new |
|
2021 Astiva Health Advantage (HMO)
| $0.00 |
$1,899 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $32.00 | $32.00 | $1899 2021 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 2020 --
|
H3815 -027 -0 | | | | | |
|
|
|
|
2021 AVA (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $40.00 | $40.00 | $999 2021 Formulary |
|
2020 Blue Shield 65 Plus (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. |
H0504 -015 -0 | $0.00 | $5.00 | $38.00 | $38.00 | $999
2020 Formulary |
|
|
|
|
2021 Blue Shield 65 Plus (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $38.00 | $38.00 | $999 2021 Formulary |
|
2020 Blue Shield 65 Plus Choice Plan (HMO)
| $0.00 |
$1,899 |
$0 | Yes, some additional gap coverage. |
H0504 -021 -0 | $0.00 | $10.00 | $40.00 | $40.00 | $1899
2020 Formulary |
|
|
|
|
2021 Blue Shield 65 Plus Plan 2 (HMO)
| $0.00 |
$1,899 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $40.00 | $40.00 | $1899 2021 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 |
2020 Blue Shield Promise AdvantageOptimum Plan (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. |
H5928 -004 -0 | $0.00 | $3.00 | $40.00 | $40.00 | $999
2020 Formulary |
|
|
|
|
2021 Blue Shield AdvantageOptimum Plan (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $40.00 | $40.00 | $999 2021 Formulary |
|
2020 Blue Shield Inspire (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. |
H0504 -043 -0 | $0.00 | $3.00 | $35.00 | $35.00 | $999
2020 Formulary |
|
|
|
|
2021 Blue Shield Inspire (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $35.00 | $35.00 | $999 2021 Formulary |
|
2020 Blue Shield Vital (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H0504 -044 -0 | $0.00 | $10.00 | $40.00 | $40.00 | $3400
2020 Formulary |
|
|
|
|
2021 Blue Shield Vital (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $40.00 | $40.00 | $3400 2021 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 |
2020 Brand New Day Bridges Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0838 -028 -0 | $0.00 | $9.00 | $45.00 | $45.00 | n/a |
|
|
|
|
2021 Brand New Day Bridges Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | tbd 2021 Formulary |
|
2020 Brand New Day Classic Care I Plan (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. |
H0838 -025 -0 | $0.00 | $9.00 | $47.00 | $47.00 | $999 |
|
|
|
|
2021 Brand New Day Classic Care I Plan (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | $999 2021 Formulary |
|
2020 Brand New Day Classic Care II Plan (HMO)
| $0.00 |
$999 |
$125 | Yes, some additional gap coverage. |
H0838 -037 -0 | $0.00 | $12.00 | $47.00 | $47.00 | $999 |
|
|
|
|
2021 Brand New Day Classic Care II Plan (HMO)
| $0.00 |
$999 |
$50 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | $999 2021 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 |
2020 Brand New Day Embrace Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0838 -039 -1 | $0.00 | $12.00 | $47.00 | $47.00 | n/a |
|
|
|
|
2021 Brand New Day Embrace Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $9.00 | $47.00 | $47.00 | tbd 2021 Formulary |
|
2020 Brand New Day Harmony Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$100 | Yes, some additional gap coverage. |
H0838 -032 -0 | $0.00 | $10.00 | $45.00 | $45.00 | n/a |
|
|
|
|
2021 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 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0838 -042 -0 | | | | | |
|
|
|
|
2021 Brand New Day Select Care I Plan (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $9.00 | $47.00 | $47.00 | tbd 2021 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 |
2020 Central Health Focus Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5649 -006 -0 | $0.00 | $0.00 | $35.00 | $35.00 | n/a
