There are 62 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 --
|
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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|
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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 Aetna Medicare Advantra Credit Value (PPO)
| $0.00 |
$6,700 |
$250 | Yes, some additional gap coverage. |
H5522 -017 -0 | $3.00 | $7.00 | $47.00 | $47.00 | 3,763
2020 Formulary |
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|
|
|
2021 Aetna Medicare Advantra Credit Value (PPO)
| $0.00 |
$7,550 |
$250 | Yes, some additional gap coverage. | $3.00 | $7.00 | $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 Aetna Medicare Advantra Core (HMO)
| $0.00 |
$4,900 |
No Rx Coverage |
H3959 -041 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
|
|
2021 Aetna Medicare Advantra Eagle (HMO)
| $0.00 |
$4,000 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2020 Aetna Medicare Advantra Silver (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H5522 -004 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,763
2020 Formulary |
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|
|
|
2021 Aetna Medicare Advantra Silver (PPO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,659 2021 Formulary |
|
2020 Aetna Medicare Value (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H5521 -263 -0 | $2.00 | $5.00 | $47.00 | $47.00 | 3,763
2020 Formulary |
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|
|
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2021 Aetna Medicare Value (PPO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $2.00 | $5.00 | $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 |
-- This plan not offered in 2020 --
|
H2915 -015 -2 | | | | | |
|
new |
|
|
2021 Allwell Medicare (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,370 2021 Formulary |
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-- This plan not offered in 2020 --
|
H2915 -012 -0 | | | | | |
|
new |
|
|
2021 Allwell Medicare Boost (HMO)
| $0.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,370 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H2915 -010 -0 | | | | | |
|
new |
|
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2021 Allwell Medicare Simple (HMO)
| $0.00 |
$3,450 |
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 BlueJourney Essential (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3962 -007 -0 | $0.00 | $5.00 | $40.00 | $40.00 | 3,341
2020 Formulary |
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|
|
2021 BlueJourney Essential (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $40.00 | $40.00 | 3,471 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H3923 -028 -0 | | | | | |
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|
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2021 BlueJourney Select (PPO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $12.00 | $40.00 | $40.00 | 2,744 2021 Formulary |
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-- This plan not offered in 2020 --
|
H3957 -042 -2 | | | | | |
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|
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2021 Community Blue Medicare HMO Signature (HMO)
| $0.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $47.00 | $47.00 | 3,586 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 Community Blue Medicare PPO Signature (PPO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3916 -037 -2 | $0.00 | $5.00 | $47.00 | $47.00 | 3,572
2020 Formulary |
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|
|
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2021 Community Blue Medicare PPO Signature (PPO)
| $0.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $47.00 | $47.00 | 3,586 2021 Formulary |
|
2020 Geisinger Gold Classic Essential Rx (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H3954 -159 -16 | $3.00 | $20.00 | $47.00 | $47.00 | 3,787
2020 Formulary |
|
|
|
|
2021 Geisinger Gold Classic Essential Rx (HMO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $3.00 | $20.00 | $47.00 | $47.00 | 3,838 2021 Formulary |
|
2020 Geisinger Gold Preferred Complete Rx (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H3924 -060 -16 | $3.00 | $20.00 | $47.00 | $47.00 | 3,787
2020 Formulary |
|
|
|
|
2021 Geisinger Gold Preferred Complete Rx (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $3.00 | $20.00 | $47.00 | $47.00 | 3,838 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 Honor (PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
H5216 -221 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
|
