There are 88 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 |
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 2020 --
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H1924 -001 -0 | | | | | |
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2021 Lasso Healthcare Growth (MSA)
| $0.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2020 --
|
H1924 -004 -0 | | | | | |
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2021 Lasso Healthcare Growth Plus (MSA)
| $0.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2020 AARP Medicare Advantage (HMO-POS)
| $0.00 |
$4,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H1045 -028 -0 | $3.00 | $10.00 | $45.00 | $45.00 | 3,601
2020 Formulary |
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2021 AARP Medicare Advantage (HMO-POS)
| $0.00 |
$4,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $10.00 | $45.00 | $45.00 | 3,604 2021 Formulary |
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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 |
2020 AARP Medicare Advantage Choice (PPO)
| $0.00 |
$5,500 |
$150 | No additional gap coverage, only the Donut Hole Discount |
H2406 -011 -0 | $3.00 | $10.00 | $45.00 | $45.00 | 3,601
2020 Formulary |
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|
|
|
2021 AARP Medicare Advantage Choice (PPO)
| $0.00 |
$5,500 |
$150 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $10.00 | $45.00 | $45.00 | 3,604 2021 Formulary |
|
2020 AARP Medicare Advantage Choice Plan 2 (Regional PPO)
| $0.00 |
$6,700 |
$395 | No additional gap coverage, only the Donut Hole Discount |
R0759 -001 -0 | $3.00 | $14.00 | $47.00 | $47.00 | 3,601
2020 Formulary |
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2021 AARP Medicare Advantage Choice Plan 2 (Regional PPO)
| $0.00 |
$6,700 |
$395 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $14.00 | $47.00 | $47.00 | 3,604 2021 Formulary |
|
2020 AARP Medicare Advantage Focus (HMO-POS)
| $0.00 |
$3,900 |
$0 | Yes, some additional gap coverage. |
H1045 -045 -0 | $3.00 | $10.00 | $45.00 | $45.00 | 3,601
2020 Formulary |
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|
|
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2021 AARP Medicare Advantage Focus (HMO-POS)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $3.00 | $10.00 | $45.00 | $45.00 | 3,604 2021 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 |
2020 AARP Medicare Advantage Choice Essential (Regional PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
R0759 -002 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2021 AARP Medicare Advantage Patriot (Regional PPO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2020 Aetna Medicare Choice (HMO-POS)
| $0.00 |
$6,700 |
$195 | Yes, some additional gap coverage. |
H1609 -028 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,763
2020 Formulary |
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|
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2021 Aetna Medicare Choice (HMO-POS)
| $0.00 |
$6,700 |
$195 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,659 2021 Formulary |
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-- This plan not offered in 2020 --
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H5521 -308 -0 | | | | | |
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2021 Aetna Medicare Eagle (PPO)
| $0.00 |
$5,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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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 |
2020 Aetna Medicare Premier (PPO)
| $0.00 |
$6,700 |
$300 | Yes, some additional gap coverage. |
H5521 -033 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,763
2020 Formulary |
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|
|
|
2021 Aetna Medicare Premier (PPO)
| $0.00 |
$6,700 |
$300 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,659 2021 Formulary |
|
2020 Aetna Medicare Premier Plus (PPO)
| $0.00 |
$5,500 |
$150 | Yes, some additional gap coverage. |
H5521 -270 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,763
2020 Formulary |
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|
|
