There are 59 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 Lasso Healthcare (MSA)
| $0.00 |
n/a |
No Rx Coverage |
H1924 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
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 Essential (HMO)
| $0.00 |
$5,500 |
No Rx Coverage |
H1944 -030 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
|
|
2021 AARP Medicare Advantage Patriot (HMO)
| $0.00 |
$5,500 |
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 AARP Medicare Advantage Plan 1 (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H1944 -010 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,601
2020 Formulary |
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|
|
|
2021 AARP Medicare Advantage Plan 1 (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,604 2021 Formulary |
|
2020 Aetna Medicare Advantra Core (HMO)
| $0.00 |
$4,900 |
No Rx Coverage |
H3959 -041 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
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 Premier (HMO)
| $0.00 |
$5,900 |
$0 | Yes, some additional gap coverage. |
H3959 -032 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,880
2020 Formulary |
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|
|
|
2021 Aetna Medicare Advantra Premier (HMO)
| $0.00 |
$5,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,679 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 (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H3959 -011 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,880
2020 Formulary |
|
|
|
|
2021 Aetna Medicare Advantra Silver (HMO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $42.00 | $42.00 | 3,679 2021 Formulary |
|
2020 Aetna Medicare Value (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H5521 -261 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,763
2020 Formulary |
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|
|
|
2021 Aetna Medicare Value (PPO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,679 2021 Formulary |
|
2020 Allwell Medicare (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2915 -003 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,959
2020 Formulary |
|
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 |
|
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 -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 |
|
|
2021 Allwell Medicare Simple (HMO)
| $0.00 |
$3,450 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2020 Community Blue Medicare HMO Signature (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3957 -047 -2 | $0.00 | $5.00 | $47.00 | $47.00 | 3,572
2020 Formulary |
|
|
|
|
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 |
$5,750 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3916 -038 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,572
2020 Formulary |
|
|
|
|
2021 Community Blue Medicare PPO Signature (PPO)
| $0.00 |
$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 Humana Gold Plus H6622-035 (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H6622 -035 -0 | $3.00 | $15.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
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|
|
|
2021 Humana Gold Plus H6622-035 (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $47.00 | $47.00 | 3,382 2021 Formulary |
|
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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2021 Humana Honor (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 |
2020 HumanaChoice H5216-116 (PPO)
| $0.00 |
$3,900 |
No Rx Coverage |
H5216 -116 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
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 |
|
|
|
|
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 |
|
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. | |
|
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 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. | |
|
2020 UPMC for Life HMO Premier Rx (HMO)
| $0.00 |
$6,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3907 -050 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,415
2020 Formulary |
|
|
|
|
2021 UPMC for Life HMO Premier Rx (HMO)
| $0.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,547 2021 Formulary |
|
2020 Aetna Medicare Advantra Silver (PPO)
| $28.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H5522 -005 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,880
2020 Formulary |
|
|
|
|
2021 Aetna Medicare Advantra Silver (PPO)
| $19.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,679 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 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 Humana Gold Plus SNP-DE H6622-038 (HMO D-SNP)
| $28.20 |
n/a |
$410 | No additional gap coverage, only the Donut Hole Discount |
H6622 -038 -0 | $0.00 | $19.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
2021 Humana Gold Plus SNP-DE H6622-038 (HMO D-SNP)
| $26.10 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $1.00 | $19.00 | $47.00 | $47.00 | 3,382 2021 Formulary |
|
2020 Aetna Medicare Advantra Cares (HMO D-SNP)
| $20.40 |
n/a |
$200 | No additional gap coverage, only the Donut Hole Discount |
H3959 -036 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,763
2020 Formulary |
|
|
|
|
2021 Aetna Medicare Advantra Cares (HMO D-SNP)
| $27.30 |
n/a |
$220 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | 25% | 25% | 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 -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 |
|
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 |
|
-- This plan not offered in 2020 --
|
H2577 -021 -0 | | | | | |
new |
new |
new |
|
2021 AARP Medicare Advantage Choice (PPO)
| $35.00 |
$4,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $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 |
2020 AARP Medicare Advantage Plan 2 (HMO)
| $29.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H1944 -011 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,601
2020 Formulary |
|
|
|
|
2021 AARP Medicare Advantage Plan 2 (HMO)
| $35.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,604 2021 Formulary |
|
2020 Members will be assigned to Community Blue Medicare PPO Distinct (PPO) H3916-035-3
| $0.00 |
n/a |
$0 | -- |
H3916 -035 -2 | | | | | 3,572
2020 Formulary |
|
|
|
|
2021 Complete Blue PPO Distinct (PPO)
| $35.00 |
$6,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $9.00 | $47.00 | $47.00 | 3,586 2021 Formulary |
|
2020 UPMC for Life PPO High Deductible with Rx (PPO)
| $35.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5533 -003 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,470
2020 Formulary |
|
|
|
|
2021 UPMC for Life PPO High Deductible with Rx (PPO)
| $35.00 |
$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 |
2020 UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)