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2021 Humana Honor (PPO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2020 HumanaChoice H5216-116 (PPO)
| $0.00 |
$3,900 |
No Rx Coverage |
H5216 -116 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
|
|
2021 HumanaChoice H5216-116 (PPO)
| $0.00 |
$3,900 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2020 HumanaChoice H5525-038 (PPO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5525 -038 -0 | $7.00 | $17.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
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|
|
|
2021 HumanaChoice H5525-038 (PPO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $17.00 | $47.00 | $47.00 | 3,386 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 R0923-001 (Regional PPO)
| $0.00 |
$4,900 |
No Rx Coverage |
R0923 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
|
new |
|
|
2021 HumanaChoice R0923-001 (Regional PPO)
| $0.00 |
$4,900 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2020 UPMC for Life HMO No Rx (HMO)
| $0.00 |
$3,400 |
No Rx Coverage |
H3907 -002 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2021 UPMC for Life HMO No Rx (HMO)
| $0.00 |
$7,550 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2020 --
|
H9408 -006 -1 | | | | | |
|
|
|
|
2021 Vibra Essential Advocate (PPO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $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 Aetna Medicare Advantra Silver Plus (PPO)
| $28.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H5522 -013 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,763
2020 Formulary |
|
|
|
|
2021 Aetna Medicare Advantra Silver Plus (PPO)
| $19.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,679 2021 Formulary |
|
2020 UPMC for Life HMO Deductible with Rx (HMO)
| $22.00 |
$4,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3907 -037 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,470
2020 Formulary |
|
|
|
|
2021 UPMC for Life HMO Deductible with Rx (HMO)
| $22.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,574 2021 Formulary |
|
2020 Aetna Medicare Advantra Premier (HMO)
| $27.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H3959 -039 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,763
2020 Formulary |
|
|
|
|
2021 Aetna Medicare Advantra Premier (HMO)
| $25.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $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 Vibra Health Plan Enhanced Complete (PPO)
| $25.00 |
$5,800 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H9408 -005 -0 | $0.00 | $0.00 | $40.00 | $40.00 | 3,308
2020 Formulary |
|
|
|
|
2021 Vibra Health Plan Enhanced Complete (PPO)
| $26.00 |
$5,800 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $40.00 | $40.00 | 3,450 2021 Formulary |
|
2020 Humana Value Plus H5525-039 (PPO)
| $13.10 |
$6,700 |
$400 | No additional gap coverage, only the Donut Hole Discount |
H5525 -039 -0 | $5.00 | $20.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
2021 Humana Value Plus H5525-039 (PPO)
| $27.20 |
$6,700 |
$400 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $20.00 | $47.00 | $47.00 | 3,382 2021 Formulary |
|
2020 HumanaChoice H5525-006 (PPO)
| $28.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5525 -006 -0 | $3.00 | $15.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
2021 HumanaChoice H5525-006 (PPO)
| $28.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $15.00 | $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 |
-- This plan not offered in 2020 --
|
H2915 -011 -0 | | | | | |
|
new |
|
|
2021 Allwell Medicare Complement (HMO)
| $29.50 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $42.00 | $42.00 | 3,352 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H5216 -227 -0 | | | | | |
|
|
|
|
2021 HumanaChoice SNP-DE H5216-227 (PPO D-SNP)
| $29.50 |
n/a |
$425 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $19.00 | $47.00 | $47.00 | 3,382 2021 Formulary |
|
2020 UnitedHealthcare Dual Complete (HMO D-SNP)
| $22.90 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H3113 -009 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,601
2020 Formulary |
|
|
|
|
2021 UnitedHealthcare Dual Complete (HMO D-SNP)
| $30.10 |
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 Allwell Dual Medicare (HMO D-SNP)
| $34.00 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H2915 -007 -0 | $0.00 | | | | 3,451
2020 Formulary |
|
new |
|
|
2021 Allwell Dual Medicare (HMO D-SNP)
| $34.20 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $6.00 | $47.00 | $47.00 | 3,352 2021 Formulary |
|
2020 Community Blue Medicare PPO Distinct (PPO)
| $35.00 |
$5,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3916 -034 -3 | $0.00 | $5.00 | $47.00 | $47.00 | 3,572