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2021 Aetna Medicare Premier Plus (PPO)
| $0.00 |
$5,500 |
$150 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,659 2021 Formulary |
|
2020 Aetna Medicare Select (HMO)
| $0.00 |
$3,150 |
$0 | Yes, some additional gap coverage. |
H1609 -022 -0 | $0.00 | $0.00 | $35.00 | $35.00 | 3,880
2020 Formulary |
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2021 Aetna Medicare Select (HMO)
| $0.00 |
$3,150 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,682 2021 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 |
2020 BayCarePlus Complete (HMO)
| $0.00 |
$3,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2235 -001 -0 | $0.00 | $4.00 | $35.00 | $35.00 | 3,575
2020 Formulary |
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new |
|
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2021 BayCarePlus Complete (HMO)
| $0.00 |
$3,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $4.00 | $35.00 | $35.00 | 3,560 2021 Formulary |
|
2020 BayCarePlus Rewards (HMO)
| $0.00 |
$5,300 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2235 -002 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,575
2020 Formulary |
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new |
|
|
2021 BayCarePlus Rewards (HMO)
| $0.00 |
$4,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,560 2021 Formulary |
|
2020 BlueMedicare Classic (HMO)
| $0.00 |
$5,000 |
$0 | Yes, some additional gap coverage. |
H1035 -021 -0 | $2.00 | $10.00 | $40.00 | $40.00 | 3,308
2020 Formulary |
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2021 BlueMedicare Classic (HMO)
| $0.00 |
$4,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $40.00 | $40.00 | 3,450 2021 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 |
2020 BlueMedicare Classic Plus (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. |
H1035 -023 -0 | $0.00 | $0.00 | $25.00 | $25.00 | 4,205
2020 Formulary |
|
|
|
|
2021 BlueMedicare Premier (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $25.00 | $25.00 | 4,319 2021 Formulary |
|
2020 BlueMedicare Saver (HMO)
| $0.00 |
$6,700 |
$50 | Yes, some additional gap coverage. |
H1035 -037 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 2,665
2020 Formulary |
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|
|
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2021 BlueMedicare Saver (HMO)
| $0.00 |
$6,700 |
$50 | Yes, some additional gap coverage. | $3.00 | $12.00 | $47.00 | $47.00 | 2,744 2021 Formulary |
|
2020 BlueMedicare Value (PPO)
| $0.00 |
$4,500 |
$150 | Yes, some additional gap coverage. |
H5434 -034 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 2,665
2020 Formulary |
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|
|
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2021 BlueMedicare Value (PPO)
| $0.00 |
$4,500 |
$150 | Yes, some additional gap coverage. | $3.00 | $12.00 | $47.00 | $47.00 | 2,744 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H1019 -107 -0 | | | | | |
|
|
|
|
2021 CareComplete (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $35.00 | $35.00 | 3,382 2021 Formulary |
|
2020 CareFree (HMO)
| $0.00 |
$2,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H1019 -104 -1 | $0.00 | $0.00 | $35.00 | $35.00 | 3,369
2020 Formulary |
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|
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2021 CareFree (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $35.00 | $35.00 | 3,382 2021 Formulary |
|
2020 CareOne PLUS (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. |
H1019 -103 -1 | $0.00 | $0.00 | $10.00 | $10.00 | 3,369
2020 Formulary |
|
|
|
|
2021 CareOne PLUS (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $5.00 | $5.00 | 3,382 2021 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 |
2020 Cigna-HealthSpring Preferred (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5410 -024 -0 | $0.00 | $0.00 | $35.00 | $35.00 | 3,383
2020 Formulary |
|
|
|
|
2021 Cigna Preferred Medicare (HMO)
| $0.00 |
$3,750 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $35.00 | $35.00 | 3,446 2021 Formulary |
|
2020 Cigna-HealthSpring Preferred Part B Savings (HMO)
| $0.00 |
