There are 69 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 |
2020 MVP SmartFund (MSA)
| $0.00 |
n/a |
No Rx Coverage |
H5613 -002 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2021 MVP SmartFund (MSA)
| $0.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2020 --
|
H5521 -313 -0 | | | | | |
|
|
|
|
2021 Aetna Medicare Credit Plan (PPO)
| $0.00 |
$7,550 |
$250 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,659 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H5521 -323 -0 | | | | | |
|
|
|
|
2021 Aetna Medicare Eagle Plan (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 |
-- This plan not offered in 2020 --
|
H5526 -021 -0 | | | | | |
|
|
|
|
2021 BlueShield Freedom Nation (PPO)
| $0.00 |
$7,550 |
$375 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $42.00 | $42.00 | 3,652 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H3384 -066 -0 | | | | | |
|
|
|
|
2021 BlueShield Freedom No Rx (HMO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2020 BlueShield Freedom Value (HMO)
| $0.00 |
$6,700 |
$350 | No additional gap coverage, only the Donut Hole Discount |
H3384 -063 -0 | $3.00 | $10.00 | $42.00 | $42.00 | 3,646
2020 Formulary |
|
|
|
|
2021 BlueShield Freedom Value (HMO)
| $0.00 |
$7,550 |
$295 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $10.00 | $42.00 | $42.00 | 3,652 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 CDPHP $0 Medicare Rx (HMO)
| $0.00 |
$6,700 |
$300 | No additional gap coverage, only the Donut Hole Discount |
H3388 -014 -0 | $3.00 | $17.00 | $47.00 | $47.00 | 3,190
2020 Formulary |
|
|
|
|
2021 CDPHP $0 Medicare Rx (HMO)
| $0.00 |
$7,500 |
$300 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $17.00 | $47.00 | $47.00 | 3,305 2021 Formulary |
|
2020 CDPHP Flex (PPO)
| $0.00 |
$5,500 |
No Rx Coverage |
H5042 -012 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2021 CDPHP Flex (PPO)
| $0.00 |
$5,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2020 CDPHP Vital Rx (PPO)
| $0.00 |
$6,700 |
$350 | No additional gap coverage, only the Donut Hole Discount |
H5042 -009 -0 | $3.00 | $17.00 | $47.00 | $47.00 | 3,190
2020 Formulary |
|
|
|
|
2021 CDPHP Vital Rx (PPO)
| $0.00 |
$7,500 |
$350 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $17.00 | $47.00 | $47.00 | 3,305 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 EmblemHealth VIP Part B Saver (HMO)
| $0.00 |
$6,700 |
$435 | No additional gap coverage, only the Donut Hole Discount |
H3330 -040 -0 | $0.00 | $18.00 | $45.00 | $45.00 | 3,401
2020 Formulary |
|
|
|
|
2021 EmblemHealth VIP Part B Saver (HMO)
| $0.00 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $42.00 | $42.00 | 3,429 2021 Formulary |
|
2020 EmblemHealth VIP Rx Saver (HMO)
| $0.00 |
$6,700 |
$395 | No additional gap coverage, only the Donut Hole Discount |
H3330 -039 -2 | $0.00 | $18.00 | $45.00 | $45.00 | 3,401
2020 Formulary |
|
|
|
|
2021 EmblemHealth VIP Rx Saver (HMO)
| $0.00 |
$7,550 |
$395 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $42.00 | $42.00 | 3,429 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H5599 -009 -0 | | | | | |
new |
new |
new |
|
2021 Fidelis Medicare $0 Premium (HMO)
| $0.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $20.00 | $47.00 | $47.00 | 3,168 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 Plus H3533-006 (HMO)
| $0.00 |
$6,700 |
$300 | No additional gap coverage, only the Donut Hole Discount |
H3533 -006 -0 | $2.00 | $9.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
2021 Humana Gold Plus H3533-006 (HMO)
| $0.00 |
$7,200 |
$300 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $9.00 | $47.00 | $47.00 | 3,382 2021 Formulary |
|
2020 HumanaChoice H5970-016 (PPO)
| $0.00 |
$4,500 |
No Rx Coverage |
H5970 -016 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2021 Humana Honor (PPO)
| $0.00 |
$4,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2020 HumanaChoice H5970-015 (PPO)
| $0.00 |
$5,900 |
$275 | No additional gap coverage, only the Donut Hole Discount |
H5970 -015 -0 | $2.00 | $9.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