2020 Formulary |
|
|
|
|
2021 Community Blue Medicare PPO Distinct (PPO)
| $35.00 |
$6,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $47.00 | $47.00 | 3,586 2021 Formulary |
|
2020 AmeriHealth Caritas VIP Care (HMO D-SNP)
| $35.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H4227 -002 -0 | $6.00 | 25% | | | 3,430
2020 Formulary |
|
|
|
|
2021 AmeriHealth Caritas VIP Care (HMO D-SNP)
| $37.40 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $5.00 | 25% | | | 3,407 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 --
|
H5932 -001 -0 | | | | | |
|
|
|
|
2021 Gateway Health Medicare Assured Diamond (HMO D-SNP)
| $37.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $19.00 | $38.00 | $38.00 | 3,253 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H5932 -009 -0 | | | | | |
|
|
|
|
2021 Gateway Health Medicare Assured Ruby (HMO D-SNP)
| $37.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,253 2021 Formulary |
|
2020 Geisinger Gold Secure Rx (HMO D-SNP)
| $35.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H3954 -097 -0 | 15% | | | | 3,787
2020 Formulary |
|
|
|
|
2021 Geisinger Gold Secure Rx (HMO D-SNP)
| $37.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,838 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 UPMC for Life Dual (HMO D-SNP)
| $35.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H4279 -001 -0 | $2.00 | $8.00 | $10.00 | $10.00 | 3,415
2020 Formulary |
|
|
|
|
2021 UPMC for Life Complete Care (HMO D-SNP)
| $37.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $10.00 | $18.00 | $18.00 | 3,547 2021 Formulary |
|
2020 Geisinger Gold Classic Complete Rx (HMO)
| $38.00 |
$4,900 |
$0 | Yes, some additional gap coverage. |
H3954 -158 -16 | $3.00 | $20.00 | $47.00 | $47.00 | 3,787
2020 Formulary |
|
|
|
|
2021 Geisinger Gold Classic Complete Rx (HMO)
| $38.00 |
$4,900 |
$0 | Yes, some additional gap coverage. | $3.00 | $20.00 | $47.00 | $47.00 | 3,838 2021 Formulary |
|
2020 UPMC for Life HMO Rx Choice (HMO)
| $40.00 |
$4,250 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3907 -049 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,470
2020 Formulary |
|
|
|
|
2021 UPMC for Life HMO Rx Choice (HMO)
| $40.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,574 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 --
|
H3924 -062 -22 | | | | | |
|
|
|
|
2021 Geisinger Gold Preferred Enhanced Rx (PPO)
| $45.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,838 2021 Formulary |
|
2020 Aetna Medicare Advantra Premier Plus (PPO)
| $72.00 |
$5,900 |
$0 | Yes, some additional gap coverage. |
H5522 -002 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,880
2020 Formulary |
|
|
|
|
2021 Aetna Medicare Advantra Premier Plus (PPO)
| $47.00 |
$4,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $37.00 | $37.00 | 3,679 2021 Formulary |
|
2020 BlueJourney Classic (PPO)
| $49.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3923 -013 -0 | $0.00 | $5.00 | $40.00 | $40.00 | 3,341
2020 Formulary |
|
|
|
|
2021 BlueJourney Classic (PPO)
| $49.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $40.00 | $40.00 | 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 BlueJourney Value (HMO)
| $50.00 |
$4,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3962 -004 -0 | $0.00 | $5.00 | $40.00 | $40.00 | 3,341
2020 Formulary |
|
|
|
|
2021 BlueJourney Value (HMO)
| $51.00 |
$4,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $40.00 | $40.00 | 3,471 2021 Formulary |
|
2020 UPMC for Life PPO Rx Enhanced (PPO)
| $47.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5533 -008 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,470
2020 Formulary |
|
|
|
|
2021 UPMC for Life PPO Rx Enhanced (PPO)
| $60.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,574 2021 Formulary |
|
2020 HumanaChoice R0923-002 (Regional PPO)
| $71.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
R0923 -002 -0 | $6.00 | $20.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
new |
|
|
2021 HumanaChoice R0923-002 (Regional PPO)
| $63.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $20.00 | $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 Freedom Blue PPO Basic (PPO)
| $77.00 |
$5,900 |
No Rx Coverage |
H3916 -012 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2021 Freedom Blue PPO Basic (PPO)
| $66.00 |
$5,900 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2020 Aetna Medicare Silver (HMO)
| $59.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H3931 -070 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,763
2020 Formulary |
|
|
|
|
2021 Aetna Medicare Silver (HMO)
| $69.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,659 2021 Formulary |
|