$4,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5410 -026 -0 | $0.00 | $4.00 | $42.00 | $42.00 | 3,383
2020 Formulary |
|
|
|
|
2021 Cigna Preferred Savings Medicare (HMO)
| $0.00 |
$3,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $4.00 | $42.00 | $42.00 | 3,446 2021 Formulary |
|
2020 Devoted Health Greater Tampa Bay (HMO)
| $0.00 |
$2,400 |
$0 | Yes, some additional gap coverage. |
H1290 -004 -0 | $0.00 | $0.00 | $5.00 | $5.00 | 3,275
2020 Formulary |
|
new |
|
|
2021 Devoted Health Core Greater Tampa Bay (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $8.00 | $8.00 | 3,173 2021 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 |
2020 Devoted Health Essentials Greater Tampa Bay (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H1290 -017 -0 | $0.00 | $7.00 | $47.00 | $47.00 | 3,275
2020 Formulary |
|
new |
|
|
2021 Devoted Health Essentials Polk (HMO)
| $0.00 |
$4,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $7.00 | $47.00 | $47.00 | 3,173 2021 Formulary |
|
2020 Freedom Platinum Plan Rx (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. |
H5427 -092 -0 | $0.00 | $30.00 | $70.00 | $70.00 | 3,302
2020 Formulary |
|
|
|
|
2021 Freedom Platinum Plan Rx (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $30.00 | $70.00 | $70.00 | 3,322 2021 Formulary |
|
2020 Freedom Savings Plan (HMO)
| $0.00 |
$3,400 |
No Rx Coverage |
H5427 -052 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2021 Freedom Savings Plan (HMO)
| $0.00 |
$3,400 |
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 |
2020 Freedom VIP Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5427 -070 -0 | $0.00 | $20.00 | $60.00 | $60.00 | 3,302
2020 Formulary |
|
|
|
|
2021 Freedom VIP Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $20.00 | $60.00 | $60.00 | 3,327 2021 Formulary |
|
2020 Freedom VIP Rewards (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5427 -099 -0 | $0.00 | $40.00 | $90.00 | $90.00 | 3,302
2020 Formulary |
|
|
|
|
2021 Freedom VIP Rewards (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $40.00 | $90.00 | $90.00 | 3,327 2021 Formulary |
|
2020 Freedom VIP Savings (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5427 -072 -0 | $0.00 | $30.00 | $80.00 | $80.00 | 3,302
2020 Formulary |
|
|
|
|
2021 Freedom VIP Savings (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $30.00 | $80.00 | $80.00 | 3,327 2021 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 |
2020 Freedom VIP Savings COPD (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5427 -077 -0 | $0.00 | $20.00 | $60.00 | $60.00 | 3,302
2020 Formulary |
|
|
|
|
2021 Freedom VIP Savings COPD (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $20.00 | $60.00 | $60.00 | 3,322 2021 Formulary |
|
2020 Humana Gold Plus H1036-230 (HMO)
| $0.00 |
$2,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H1036 -230 -0 | $0.00 | $5.00 | $30.00 | $30.00 | 3,369
2020 Formulary |
|
|
|
|
2021 Humana Gold Plus H1036-230 (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $30.00 | $30.00 | 3,382 2021 Formulary |
|
2020 Humana Gold Plus H1036-268 (HMO)
| $0.00 |
$4,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H1036 -268 -0 | $0.00 | $15.00 | $45.00 | $45.00 | 3,369
2020 Formulary |
|
|
|
|
2021 Humana Gold Plus H1036-268 (HMO)
| $0.00 |
$4,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $45.00 | $45.00 | 3,382 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H1036 -289 -0 | | | | | |
|
|
|
|
2021 Humana Honor (HMO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2020 HumanaChoice Florida H5216-072 (PPO)
| $0.00 |
$4,900 |
$150 | No additional gap coverage, only the Donut Hole Discount |
H5216 -072 -0 | $2.00 | $10.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
2021 HumanaChoice Florida H5216-072 (PPO)
| $0.00 |
$4,900 |
$150 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $10.00 | $47.00 | $47.00 | 3,386 2021 Formulary |
|
2020 HumanaChoice R5826-018 (Regional PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
R5826 -018 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2021 HumanaChoice R5826-018 (Regional PPO)
| $0.00 |
$7,550 |
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 |