2021 HumanaChoice H5970-015 (PPO)
| $0.00 |
$6,500 |
$250 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $9.00 | $47.00 | $47.00 | 3,386 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 HumanaChoice H5970-018 (PPO)
| $0.00 |
$6,700 |
$310 | No additional gap coverage, only the Donut Hole Discount |
H5970 -018 -0 | $6.00 | $16.00 | $47.00 | $47.00 | 3,117
2020 Formulary |
|
|
|
|
2021 HumanaChoice H5970-018 (PPO)
| $0.00 |
$7,550 |
$310 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $16.00 | $47.00 | $47.00 | 3,172 2021 Formulary |
|
2020 MVP WellSelect with Part D (PPO)
| $0.00 |
$6,700 |
$325 | No additional gap coverage, only the Donut Hole Discount |
H9615 -008 -0 | $0.00 | $12.00 | $47.00 | $47.00 | 3,293
2020 Formulary |
|
|
|
|
2021 MVP Medicare WellSelect with Part D (PPO)
| $0.00 |
$7,550 |
$325 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $12.00 | $47.00 | $47.00 | 3,471 2021 Formulary |
|
2020 UnitedHealthcare Medicare Advantage Essential (Regional PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
R5342 -002 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2021 UnitedHealthcare Medicare Advantage Patriot (Regional PPO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H2775 -111 -0 | | | | | |
|
|
|
|
2021 WellCare Absolute (PPO)
| $0.00 |
$7,550 |
$150 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | 3,348 2021 Formulary |
|
2020 WellCare Today's Options Advantage Plus 550B (PPO)
| $10.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2775 -106 -0 | $2.00 | $7.00 | $37.00 | $37.00 | 3,102
2020 Formulary |
|
|
|
|
2021 WellCare Today's Options Advantage Plus 550B (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $7.00 | $37.00 | $37.00 | 3,348 2021 Formulary |
|
2020 WellCare Today's Options Premier 300 (PFFS)
| $0.00 |
n/a |
No Rx Coverage |
H2816 -038 -0 | This plan does NOT include Prescription Drug coverage. | |
|
-- |
|
|
2021 WellCare Today's Options Premier 300 (PFFS)
| $0.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2020 --
|
H2775 -113 -0 | | | | | |
|
|
|
|
2021 WellCare Summit (PPO)
| $5.10 |
$6,700 |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,348 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H5599 -007 -0 | | | | | |
new |
new |
new |
|
2021 Fidelis Medicare Advantage Flex (HMO-POS)
| $10.90 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,168 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H2775 -112 -0 | | | | | |
|
|
|
|
2021 WellCare Imperial (PPO D-SNP)
| $12.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $9.00 | $45.00 | $45.00 | 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 UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO)
| $16.00 |
$6,700 |
$300 | No additional gap coverage, only the Donut Hole Discount |
R5342 -001 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,601
2020 Formulary |
|
|
|
|
2021 UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO)
| $16.00 |
$6,700 |
$300 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 3,604 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H3312 -062 -0 | | | | | |
|
|
|
|
2021 Aetna Medicare Value Plan (HMO)
| $21.00 |
$7,550 |
$250 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,659 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H5599 -001 -0 | | | | | |
new |
new |
new |
|
2021 Fidelis Dual Advantage Flex (HMO D-SNP)
| $21.60 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | 24% | 24% | 3,168 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 --
|
H5599 -006 -0 | | | | | |
new |
new |
new |
|
2021 Fidelis Dual Advantage (HMO D-SNP)
| $22.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,168 2021 Formulary |
|
2020 HumanaChoice H5970-019 (PPO)
| $34.00 |
$5,500 |
$200 | No additional gap coverage, only the Donut Hole Discount |
H5970 -019 -0 | $2.00 | $8.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
2021 HumanaChoice H5970-019 (PPO)
| $23.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $47.00 | $47.00 | 3,386 2021 Formulary |
|
2020 Humana Gold Plus H3533-013 (HMO)