2020 Freedom Blue PPO ValueRx (PPO)
| $70.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3916 -018 -0 | $0.00 | $13.00 | $45.00 | $45.00 | 3,572
2020 Formulary |
|
|
|
|
2021 Freedom Blue PPO ValueRx (PPO)
| $70.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $13.00 | $45.00 | $45.00 | 3,586 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 Geisinger Gold Classic Advantage (HMO)
| $75.00 |
$3,400 |
No Rx Coverage |
H3954 -156 -16 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2021 Geisinger Gold Classic Advantage (HMO)
| $75.00 |
$3,450 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2020 UPMC for Life HMO Rx (HMO)
| $81.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3907 -029 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,470
2020 Formulary |
|
|
|
|
2021 UPMC for Life HMO Rx (HMO)
| $81.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,574 2021 Formulary |
|
2020 BlueJourney Premier (HMO)
| $148.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H3962 -001 -0 | $0.00 | $0.00 | $40.00 | $40.00 | 3,341
2020 Formulary |
|
|
|
|
2021 BlueJourney Premier (HMO)
| $106.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $40.00 | $40.00 | 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 Geisinger Gold Preferred Advantage Rx (PPO)
| $112.00 |
$4,000 |
$0 | Yes, some additional gap coverage. |
H3924 -059 -16 | $3.00 | $20.00 | $47.00 | $47.00 | 3,787
2020 Formulary |
|
|
|
|
2021 Geisinger Gold Preferred Advantage Rx (PPO)
| $110.00 |
$4,000 |
$0 | Yes, some additional gap coverage. | $3.00 | $20.00 | $47.00 | $47.00 | 3,838 2021 Formulary |
|
2020 Geisinger Gold Classic Advantage Rx (HMO)
| $158.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H3954 -157 -16 | $3.00 | $20.00 | $47.00 | $47.00 | 3,787
2020 Formulary |
|
|
|
|
2021 Geisinger Gold Classic Advantage Rx (HMO)
| $159.00 |
$3,450 |
$0 | Yes, some additional gap coverage. | $3.00 | $20.00 | $47.00 | $47.00 | 3,838 2021 Formulary |
|
2020 Aetna Medicare Gold Plan (PPO)
| $146.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H5521 -122 -0 | $2.00 | $5.00 | $47.00 | $47.00 | 3,763
2020 Formulary |
|
|
|
|
2021 Aetna Medicare Gold Plan (PPO)
| $169.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $2.00 | $5.00 | $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 BlueJourney Prime (PPO)
| $170.00 |
$4,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3923 -017 -0 | $0.00 | $5.00 | $40.00 | $40.00 | 3,341
2020 Formulary |
|
|
|
|
2021 BlueJourney Prime (PPO)
| $171.00 |
$4,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $40.00 | $40.00 | 3,471 2021 Formulary |
|
2020 Freedom Blue PPO Standard (PPO)
| $185.50 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3916 -015 -0 | $0.00 | $13.00 | $45.00 | $45.00 | 4,265
2020 Formulary |
|
|
|
|
2021 Freedom Blue PPO Standard (PPO)
| $175.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $13.00 | $45.00 | $45.00 | 4,161 2021 Formulary |
|
2020 Freedom Blue PPO Deluxe (PPO)
| $288.50 |
$4,500 |
$0 | Yes, some additional gap coverage. |
H3916 -005 -0 | $0.00 | $13.00 | $45.00 | $45.00 | 4,265
2020 Formulary |
|
|
|
|
2021 Freedom Blue PPO Deluxe (PPO)
| $289.00 |
$4,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $13.00 | $45.00 | $45.00 | 4,161 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 UPMC for Life HMO Rx Enhanced (HMO)
| $301.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3907 -006 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,470
2020 Formulary |
|
|
|
|
2021 UPMC for Life HMO Rx Enhanced (HMO)
| $302.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,574 2021 Formulary |
|
2020 Allwell Medicare (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2915 -006 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,959
2020 Formulary |
|
new |
|
|
-- Members will be assigned to Allwell Medicare (HMO) H2915-015-2 --
| | | | | |
|
2020 Geisinger Gold Preferred Enhanced Rx (PPO)
| $45.00 |
$5,500 |
$0 | Yes, some additional gap coverage. |
H3924 -062 -16 | $3.00 | $20.00 | $47.00 | $47.00 | 3,787
2020 Formulary |
|
|
|
|
-- Members will be assigned to Geisinger Gold Preferred Enhanced Rx (PPO) H3924-062-22 --
| | | | | |
|
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 Lasso Healthcare (MSA)
| $0.00 |
n/a |
No Rx Coverage |
H1924 -003 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
-- Members will be assigned to Lasso Healthcare Growth (MSA) H1924-001-0 --
| | | | | |
|
2020 Vibra Health Plan Essential (PPO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H9408 -001 -0 | $0.00 | $0.00 | $40.00 | $40.00 | 3,308
2020 Formulary |
|
|
|
|
-- Members will be assigned to Vibra Essential Advocate (PPO) H9408-006-1 --
| | | | | |
|