2020 Formulary |
|
-- |
|
|
2021 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 2021 Formulary |
|
2020 Central Health Medicare Plan (HMO)
| $0.00 |
$2,995 |
$0 | Yes, some additional gap coverage. |
H5649 -001 -0 | $0.00 | $0.00 | $35.00 | $35.00 | $2995
2020 Formulary |
|
-- |
|
|
2021 Central Health Medicare Plan (HMO)
| $0.00 |
$1,800 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | $1800 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H7607 -002 -2 | | | | | |
new |
new |
new |
|
2021 Clever Care Longevity Medicare Advantage (HMO)
| $0.00 |
$2,999 |
$0 | Yes, some additional gap coverage. | 0% | $5.00 | $35.00 | $35.00 | $2999 2021 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 |
2020 Connected Care (HMO)
| $0.00 |
$1,499 |
$0 | Yes, some additional gap coverage. |
H2241 -013 -0 | $0.00 | $10.00 | $45.00 | $45.00 | $1499
2020 Formulary |
|
|
|
|
2021 Connected Care (HMO)
| $0.00 |
$1,499 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $45.00 | $45.00 | $1499 2021 Formulary |
|
2020 Connected Care Select (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H2241 -019 -0 | $0.00 | $10.00 | $45.00 | $45.00 | n/a
2020 Formulary |
|
|
|
|
2021 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 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0562 -125 -0 | | | | | |
|
|
|
|
2021 Health Net Gold Select (HMO)
| $0.00 |
$850 |
$0 | Yes, some additional gap coverage. | $0.00 | $1.00 | $42.00 | $42.00 | $850 2021 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 |
2020 Health Net Jade (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0562 -092 -0 | $0.00 | $10.00 | $37.00 | $37.00 | n/a
2020 Formulary |
|
|
|
|
2021 Health Net Jade (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $42.00 | $42.00 | tbd 2021 Formulary |
|
2020 Alignment Health Plan Heart & Diabetes (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H3815 -010 -0 | $0.00 | $5.00 | $30.00 | $30.00 | n/a
2020 Formulary |
|
|
|
|
2021 Heart & Diabetes (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $30.00 | $30.00 | tbd 2021 Formulary |
|
2020 Humana Gold Plus H5619-021 (HMO)
| $0.00 |
$990 |
$0 | Yes, some additional gap coverage. |
H5619 -021 -0 | $0.00 | $0.00 | $35.00 | $35.00 | $990
2020 Formulary |
|
|
|
|
2021 Humana Gold Plus H5619-021 (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | $1000 2021 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 |
2020 Humana Honor (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H5619 -120 -0 | This plan does NOT include Prescription Drug coverage. | $6700 |
|
|
|
|
2021 Humana Honor (HMO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | $6700 |
|
-- This plan not offered in 2020 --
|
H5496 -012 -0 | | | | | |
new |
new |
|
|
2021 Imperial Dynamic Plan (HMO)
| $0.00 |
$899 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $30.00 | $30.00 | $899 2021 Formulary |
|
2020 Imperial Senior Value (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5496 -005 -0 | $0.00 | $5.00 | $45.00 | $45.00 | n/a
2020 Formulary |
new |
new |
|
|
2021 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 2021 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 |
2020 Imperial Traditional (HMO) (HMO)
| $0.00 |
$4,000 |
$0 | Yes, some additional gap coverage. |
H5496 -007 -0 | $0.00 | $5.00 | $45.00 | $45.00 | $4000
2020 Formulary |
new |
new |
|
|
2021 Imperial Traditional (HMO)
| $0.00 |
$2,999 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | $2999 2021 Formulary |
|
2020 Inter Valley Health Plan Service To Seniors (HMO)
| $0.00 |
$2,000 |
$0 | Yes, some additional gap coverage. |
H0545 -001 -0 | $0.00 | $5.00 | $47.00 | $47.00 | $2000
