There are 95 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. | |
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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. | |
|
-- This plan not offered in 2020 --
|
H4527 -024 -0 | | | | | |
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2021 AARP Medicare Advantage Patriot (HMO-POS)
| $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-POS)
| $0.00 |
$3,900 |
$195 | No additional gap coverage, only the Donut Hole Discount |
H4527 -037 -0 | $3.00 | $14.00 | $47.00 | $47.00 | 3,601
2020 Formulary |
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|
|
2021 AARP Medicare Advantage Plan 1 (HMO-POS)
| $0.00 |
$3,900 |
$195 | 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 Plan 2 (HMO)
| $0.00 |
$5,900 |
$195 | No additional gap coverage, only the Donut Hole Discount |
H4514 -007 -0 | $3.00 | $14.00 | $47.00 | $47.00 | 3,601
2020 Formulary |
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2021 AARP Medicare Advantage Plan 2 (HMO)
| $0.00 |
$5,900 |
$195 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $14.00 | $47.00 | $47.00 | 3,604 2021 Formulary |
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-- This plan not offered in 2020 --
|
H3288 -050 -0 | | | | | |
new |
new |
new |
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2021 Aetna Medicare Eagle Plan (PPO)
| $0.00 |
$5,000 |
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 Aetna Medicare Premier Plan (HMO)
| $0.00 |
$6,700 |
$250 | Yes, some additional gap coverage. |
H4523 -015 -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 Plan (HMO)
| $0.00 |
$7,550 |
$250 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,659 2021 Formulary |
|
2020 Aetna Medicare Prime Plan (HMO)
| $0.00 |
$3,400 |
$250 | Yes, some additional gap coverage. |
H4523 -024 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,763
2020 Formulary |
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|
|
|
2021 Aetna Medicare Prime Plan (HMO)
| $0.00 |
$5,900 |
$250 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,659 2021 Formulary |
|
2020 Aetna Medicare Value Plan (PPO)
| $0.00 |
$6,700 |
$195 | Yes, some additional gap coverage. |
H3288 -047 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,763
2020 Formulary |
new |
new |
new |
|
2021 Aetna Medicare Value Plan (PPO)
| $0.00 |
$6,700 |
$195 | 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 Amerigroup Medicare-Medicaid Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H8786 -001 -0 | 0% | 0% | 0% | 0% | 3,024
2020 Formulary |
-- |
-- |
-- |
|
2021 Amerigroup Medicare-Medicaid Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics, All Brands | | | | | 3,085 2021 Formulary |
|
2020 Amerivantage Care To You (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H2593 -042 -0 | $0.00 | $7.50 | $40.00 | $40.00 | 2,988
2020 Formulary |
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|
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2021 Amerivantage Care To You (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $40.00 | $40.00 | 3,057 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H8849 -002 -0 | | | | | |
new |
new |
new |
|
2021 Amerivantage Care To You Plus (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $40.00 | $40.00 | 3,057 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 Amerivantage Classic (HMO)
| $0.00 |
$5,500 |
$0 | Yes, some additional gap coverage. |
H2593 -028 -1 | $5.00 | $12.00 | $42.00 | $42.00 | 3,780
2020 Formulary |
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2021 Amerivantage Classic (HMO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $5.00 | $12.00 | $42.00 | $42.00 | 3,639 2021 Formulary |
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-- This plan not offered in 2020 --
|
H8849 -008 -1 | | | | | |
new |
new |
new |
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2021 Amerivantage Classic Plus (HMO)
| $0.00 |
$5,500 |
$0 | Yes, some additional gap coverage. | $5.00 | $12.00 | $42.00 | $42.00 | 3,639 2021 Formulary |
|
2020 Amerivantage Diabetes (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H2593 -037 -0 | $0.00 | $15.00 | $42.00 | $42.00 | 2,988
2020 Formulary |
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|
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2021 Amerivantage Diabetes Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $40.00 | $40.00 | 3,057 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 --
|
H8849 -003 -0 | | | | | |
new |
new |
new |
|
2021 Amerivantage Diabetes Care Plus (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $40.00 | $40.00 | 3,057 2021 Formulary |
|
2020 Amerivantage Heart (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H2593 -038 -0 | $0.00 | $15.00 | $42.00 | $42.00 | 2,988
2020 Formulary |
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|
|
|
2021 Amerivantage Heart Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $40.00 | $40.00 | 3,057 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H8849 -004 -0 | | | | | |
new |
new |
new |
|
2021 Amerivantage Heart Care Plus (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $40.00 | $40.00 | 3,057 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 Amerivantage COPD (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H2593 -039 -0 | $0.00 | $15.00 | $42.00 | $42.00 | 2,988
2020 Formulary |
|
|
|
|
2021 Amerivantage Lung Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $40.00 | $40.00 | 3,057 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H8849 -005 -0 | | | | | |
new |
new |
new |
|