| $24.00 |
$6,700 |
$275 | No additional gap coverage, only the Donut Hole Discount |
H3533 -013 -0 | $4.00 | $12.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
2021 Humana Gold Plus H3533-013 (HMO)
| $25.00 |
$6,700 |
$275 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $12.00 | $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 |
-- This plan not offered in 2020 --
|
H3312 -070 -0 | | | | | |
|
|
|
|
2021 Aetna Medicare Assure Plan (HMO D-SNP)
| $27.10 |
n/a |
$190 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $47.00 | $47.00 | 3,659 2021 Formulary |
|
2020 Humana Gold Plus SNP-DE H3533-002 (HMO D-SNP)
| $24.80 |
n/a |
$350 | No additional gap coverage, only the Donut Hole Discount |
H3533 -002 -0 | $0.00 | $17.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
2021 Humana Gold Plus SNP-DE H3533-002 (HMO D-SNP)
| $28.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $47.00 | $47.00 | 3,382 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H5521 -119 -0 | | | | | |
|
|
|
|
2021 Aetna Medicare Elite Plan (PPO)
| $29.00 |
$7,550 |
$100 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,659 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 CDPHP Basic RX (HMO)
| $29.50 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3388 -013 -0 | $3.00 | $15.00 | $45.00 | $45.00 | 3,190
2020 Formulary |
|
|
|
|
2021 CDPHP Basic RX (HMO)
| $31.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $15.00 | $45.00 | $45.00 | 3,305 2021 Formulary |
|
2020 UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
| $36.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H2292 -001 -0 | 25% | 25% | 25% | 25% | 3,601
2020 Formulary |
|
new |
|
|
2021 UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
| $34.10 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,604 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H8432 -039 -2 | | | | | |
|
|
|
|
2021 Empire MediBlue Dual Advantage (HMO D-SNP)
| $37.70 |
n/a |
$445 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,639 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 CDPHP Choice (HMO)
| $39.90 |
$5,000 |
No Rx Coverage |
H3388 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2021 CDPHP Choice (HMO)
| $39.90 |
$5,000 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2020 MVP GoldSecure with Part D (HMO-POS)
| $39.00 |
$6,700 |
$150 | No additional gap coverage, only the Donut Hole Discount |
H3305 -032 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,293
2020 Formulary |
|
|
|
|
2021 MVP Medicare Secure with Part D (HMO-POS)
| $40.00 |
$7,550 |
$150 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,471 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H8432 -038 -2 | | | | | |
|
|
|
|
2021 Empire MediBlue Plus (HMO)
| $41.00 |
$5,000 |
$325 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $37.00 | $37.00 | 2,902 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 CDPHP Flex Rx (PPO)
| $40.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5042 -011 -0 | $2.00 | $14.00 | $44.00 | $44.00 | 3,190
2020 Formulary |
|
|
|
|
2021 CDPHP Flex Rx (PPO)
| $41.80 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $14.00 | $44.00 | $44.00 | 3,305 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H3330 -042 -3 | | | | | |
|
|
|
|
2021 EmblemHealth VIP Dual (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,429 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H5991 -002 -0 | | | | | |
|
-- |
|
|
2021 EmblemHealth VIP Solutions (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,429 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 Dual Complete (HMO D-SNP)
| $29.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H3387 -010 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,601
2020 Formulary |
|
|
|
|
2021 UnitedHealthcare Dual Complete (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,604 2021 Formulary |
|
2020 UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO)
| $46.00 |
$6,700 |
$275 | No additional gap coverage, only the Donut Hole Discount |