2020 Formulary |
|
|
|
|
2021 Inter Valley Health Plan Service To Seniors (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | $1000 2021 Formulary |
|
2020 Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
| $0.00 |
$4,000 |
$0 | Yes, some additional gap coverage. |
H0524 -003 -0 | $3.00 | $15.00 | $47.00 | $47.00 | $4000
2020 Formulary |
|
|
|
|
2021 Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $3.00 | $10.00 | $47.00 | $47.00 | $3400 2021 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 |
2020 Alignment Health Plan My Choice (HMO)
| $0.00 |
$3,200 |
$0 | Yes, some additional gap coverage. |
H3815 -001 -0 | $0.00 | $5.00 | $30.00 | $30.00 | $3200
2020 Formulary |
|
|
|
|
2021 My Choice (HMO)
| $0.00 |
$2,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $30.00 | $30.00 | $2400 2021 Formulary |
|
2020 OneCare Connect (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H8016 -001 -0 | 0% | 0% | 0% | | n/a
2020 Formulary |
-- |
-- |
-- |
|
2021 OneCare Connect (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics, All Brands | | | | | tbd 2021 Formulary |
|
2020 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
2020 Formulary |
|
|
|
|
2021 Platinum (HMO)
| $0.00 |
$800 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $30.00 | $30.00 | $800 2021 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 |
2020 SCAN Balance (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5425 -034 -0 | $0.00 | $2.00 | $30.00 | $30.00 | n/a
2020 Formulary |
|
|
|
|
2021 SCAN Balance (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $2.00 | $30.00 | $30.00 | tbd 2021 Formulary |
|
2020 SCAN Classic (HMO)
| $0.00 |
$899 |
$0 | Yes, some additional gap coverage. |
H5425 -007 -0 | $0.00 | $5.00 | $42.00 | $42.00 | $899
2020 Formulary |
|
|
|
|
2021 SCAN Classic (HMO)
| $0.00 |
$799 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $37.00 | $37.00 | $799 2021 Formulary |
|
2020 SCAN Healthy at Home (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H9104 -006 -0 | $0.00 | $5.00 | $42.00 | $42.00 | n/a
2020 Formulary |
-- |
-- |
-- |
|
2021 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 2021 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 |
2020 SCAN Heart First (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5425 -028 -0 | $0.00 | $2.00 | $42.00 | $42.00 | n/a
2020 Formulary |
|
|
|
|
2021 SCAN Heart First (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $2.00 | $37.00 | $37.00 | tbd 2021 Formulary |
|
2020 WellCare Best (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. |
H5087 -005 -0 | $0.00 | $0.00 | $25.00 | $25.00 | $2500
2020 Formulary |
|
-- |
|
|
2021 WellCare Best (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $25.00 | $25.00 | $1000 2021 Formulary |
|
2020 WellCare Dividend (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H5087 -025 -0 | $0.00 | $10.00 | $47.00 | $47.00 | $3400
2020 Formulary |
|
-- |
|
|
2021 WellCare Dividend (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | $2900 2021 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 |
2020 WellCare Plus (HMO)
| $0.00 |
$2,500 |
$435 | No additional gap coverage, only the Donut Hole Discount |
H5087 -002 -0 | $0.00 | $20.00 | $47.00 | $47.00 | $2500
2020 Formulary |
|
-- |
|
|
2021 WellCare Plus (HMO)
| $4.60 |
$2,500 |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | $2500 2021 Formulary |
|
2020 Anthem MediBlue Coordination Plus (HMO)
| $25.30 |
$6,700 |
$435 | Yes, some additional gap coverage. |
H0544 -072 -0 | $0.00 | $15.00 | $47.00 | $47.00 | $6700
2020 Formulary |
|
|
|
|
2021 Anthem MediBlue Coordination Plus (HMO)
| $12.20 |
$7,550 |