2020 HumanaChoice R5826-074 (Regional PPO)
| $0.00 |
$6,700 |
$395 | No additional gap coverage, only the Donut Hole Discount |
R5826 -074 -0 | $6.00 | $20.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
2021 HumanaChoice R5826-074 (Regional PPO)
| $0.00 |
$7,550 |
$395 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $20.00 | $47.00 | $47.00 | 3,386 2021 Formulary |
|
2020 Optimum Diamond Rewards (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5594 -030 -0 | $0.00 | $30.00 | $80.00 | $80.00 | 3,302
2020 Formulary |
|
|
|
|
2021 Optimum Diamond Rewards (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $30.00 | $80.00 | $80.00 | 3,327 2021 Formulary |
|
2020 Optimum Diamond Rewards COPD (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5594 -031 -0 | $0.00 | $30.00 | $80.00 | $80.00 | 3,302
2020 Formulary |
|
|
|
|
2021 Optimum Diamond Rewards COPD (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $30.00 | $80.00 | $80.00 | 3,322 2021 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 |
2020 Optimum Platinum Plan (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H5594 -019 -0 | $0.00 | $35.00 | $85.00 | $85.00 | 3,302
2020 Formulary |
|
|
|
|
2021 Optimum Platinum Plan (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $35.00 | $85.00 | $85.00 | 3,322 2021 Formulary |
|
2020 Simply Level (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5471 -070 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,911
2020 Formulary |
|
|
|
|
2021 Simply Level (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $0.00 | $0.00 | 3,912 2021 Formulary |
|
2020 Simply More (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H5471 -071 -0 | $0.00 | $0.00 | $10.00 | $10.00 | 3,911
2020 Formulary |
|
|
|
|
2021 Simply More (HMO)
| $0.00 |
$3,450 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $10.00 | $10.00 | 3,912 2021 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 |
2020 UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP)
| $0.00 |
n/a |
$150 | No additional gap coverage, only the Donut Hole Discount |
H1045 -048 -3 | $0.00 | $5.00 | $47.00 | $47.00 | 3,601
2020 Formulary |
|
|
|
|
2021 UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP)
| $0.00 |
n/a |
$150 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $47.00 | $47.00 | 3,604 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H1032 -203 -0 | | | | | |
|
|
|
|
2021 WellCare Champion (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $10.00 | $10.00 | 3,348 2021 Formulary |
|
2020 WellCare Dividend Prime (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H1032 -200 -0 | $0.00 | $10.00 | $35.00 | $35.00 | 3,274
2020 Formulary |
|
|
|
|
2021 WellCare Dividend Prime (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $35.00 | $35.00 | 3,348 2021 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 |
2020 WellCare Elite (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H1032 -201 -0 | $0.00 | $0.00 | $15.00 | $15.00 | 3,274
2020 Formulary |
|
|
|
|
2021 WellCare Elite (HMO)
| $0.00 |
$1,200 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $5.00 | $5.00 | 3,348 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H1032 -184 -0 | | | | | |
|
|
|
|
2021 WellCare Guardian (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $10.00 | $10.00 | 3,348 2021 Formulary |
|
2020 WellCare Premier (PPO)
| $0.00 |
$3,400 |
$100 | Yes, some additional gap coverage. |
H5199 -012 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,274
2020 Formulary |
new |
new |
|
|
2021 WellCare Premier (PPO)
| $0.00 |
$3,400 |
$100 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,348 2021 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 |
2020 Simply Care (HMO I-SNP)
| $28.50 |
n/a |
$435 | Yes, some additional gap coverage. |
H5471 -090 -0 | $0.00 | $10.00 | 25% | 25% | 3,911
2020 Formulary |
|
|
|
|
2021 Simply Care (HMO I-SNP)
| $10.00 |
n/a |
$445 | Yes, some additional gap coverage. | $0.00 | $10.00 | 25% | 25% | 3,912 2021 Formulary |
|
2020 CareNeeds PLUS (HMO D-SNP)
| $3.90 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H1019 -026 -0 | $0.00 | $6.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