R5342 -005 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,601
2020 Formulary |
|
|
|
|
2021 UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO)
| $46.00 |
$6,700 |
$275 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 3,604 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H5521 -110 -0 | | | | | |
|
|
|
|
2021 Aetna Medicare Premier Plan (PPO)
| $51.00 |
$7,550 |
$200 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,659 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 Today's Options Premier Plus 650B (PFFS)
| $55.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2816 -019 -0 | $1.00 | $7.00 | $37.00 | $37.00 | 3,274
2020 Formulary |
|
-- |
|
|
2021 WellCare Today's Options Premier Plus 650B (PFFS)
| $55.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $1.00 | $7.00 | $37.00 | $37.00 | 3,348 2021 Formulary |
|
2020 BlueShield Freedom Plus (HMO)
| $55.00 |
$6,700 |
$295 | No additional gap coverage, only the Donut Hole Discount |
H3384 -059 -0 | $2.00 | $8.00 | $42.00 | $42.00 | 3,646
2020 Formulary |
|
|
|
|
2021 BlueShield Freedom Plus (HMO)
| $56.00 |
$6,700 |
$275 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $42.00 | $42.00 | 3,652 2021 Formulary |
|
2020 CDPHP Value Rx (HMO)
| $59.00 |
$5,800 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3388 -004 -0 | $2.00 | $13.00 | $42.00 | $42.00 | 3,190
2020 Formulary |
|
|
|
|
2021 CDPHP Value Rx (HMO)
| $60.80 |
$5,800 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $13.00 | $42.00 | $42.00 | 3,305 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 MVP Preferred Gold without Part D (HMO-POS)
| $62.00 |
$6,700 |
No Rx Coverage |
H3305 -020 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2021 MVP Medicare Preferred Gold without Part D (HMO-POS)
| $62.00 |
$7,550 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2020 WellCare Today's Options Premier 200 (PFFS)
| $76.00 |
n/a |
No Rx Coverage |
H2816 -037 -0 | This plan does NOT include Prescription Drug coverage. | |
|
-- |
|
|
2021 WellCare Today's Options Premier 200 (PFFS)
| $71.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2020 EmblemHealth VIP Go (HMO-POS)
| $71.00 |
$6,700 |
$250 | No additional gap coverage, only the Donut Hole Discount |
H3330 -041 -1 | $0.00 | $18.00 | $45.00 | $45.00 | 3,401
2020 Formulary |
|
|
|
|
2021 EmblemHealth VIP Go (HMO-POS)
| $72.00 |
$7,550 |
$250 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $42.00 | $42.00 | 3,429 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 Choice Plan 4 (Regional PPO)
| $79.00 |
$6,700 |
$150 | No additional gap coverage, only the Donut Hole Discount |
R5342 -006 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,601
2020 Formulary |
|
|
|
|
2021 UnitedHealthcare Medicare Advantage Choice Plan 4 (Regional PPO)
| $84.00 |
$6,700 |
$150 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 3,604 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H3342 -023 -2 | | | | | |
-- |
-- |
|
|
2021 Empire MediBlue Access (PPO)
| $90.00 |
$6,200 |
$310 | Yes, some additional gap coverage. | $3.00 | $10.00 | $38.00 | $38.00 | 3,639 2021 Formulary |
|
2020 MVP GoldValue with Part D (HMO-POS)
| $89.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H3305 -022 -0 | $0.00 | $15.00 | $45.00 | $45.00 | 3,293
2020 Formulary |
|
|
|
|
2021 MVP Medicare Secure Plus with Part D (HMO-POS)
| $90.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $15.00 | $45.00 | $45.00 | 3,471 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 BlueShield Freedom Premier (HMO)
| $110.00 |
$6,700 |
$100 | No additional gap coverage, only the Donut Hole Discount |
H3384 -064 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,646
2020 Formulary |
|
|
|
|
2021 BlueShield Freedom Premier (HMO)
| $111.00 |
$6,700 |
$100 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $42.00 | $42.00 | 3,652 2021 Formulary |
|
2020 MVP Gold PPO with Part D (PPO)
| $115.00 |
$5,800 |
$0 | Yes, some additional gap coverage. |
H9615 -007 -0 | $0.00 | $10.00 | $35.00 | $35.00 | 3,293
2020 Formulary |
|
|
|
|