$445 | Yes, some additional gap coverage. | $0.00 | $15.00 | $47.00 | $47.00 | $7550 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0562 -123 -0 | | | | | |
|
|
|
|
2021 Health Net Healthy Heart (HMO)
| $17.00 |
$2,400 |
$0 | Yes, some additional gap coverage. | $1.00 | $8.00 | $42.00 | $42.00 | $2400 2021 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 |
2020 Alignment Health Plan CalPlus (HMO)
| $27.30 |
$6,700 |
$435 | No additional gap coverage, only the Donut Hole Discount |
H3815 -009 -0 | $0.00 | $14.00 | 25% | 25% | $6700
2020 Formulary |
|
|
|
|
2021 CalPlus (HMO)
| $20.10 |
$4,900 |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $14.00 | 23% | 23% | $4900 2021 Formulary |
|
2020 Humana Value Plus H5619-037 (HMO)
| $16.80 |
$6,700 |
$435 | No additional gap coverage, only the Donut Hole Discount |
H5619 -037 -0 | $0.00 | $19.00 | $47.00 | $47.00 | $6700
2020 Formulary |
|
|
|
|
2021 Humana Value Plus H5619-037 (HMO)
| $20.40 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $19.00 | $47.00 | $47.00 | $7550 2021 Formulary |
|
2020 UnitedHealthcare Medicare Advantage Assure (HMO)
| $14.90 |
$6,700 |
$435 | No additional gap coverage, only the Donut Hole Discount |
H0543 -153 -0 | 25% | 25% | 25% | 25% | $6700
2020 Formulary |
|
|
|
|
2021 UnitedHealthcare Medicare Advantage Assure (HMO)
| $22.50 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | $7550 2021 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 2020 --
|
H0544 -122 -1 | | | | | |
|
|
|
|
2021 Anthem MediBlue Connect Plus (HMO)
| $23.50 |
$7,550 |
$445 | Yes, some additional gap coverage. | 25% | 25% | 25% | 25% | $7550 2021 Formulary |
|
2020 Health Net Seniority Plus Sapphire Premier (HMO)
| $32.00 |
$6,700 |
$370 | No additional gap coverage, only the Donut Hole Discount |
H3561 -002 -0 | $0.00 | $20.00 | $47.00 | $47.00 | $6700
2020 Formulary |
|
|
|
|
2021 Health Net Sapphire Premier (HMO)
| $25.40 |
$3,450 |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | $3450 2021 Formulary |
|
2020 SCAN Prime (HMO)
| $26.00 |
$800 |
$0 | Yes, some additional gap coverage. |
H5425 -066 -0 | $0.00 | $5.00 | $42.00 | $42.00 | $800
2020 Formulary |
|
|
|
|
2021 SCAN Prime (HMO)
| $26.00 |
$699 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $37.00 | $37.00 | $699 2021 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 |
2020 Health Net Seniority Plus Amber II (HMO D-SNP)
| $32.00 |
n/a |
$350 | No additional gap coverage, only the Donut Hole Discount |
H0562 -121 -0 | $0.00 | $20.00 | $47.00 | $47.00 | n/a
2020 Formulary |
|
|
|
|
2021 Health Net Amber II (HMO D-SNP)
| $26.60 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | tbd 2021 Formulary |
|
2020 Health Net Seniority Plus Sapphire Premier II (HMO)
| $32.00 |
$6,700 |
$410 | No additional gap coverage, only the Donut Hole Discount |
H3561 -005 -0 | $0.00 | $20.00 | $47.00 | $47.00 | $6700
2020 Formulary |
|
|
|
|
2021 Health Net Sapphire Premier II (HMO)
| $26.70 |
$3,450 |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | $3450 2021 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 |
H0562 -055 -0 | $0.00 | $20.00 | $47.00 | $47.00 | n/a
2020 Formulary |
|
|
|
|
2021 Health Net Amber I (HMO D-SNP)
| $27.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | tbd 2021 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 |
2020 AARP Medicare Advantage SecureHorizons Premier (HMO)
| $26.00 |
$1,000 |
$0 | Yes, some additional gap coverage. |
H0543 -165 -0 | $0.00 | $9.00 | $47.00 | $47.00 | $1000
2020 Formulary |
|
|
|
|
2021 AARP Medicare Advantage SecureHorizons Premier (HMO)
| $28.20 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $9.00 | $47.00 | $47.00 | $1000 2021 Formulary |
|
2020 Health Net Seniority Plus Sapphire (HMO)