2021 CareNeeds PLUS (HMO D-SNP)
| $14.00 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $4.00 | $47.00 | $47.00 | 3,382 2021 Formulary |
|
2020 Cigna-HealthSpring TotalCare (HMO D-SNP)
| $12.10 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H5410 -025 -0 | 15% | 15% | 15% | 15% | 3,383
2020 Formulary |
|
|
|
|
2021 Cigna TotalCare (HMO D-SNP)
| $18.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $1.00 | $15.00 | 17% | 17% | 3,446 2021 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 |
2020 Cigna-HealthSpring Primary (HMO)
| $11.00 |
$3,400 |
$435 | No additional gap coverage, only the Donut Hole Discount |
H5410 -033 -0 | 25% | 25% | 25% | 25% | 3,383
2020 Formulary |
|
|
|
|
2021 Cigna Primary Medicare (HMO)
| $18.90 |
$3,500 |
$445 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | 18% | 18% | 3,446 2021 Formulary |
|
2020 Humana Fully Integrated H1036-283 (HMO D-SNP)
| $18.80 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H1036 -283 -0 | $0.00 | $3.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
2021 Humana Fully Integrated H1036-283 (HMO D-SNP)
| $19.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $3.00 | $47.00 | $47.00 | 3,382 2021 Formulary |
|
2020 Humana Gold Plus SNP-DE H1036-231 (HMO D-SNP)
| $19.30 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H1036 -231 -0 | $0.00 | $1.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
2021 Humana Gold Plus SNP-DE H1036-231 (HMO D-SNP)
| $22.00 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $1.00 | $47.00 | $47.00 | 3,382 2021 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 |
2020 Allwell Dual Medicare (HMO D-SNP)
| $28.50 |
n/a |
$435 | Yes, some additional gap coverage. |
H5190 -002 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,451
2020 Formulary |
|
-- |
|
|
2021 Allwell Dual Medicare (HMO D-SNP)
| $25.00 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $47.00 | $47.00 | 3,352 2021 Formulary |
|
2020 Aetna Medicare Assure Plus (HMO D-SNP)
| $28.50 |
n/a |
$250 | Yes, some additional gap coverage. |
H1609 -049 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,880
2020 Formulary |
|
|
|
|
2021 Aetna Medicare Assure Plus (HMO D-SNP)
| $28.00 |
n/a |
$250 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $47.00 | $47.00 | 3,682 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H2235 -004 -0 | | | | | |
|
new |
|
|
2021 BayCarePlus Signature (HMO)
| $28.00 |
$2,800 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $35.00 | $35.00 | 3,560 2021 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 |
2020 WellCare Access (HMO D-SNP)
| $24.20 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H1032 -124 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,274
2020 Formulary |
|
|
|
|
2021 WellCare Access (HMO D-SNP)
| $28.10 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $47.00 | $47.00 | 3,348 2021 Formulary |
|
2020 WellCare Reserve (HMO D-SNP)
| $22.80 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H1032 -202 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,274
2020 Formulary |
|
|
|
|
2021 WellCare Reserve (HMO D-SNP)
| $28.60 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $47.00 | $47.00 | 3,348 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H1032 -229 -1 | | | | | |
|
|
|
|
2021 WellCare Select (HMO D-SNP)
| $29.40 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $47.00 | $47.00 | 3,348 2021 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 |
2020 WellCare Liberty (HMO D-SNP)
| $26.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H1032 -175 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,274
2020 Formulary |
|
|
|
|
2021 WellCare Liberty (HMO D-SNP)
| $30.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $47.00 | $47.00 | 3,348 2021 Formulary |
|
2020 Aetna Medicare Assure (HMO D-SNP)
| $28.50 |
n/a |
$250 | Yes, some additional gap coverage. |
H1609 -019 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,880
2020 Formulary |
|
|
|
|
2021 Aetna Medicare Assure (HMO D-SNP)
| $30.80 |
n/a |
$250 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $47.00 | $47.00 | 3,682 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H5190 -005 -0 | | | | | |