| $35.40 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H0710 -017 -0 | 25% | 25% | 25% | 25% | 3,601
2020 Formulary |
|
-- |
|
|
2021 UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)
| $37.20 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,604 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 |
|
2020 Allwell Dual Medicare (HMO D-SNP)
| $34.00 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H2915 -001 -0 | $0.00 | | | | 3,451
2020 Formulary |
|
new |
|
|
2021 Allwell Dual Medicare (HMO D-SNP)
| $37.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $4.00 | $40.00 | $40.00 | 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 Gateway Health Medicare Assured Diamond (HMO D-SNP)
| $35.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H5932 -001 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,167
2020 Formulary |
|
|
|
|
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 |
|
2020 Gateway Health Medicare Assured Ruby (HMO D-SNP)
| $35.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H5932 -009 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,167
2020 Formulary |
|
|
|
|
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 Provider Partners Pennsylvania Advantage Plan (HMO I-SNP)
| $35.60 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H4093 -001 -0 | 25% | | | | 3,603
2020 Formulary |
-- |
-- |
|
|
2021 Provider Partners Pennsylvania Advantage Plan (HMO I-SNP)
| $37.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,578 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 --
|
H4093 -004 -0 | | | | | |
-- |
-- |
|
|
2021 Provider Partners Pennsylvania Community Plan (HMO I-SNP)
| $37.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,578 2021 Formulary |
|
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 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 |
2020 HumanaChoice H5216-051 (PPO)
| $42.00 |
$6,300 |
$175 | No additional gap coverage, only the Donut Hole Discount |
H5216 -051 -0 | $7.00 | $17.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
2021 HumanaChoice H5216-051 (PPO)
| $43.00 |
$6,300 |
$0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $17.00 | $47.00 | $47.00 | 3,386 2021 Formulary |
|
2020 Aetna Medicare Advantra Gold (HMO)
| $58.00 |
$4,900 |
$0 | Yes, some additional gap coverage. |
H3959 -002 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,880
2020 Formulary |
|
|
|
|
2021 Aetna Medicare Advantra Gold (HMO)
| $49.00 |
$4,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $37.00 | $37.00 | 3,679 2021 Formulary |
|
2020 HumanaChoice H5525-007 (PPO)
| $48.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5525 -007 -0 | $5.00 | $15.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
2021 HumanaChoice H5525-007 (PPO)
| $54.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $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 |
2020 Security Blue HMO-POS Basic (HMO-POS)
| $58.50 |
$5,900 |
No Rx Coverage |
H3957 -043 -2 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2021 Security Blue HMO-POS Basic (HMO-POS)
| $57.00 |
$5,900 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2020 Security Blue HMO-POS ValueRx (HMO-POS)
| $59.50 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3957 -044 -1 | $0.00 | $13.00 | $45.00 | $45.00 | 3,572
2020 Formulary |
|
|
|
|
2021 Security Blue HMO-POS ValueRx (HMO-POS)
| $58.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $13.00 | $45.00 | $45.00 | 3,586 2021 Formulary |
|
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 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)
| $73.50 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3916 -033 -0 | $0.00 | $13.00 | $45.00 | $45.00 | 3,572
2020 Formulary |
|
|
|
|
2021 Freedom Blue PPO ValueRx (PPO)
| $72.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $13.00 | $45.00 | $45.00 | 3,586 2021 Formulary |
|
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 |
|
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 --
|
H5216 -120 -0 | | | | | |
|
|
|
|
2021 HumanaChoice H5216-120 (PPO)
| $127.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $47.00 | $47.00 | 3,386 2021 Formulary |
|
2020 Freedom Blue PPO Select (PPO)
| $132.50 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3916 -024 -0 | $0.00 | $13.00 | $45.00 | $45.00 | 4,265
2020 Formulary |
|
|
|
|
2021 Freedom Blue PPO Select (PPO)
| $131.00 |
$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 UPMC for Life PPO Rx Enhanced (PPO)
| $135.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5533 -005 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,470
2020 Formulary |
|
|
|
|
2021 UPMC for Life PPO Rx Enhanced (PPO)
| $136.00 |
$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 |
2020 Security Blue HMO-POS Standard (HMO-POS)
| $166.50 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3957 -045 -2 | $0.00 | $13.00 | $44.00 | $44.00 | 4,265
2020 Formulary |
|
|
|
|
2021 Security Blue HMO-POS Standard (HMO-POS)
| $165.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $13.00 | $44.00 | $44.00 | 4,161 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 |
|
2020 Security Blue HMO-POS Deluxe (HMO-POS)
| $226.50 |
$4,500 |
$0 | Yes, some additional gap coverage. |
H3957 -046 -2 | $0.00 | $13.00 | $42.00 | $42.00 | 4,265
2020 Formulary |
|
|
|
|
2021 Security Blue HMO-POS Deluxe (HMO-POS)
| $225.00 |
$4,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $13.00 | $42.00 | $42.00 | 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 Freedom Blue PPO Classic (PPO)
| $255.50 |
$4,500 |
$0 | Yes, some additional gap coverage. |
H3916 -002 -0 | $0.00 | $13.00 | $45.00 | $45.00 | 4,265
2020 Formulary |
|
|
|
|
2021 Freedom Blue PPO Classic (PPO)
| $254.00 |
$4,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $13.00 | $45.00 | $45.00 | 4,161 2021 Formulary |
|
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 AARP Medicare Advantage Plan 3 (HMO)
| $89.00 |
$4,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H1944 -025 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,601
2020 Formulary |
|
|
|
|
-- Members will be assigned to AARP Medicare Advantage Plan 2 (HMO) H1944-011-0 --
| | | | | |
|
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 Community Blue Medicare PPO Distinct (PPO)
| $35.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3916 -035 -3 | $0.00 | $9.00 | $47.00 | $47.00 | 3,572
2020 Formulary |
|
|
|
|
-- Members will be assigned to Complete Blue PPO Distinct (PPO) H3916-035-1 --
| | | | | |
|
2020 HumanaChoice H5216-119 (PPO)
| $122.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5216 -119 -0 | $5.00 | $15.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
-- Members will be assigned to HumanaChoice H5216-120 (PPO) H5216-120-0 --
| | | | | |
|