| $0.00 |
$4,500 |
$370 | No additional gap coverage, only the Donut Hole Discount |
H0562 -122 -0 | $0.00 | $20.00 | $47.00 | $47.00 | $4500
2020 Formulary |
|
|
|
|
2021 Health Net Sapphire (HMO)
| $28.50 |
$3,450 |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | $3450 2021 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 |
H0524 -029 -0 | 15% | 15% | 15% | 15% | n/a
2020 Formulary |
|
|
|
|
2021 Senior Advantage Medicare Medi-Cal Plan South (HMO D-SNP)
| $30.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | tbd 2021 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 |
2020 Anthem MediBlue Extra (HMO)
| $14.40 |
$900 |
$435 | Yes, some additional gap coverage. |
H0544 -081 -0 | $0.00 | $2.00 | $47.00 | $47.00 | $900
2020 Formulary |
|
|
|
|
2021 Anthem MediBlue Extra (HMO)
| $31.50 |
$900 |
$445 | Yes, some additional gap coverage. | $0.00 | $2.00 | $47.00 | $47.00 | $900 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H1993 -002 -0 | | | | | |
new |
new |
new |
|
2021 Astiva Health Value (HMO)
| $31.50 |
$7,550 |
$445 | Yes, some additional gap coverage. | $0.00 | $0.00 | 25% | 25% | $7550 2021 Formulary |
|
2020 Blue Shield Promise Coordinated Choice Plan (HMO)
| $32.00 |
$6,700 |
$435 | Yes, some additional gap coverage. |
H5928 -037 -0 | $0.00 | 25% | 25% | 25% | $6700
2020 Formulary |
|
|
|
|
2021 Blue Shield Coordinated Choice Plan (HMO)
| $31.50 |
$6,700 |
$445 | Yes, some additional gap coverage. | $0.00 | 25% | 25% | 25% | $6700 2021 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 |
2020 Blue Shield Promise TotalDual Plan (HMO D-SNP)
| $32.00 |
n/a |
$435 | Yes, some additional gap coverage. |
H5928 -005 -0 | $0.00 | 25% | 25% | 25% | n/a
2020 Formulary |
|
|
|
|
2021 Blue Shield TotalDual Plan (HMO D-SNP)
| $31.50 |
n/a |
$445 | Yes, some additional gap coverage. | $0.00 | 25% | 25% | 25% | tbd 2021 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 |
H0838 -029 -0 | 0% | 25% | 25% | 25% | n/a |
|
|
|
|
2021 Brand New Day Bridges Choice Plan (HMO C-SNP)
| $31.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | 0% | 25% | 25% | 25% | tbd 2021 Formulary |
|
2020 Brand New Day Classic Choice Plan (HMO)
| $32.00 |
$6,700 |
$435 | No additional gap coverage, only the Donut Hole Discount |
H0838 -033 -0 | 0% | 25% | 25% | 25% | $6700 |
|
|
|
|
2021 Brand New Day Classic Choice Plan (HMO)
| $31.50 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount | 0% | 25% | 25% | 25% | $7550 2021 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 |
2020 Brand New Day Dual Access Plan (HMO D-SNP)
| $32.00 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H0838 -024 -0 | 0% | 25% | 25% | 25% | n/a |
|
|
|
|
2021 Brand New Day Dual Access Plan (HMO D-SNP)
| $31.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | 0% | 25% | 25% | 25% | tbd 2021 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 |
H0838 -040 -1 | 0% | 25% | 25% | 25% | n/a |
|
|
|
|
2021 Brand New Day Embrace Choice Plan (HMO C-SNP)
| $31.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | 0% | 25% | 25% | 25% | tbd 2021 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 |
H0838 -020 -0 | 0% | 25% | 25% | 25% | n/a |
|
|
|
|
2021 Brand New Day Harmony Choice Plan (HMO C-SNP)
| $31.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | 0% | 25% | 25% | 25% | tbd 2021 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 2020 --
|
H0838 -044 -0 | | | | | |
|
|
|
|
2021 Brand New Day Select Choice I Plan (HMO I-SNP)
| $31.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | 0% | 25% | 25% | 25% | tbd 2021 Formulary |
|
2020 Central Health Premier Plan (HMO)
| $32.00 |
$6,700 |
$435 | Yes, some additional gap coverage. |