|
-- |
|
|
2021 Allwell Medicare Nurture (HMO D-SNP)
| $30.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $1.00 | $20.00 | $47.00 | $47.00 | 3,352 2021 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 |
2020 BlueMedicare Complete (HMO D-SNP)
| $28.50 |
n/a |
$435 | Yes, some additional gap coverage. |
H1035 -030 -0 | $0.00 | $0.00 | $40.00 | $40.00 | 4,205
2020 Formulary |
|
|
|
|
2021 BlueMedicare Complete (HMO D-SNP)
| $30.80 |
n/a |
$445 | Yes, some additional gap coverage. | $0.00 | $0.00 | $40.00 | $40.00 | 4,319 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H1290 -024 -0 | | | | | |
|
new |
|
|
2021 Devoted Health Dual Greater Tampa Bay (HMO D-SNP)
| $30.80 |
n/a |
$445 | Yes, some additional gap coverage. | $0.00 | $0.00 | 25% | 25% | 3,173 2021 Formulary |
|
2020 Devoted Health Prime Greater Tampa Bay (HMO)
| $28.50 |
$3,400 |
$435 | No additional gap coverage, only the Donut Hole Discount |
H1290 -009 -0 | $0.00 | $0.00 | 25% | 25% | 3,275
2020 Formulary |
|
new |
|
|
2021 Devoted Health Prime Greater Tampa Bay (HMO)
| $30.80 |
$3,400 |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | 25% | 25% | 3,173 2021 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 |
2020 Freedom Medi-Medi Full (HMO D-SNP)
| $28.50 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H5427 -087 -0 | $0.00 | $45.00 | $95.00 | $95.00 | 3,302
2020 Formulary |
|
|
|
|
2021 Freedom Medi-Medi Full (HMO D-SNP)
| $30.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $45.00 | $95.00 | $95.00 | 3,322 2021 Formulary |
|
2020 Freedom Medi-Medi Partial (HMO D-SNP)
| $28.50 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H5427 -078 -0 | $0.00 | $45.00 | $95.00 | $95.00 | 3,302
2020 Formulary |
|
|
|
|
2021 Freedom Medi-Medi Partial (HMO D-SNP)
| $30.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $45.00 | $95.00 | $95.00 | 3,322 2021 Formulary |
|
2020 Longevity Health Plan (HMO I-SNP)
| $28.50 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H1644 -001 -0 | 25% | | | | 3,717
2020 Formulary |
new |
new |
new |
|
2021 Longevity Health Plan (HMO I-SNP)
| $30.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,764 2021 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 |
2020 Molina Medicare Complete Care (HMO D-SNP)
| $28.50 |
n/a |
$435 | Yes, some additional gap coverage. |
H8130 -001 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,185
2020 Formulary |
|
|
|
|
2021 Molina Medicare Complete Care (HMO D-SNP)
| $30.80 |
n/a |
$445 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,245 2021 Formulary |
|
2020 Optimum Emerald Full (HMO D-SNP)
| $28.50 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H5594 -017 -0 | $0.00 | $45.00 | $95.00 | $95.00 | 3,302
2020 Formulary |
|
|
|
|
2021 Optimum Emerald Full (HMO D-SNP)
| $30.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $45.00 | $95.00 | $95.00 | 3,322 2021 Formulary |
|
2020 Optimum Emerald Partial (HMO D-SNP)
| $28.50 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H5594 -016 -0 | $0.00 | $45.00 | $95.00 | $95.00 | 3,302
2020 Formulary |
|
|
|
|
2021 Optimum Emerald Partial (HMO D-SNP)
| $30.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $45.00 | $95.00 | $95.00 | 3,322 2021 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 |
2020 Simply Comfort (HMO I-SNP)
| $26.30 |
n/a |
$435 | Yes, some additional gap coverage. |
H5471 -091 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,911
2020 Formulary |
|
|
|
|
2021 Simply Comfort (HMO I-SNP)
| $30.80 |
n/a |
$445 | Yes, some additional gap coverage. | $0.00 | $0.00 | $0.00 | $0.00 | 3,912 2021 Formulary |
|
2020 Simply Complete (HMO D-SNP)
| $28.50 |
n/a |
$435 | Yes, some additional gap coverage. |
H5471 -066 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,911
2020 Formulary |
|
|
|
|
2021 Simply Complete (HMO D-SNP)
| $30.80 |
n/a |
$445 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,912 2021 Formulary |
|
2020 UnitedHealthcare Assisted Living Plan (PPO I-SNP)
| $16.30 |
n/a |
$200 | No additional gap coverage, only the Donut Hole Discount |
H0710 -012 -0 | $2.00 | $12.00 | $47.00 | $47.00 | 3,601
2020 Formulary |
|
-- |
|
|