2021 MVP Medicare WellSelect Plus with Part D (PPO)
| $116.00 |
$6,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $35.00 | $35.00 | 3,471 2021 Formulary |
|
2020 WellCare Today's Options Advantage Plus 150A (PPO)
| $136.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2775 -105 -0 | $0.00 | $5.00 | $35.00 | $35.00 | 3,102
2020 Formulary |
|
|
|
|
2021 WellCare Today's Options Advantage Plus 150A (PPO)
| $121.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $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 CDPHP Choice Rx (HMO)
| $128.50 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3388 -002 -0 | $0.00 | $11.00 | $40.00 | $40.00 | 3,190
2020 Formulary |
|
|
|
|
2021 CDPHP Choice Rx (HMO)
| $130.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $11.00 | $40.00 | $40.00 | 3,305 2021 Formulary |
|
2020 BlueShield Senior Blue 652 (HMO)
| $139.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3384 -013 -0 | $4.00 | $10.00 | $42.00 | $42.00 | 3,646
2020 Formulary |
|
|
|
|
2021 BlueShield Senior Blue 652 (HMO)
| $135.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $42.00 | $42.00 | 3,652 2021 Formulary |
|
2020 MVP Preferred Gold with Part D (HMO-POS)
| $139.00 |
$4,800 |
$0 | Yes, some additional gap coverage. |
H3305 -021 -0 | $0.00 | $10.00 | $35.00 | $35.00 | 3,293
2020 Formulary |
|
|
|
|
2021 MVP Medicare Preferred Gold with Part D (HMO-POS)
| $140.00 |
$5,800 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $35.00 | $35.00 | 3,471 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 Today's Options Premier Plus 250A (PFFS)
| $156.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2816 -013 -0 | $0.00 | $5.00 | $35.00 | $35.00 | 3,274
2020 Formulary |
|
-- |
|
|
2021 WellCare Today's Options Premier Plus 250A (PFFS)
| $156.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $35.00 | $35.00 | 3,348 2021 Formulary |
|
2020 BlueShield Forever Blue 770 (PPO)
| $197.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5526 -018 -0 | $2.00 | $12.00 | $42.00 | $42.00 | 3,646
2020 Formulary |
|
|
|
|
2021 BlueShield Forever Blue 770 (PPO)
| $200.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $12.00 | $42.00 | $42.00 | 3,652 2021 Formulary |
|
2020 Empire MediBlue Access (PPO)
| $89.00 |
$6,200 |
$310 | Yes, some additional gap coverage. |
H3342 -019 -0 | $3.00 | $10.00 | $38.00 | $38.00 | 3,780
2020 Formulary |
-- |
-- |
|
|
-- Members will be assigned to Empire MediBlue Access (PPO) H3342-023-1 --
| | | | | |
|
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 Empire MediBlue Dual Advantage (HMO D-SNP)
| $35.00 |
n/a |
$435 | Yes, some additional gap coverage. |
H8432 -018 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,780
2020 Formulary |
|
|
|
|
-- Members will be assigned to Empire MediBlue Dual Advantage (HMO D-SNP) H8432-039-1 --
| | | | | |
|
2020 Empire MediBlue Plus (HMO)
| $53.00 |
$5,000 |
$325 | No additional gap coverage, only the Donut Hole Discount |
H8432 -017 -0 | $0.00 | $10.00 | $42.00 | $42.00 | 2,847
2020 Formulary |
|
|
|
|
-- Members will be assigned to Empire MediBlue Plus (HMO) H8432-038-1 --
| | | | | |
|
2020 Fidelis Dual Advantage (HMO D-SNP)
| $31.80 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3328 -002 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,098
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 Fidelis Dual Advantage Flex (HMO D-SNP)
| $27.10 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3328 -017 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,098
2020 Formulary |
|
|
|
|
-- This plan not offered in 2021 --
|
| | | | |
|
2020 Fidelis Medicare Advantage Flex (HMO-POS)
| $22.50 |
$6,700 |
$435 | No additional gap coverage, only the Donut Hole Discount |
H3328 -022 -2 | $0.00 | $15.00 | 22% | 22% | 3,098
2020 Formulary |
|
|
|
|
-- This plan not offered in 2021 --
|
| | | | |
|
2020 Fidelis Medicare $0 Premium (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3328 -024 -2 | $5.00 | $20.00 | $47.00 | $47.00 | 3,098
2020 Formulary |
|
|
|
|
-- This plan not offered in 2021 --
|
| | | | |
|