H5649 -004 -0 | $0.00 | $0.00 | 25% | 25% | $6700
2020 Formulary |
|
-- |
|
|
2021 Central Health Premier Plan (HMO)
| $31.50 |
$6,700 |
$445 | Yes, some additional gap coverage. | $0.00 | $0.00 | 25% | 25% | $6700 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H7607 -003 -2 | | | | | |
new |
new |
new |
|
2021 Clever Care Balance Medicare Advantage (HMO)
| $31.50 |
$7,550 |
$435 | Yes, some additional gap coverage. | 0% | 25% | 25% | 25% | $7550 2021 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 |
2020 Imperial Traditional Plus (HMO) (HMO)
| $32.00 |
$4,000 |
$435 | Yes, some additional gap coverage. |
H5496 -009 -0 | 0% | 25% | 25% | 25% | $4000
2020 Formulary |
new |
new |
|
|
2021 Imperial Traditional Plus (HMO)
| $31.50 |
$2,999 |
$445 | Yes, some additional gap coverage. | 0% | 25% | 25% | 25% | $2999 2021 Formulary |
|
2020 Inter Valley Health Plan Vitality Plus (HMO)
| $32.00 |
$5,900 |
$435 | No additional gap coverage, only the Donut Hole Discount |
H0545 -015 -0 | $0.00 | 25% | 25% | 25% | $5900
2020 Formulary |
|
|
|
|
2021 Inter Valley Health Plan Vitality Plus (HMO)
| $31.50 |
$5,900 |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | 25% | 25% | 25% | $5900 2021 Formulary |
|
2020 OneCare (HMO D-SNP)
| $32.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5433 -001 -0 | $0.00 | $0.00 | | | n/a
2020 Formulary |
|
|
|
|
2021 OneCare (HMO D-SNP)
| $31.50 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | | | | tbd 2021 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 |
2020 SCAN Plus (HMO)
| $32.00 |
$6,700 |
$435 | No additional gap coverage, only the Donut Hole Discount |
H5425 -045 -0 | $0.00 | 25% | 25% | 25% | $6700
2020 Formulary |
|
|
|
|
2021 SCAN Plus (HMO)
| $31.50 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | 25% | 25% | 25% | $7550 2021 Formulary |
|
2020 Aetna Medicare Choice Plan (PPO)
| $98.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H5521 -056 -0 | $0.00 | $0.00 | $47.00 | $47.00 | $6700
2020 Formulary |
|
|
|
|
2021 Aetna Medicare Choice Plan (PPO)
| $89.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | $7550 2021 Formulary |
|
2020 Anthem MediBlue Access (PPO)
| $171.00 |
$6,700 |
$370 | No additional gap coverage, only the Donut Hole Discount |
H8552 -020 -0 | $4.00 | $8.00 | $42.00 | $42.00 | $6700
2020 Formulary |
|
|
|
|
2021 Anthem MediBlue Access (PPO)
| $172.00 |
$6,700 |
$370 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $8.00 | $42.00 | $42.00 | $6700 2021 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 |
2020 Anthem MediBlue Connect Plus (HMO)
| $20.20 |
$6,700 |
$435 | Yes, some additional gap coverage. |
H0544 -049 -0 | 25% | 25% | 25% | 25% | $6700
2020 Formulary |
|
|
|
|
-- Members will be assigned to Anthem MediBlue Connect Plus (HMO) H0544-122-1 --
| | | | | |
|
2020 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
2020 Formulary |
|
|
|
|
-- Members will be assigned to Health Net Healthy Heart (HMO) H0562-123-0 --
| | | | | |
|
2020 Health Net Gold Select (HMO)
| $0.00 |
$899 |
$0 | Yes, some additional gap coverage. |
H0562 -101 -1 | $0.00 | $10.00 | $37.00 | $37.00 | $899
2020 Formulary |
|
|
|
|
-- This plan not offered in 2021 --
|
| | | | |
|
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 |
2020 Brand New Day Select Care Plan (HMO I-SNP)
| $32.00 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H0838 -041 -0 | 0% | 25% | 25% | 25% | n/a |
|
|
|
|
-- This plan not offered in 2021 --
|
| | | | |
|
2020 VillageHealth (HMO-POS C-SNP)
| $32.00 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H5943 -002 -0 | $0.00 | 25% | 25% | 25% | n/a
2020 Formulary |
|
-- |
-- |
|
-- This plan not offered in 2021 --
|
| | | | |
|