2021 UnitedHealthcare Assisted Living Plan (PPO I-SNP)
| $30.80 |
n/a |
$200 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $12.00 | $47.00 | $47.00 | 3,604 2021 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H1889 -002 -1 | | | | | |
new |
new |
new |
|
2021 UnitedHealthcare Dual Complete Choice (PPO D-SNP)
| $30.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,604 2021 Formulary |
|
2020 UnitedHealthcare Dual Complete LP (HMO D-SNP)
| $19.80 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H1045 -039 -0 | $0.00 | 25% | 25% | 25% | 3,601
2020 Formulary |
|
|
|
|
2021 UnitedHealthcare Dual Complete LP (HMO D-SNP)
| $30.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,604 2021 Formulary |
|
2020 UnitedHealthcare Dual Complete RP (Regional PPO D-SNP)
| $28.10 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
R0759 -003 -0 | 15% | 15% | 15% | 15% | 3,601
2020 Formulary |
|
|
|
|
2021 UnitedHealthcare Dual Complete RP (Regional PPO D-SNP)
| $30.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,604 2021 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 |
2020 UnitedHealthcare Nursing Home Plan (PPO I-SNP)
| $28.50 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H0710 -010 -0 | 25% | 25% | 25% | 25% | 3,601
2020 Formulary |
|
-- |
|
|
2021 UnitedHealthcare Nursing Home Plan (PPO I-SNP)
| $30.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,604 2021 Formulary |
|
2020 BlueMedicare Choice (Regional PPO)
| $47.90 |
$6,500 |
$250 | Yes, some additional gap coverage. |
R3332 -001 -0 | $0.00 | $10.00 | $40.00 | $40.00 | 3,308
2020 Formulary |
|
|
|
|
2021 BlueMedicare Choice (Regional PPO)
| $47.90 |
$6,500 |
$250 | Yes, some additional gap coverage. | $0.00 | $10.00 | $40.00 | $40.00 | 3,450 2021 Formulary |
|
2020 WellCare Prime (PPO)
| $75.00 |
$2,000 |
$0 | Yes, some additional gap coverage. |
H5199 -010 -0 | $0.00 | $9.00 | $47.00 | $47.00 | 3,274
2020 Formulary |
new |
new |
|
|
2021 WellCare Prime (PPO)
| $75.00 |
$1,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,348 2021 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 |
2020 Humana Gold Choice H8145-061 (PFFS)
| $116.00 |
n/a |
$200 | No additional gap coverage, only the Donut Hole Discount |
H8145 -061 -0 | $7.00 | $17.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
-- |
|
|
2021 Humana Gold Choice H8145-061 (PFFS)
| $101.00 |
n/a |
$200 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $17.00 | $47.00 | $47.00 | 3,386 2021 Formulary |
|
2020 HumanaChoice R5826-005 (Regional PPO)
| $101.00 |
$6,700 |
$100 | No additional gap coverage, only the Donut Hole Discount |
R5826 -005 -0 | $5.00 | $15.00 | $45.00 | $45.00 | 3,369
2020 Formulary |
|
|
|
|
2021 HumanaChoice R5826-005 (Regional PPO)
| $105.00 |
$6,700 |
$100 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $45.00 | $45.00 | 3,386 2021 Formulary |
|
2020 CareNeeds (HMO D-SNP)
| $8.20 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H1019 -079 -0 | $0.00 | $3.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
-- Members will be assigned to CareNeeds PLUS (HMO D-SNP) H1019-026-0 --
| | | | | |
|
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 |
2020 Humana Gold Plus SNP-DE H1036-253 (HMO D-SNP)
| $19.00 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H1036 -253 -0 | $0.00 | $1.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
-- Members will be assigned to Humana Gold Plus SNP-DE H1036-231 (HMO D-SNP) H1036-231-0 --
| | | | | |
|
2020 WellCare Dividend (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H1032 -219 -0 | $0.00 | $0.00 | $35.00 | $35.00 | 3,274
2020 Formulary |
|
|
|
|
-- Members will be assigned to WellCare Dividend Prime (HMO) H1032-200-0 --
| | | | | |
|
2020 WellCare Select (HMO D-SNP)
| $23.70 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H1032 -061 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,274
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 |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2020 WellCare Essential (HMO-POS)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H1032 -222 -3 | $0.00 | $0.00 | $35.00 | $35.00 | 3,274
2020 Formulary |
|
|
|
|
-- This plan not offered in 2021 --
|
| | | | |
|