2021 Amerivantage Lung Care Plus (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $40.00 | $40.00 | 3,057 2021 Formulary |
|
2020 Amerivantage Select (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H2593 -029 -0 | $3.00 | $10.00 | $42.00 | $42.00 | 3,780
2020 Formulary |
|
|
|
|
2021 Amerivantage Select (HMO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $3.00 | $10.00 | $42.00 | $42.00 | 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 |
-- This plan not offered in 2020 --
|
H8849 -009 -0 | | | | | |
new |
new |
new |
|
2021 Amerivantage Select Plus (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $3.00 | $10.00 | $42.00 | $42.00 | 3,639 2021 Formulary |
|
2020 Blue Cross Medicare Advantage Basic (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H8133 -001 -0 | $0.00 | $8.00 | $39.00 | $39.00 | 3,487
2020 Formulary |
|
|
|
|
2021 Blue Cross Medicare Advantage Basic (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $39.00 | $39.00 | 3,563 2021 Formulary |
|
2020 Blue Cross Medicare Advantage Choice Plus (PPO)
| $20.00 |
$6,700 |
$435 | Yes, some additional gap coverage. |
H1666 -006 -0 | $0.00 | $14.00 | $42.00 | $42.00 | 3,487
2020 Formulary |
|
|
|
|
2021 Blue Cross Medicare Advantage Choice Plus (PPO)
| $0.00 |
$7,550 |
$445 | Yes, some additional gap coverage. | $0.00 | $13.00 | $40.00 | $40.00 | 3,563 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 Advantage (HMO)
| $0.00 |
$3,400 |
No Rx Coverage |
H4513 -009 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2021 Cigna Fundamental Medicare (HMO)
| $0.00 |
$3,900 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2020 --
|
H4513 -061 -1 | | | | | |
|
|
|
|
2021 Cigna Preferred Medicare (HMO)
| $0.00 |
$4,300 |
$190 | Yes, some additional gap coverage. | $0.00 | $4.00 | $42.00 | $42.00 | 3,446 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H7849 -038 -0 | | | | | |
new |
new |
new |
|
2021 Cigna True Choice Medicare (PPO)
| $0.00 |
$6,800 |
$190 | Yes, some additional gap coverage. | $0.00 | $4.00 | $42.00 | $42.00 | 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 Devoted Health Greater Houston (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H7993 -001 -0 | $0.00 | $0.00 | $40.00 | $40.00 | 3,275
2020 Formulary |
new |
new |
new |
|
2021 Devoted Health Core Greater Houston (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $40.00 | $40.00 | 3,173 2021 Formulary |
|
2020 Erickson Advantage Liberty with Drugs (HMO)
| $25.00 |
$6,700 |
$250 | No additional gap coverage, only the Donut Hole Discount |
H5652 -008 -0 | $5.00 | $20.00 | $45.00 | $45.00 | 3,601
2020 Formulary |
|
|
|
|
2021 Erickson Advantage Liberty with Drugs (HMO-POS)
| $0.00 |
$6,700 |
$400 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $20.00 | $45.00 | $45.00 | 3,604 2021 Formulary |
|
2020 Erickson Advantage Liberty without Drugs (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H5652 -002 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2021 Erickson Advantage Liberty without Drugs (HMO-POS)
| $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 Humana Gold Plus H0028-042 (HMO)
| $0.00 |
$3,400 |
$195 | No additional gap coverage, only the Donut Hole Discount |
H0028 -042 -0 | $2.00 | $14.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
2021 Humana Gold Plus H0028-042 (HMO)
| $0.00 |
$3,450 |
$195 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $14.00 | $47.00 | $47.00 | 3,382 2021 Formulary |
|
2020 HumanaChoice H5216-128 (PPO)
| $0.00 |
$5,400 |
No Rx Coverage |
H5216 -128 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2021 Humana Honor (PPO)
| $0.00 |
$5,400 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2020 HumanaChoice R4182-001 (Regional PPO)
| $0.00 |
$5,700 |
No Rx Coverage |
R4182 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2021 HumanaChoice R4182-001 (Regional PPO)
| $0.00 |
$5,700 |
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 Imperial Health Insurance Traditional (HMO)
| $0.00 |
$4,000 |
$0 | Yes, some additional gap coverage. |
H2793 -003 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,305
2020 Formulary |
new |
new |
|
|
2021 Imperial Insurance Company Traditional (HMO)
| $0.00 |
$2,999 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,359 2021 Formulary |
|
2020 Imperial Health Insurance Value (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H2793 -005 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,374
2020 Formulary |
new |
new |
|
|
2021 Imperial Insurance Value (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,404 2021 Formulary |
|
2020 KelseyCare Advantage Essential (HMO)
| $0.00 |
$3,400 |
No Rx Coverage |
H0332 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2021 KelseyCare Advantage Essential (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 KelseyCare Advantage Essential+Choice (HMO-POS)
| $0.00 |
$3,400 |
No Rx Coverage |
H0332 -003 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2021 KelseyCare Advantage Essential+Choice (HMO-POS)
| $0.00 |
$3,450 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2020 KelseyCare Advantage Rx (HMO)
| $0.00 |
$3,400 |
$100 | Yes, some additional gap coverage. |
H0332 -002 -0 | $3.00 | $5.00 | $40.00 | $40.00 | 3,667
2020 Formulary |
|
|
|
|
2021 KelseyCare Advantage Rx (HMO)
| $0.00 |
$3,450 |
$100 | Yes, some additional gap coverage. | $0.00 | $5.00 | $40.00 | $40.00 | 3,339 2021 Formulary |
|
2020 Memorial Hermann Advantage (HMO)
| $0.00 |
$3,900 |
$300 | No additional gap coverage, only the Donut Hole Discount |
H7115 -001 -0 | $2.00 | $10.00 | $39.00 | $39.00 | 3,560
2020 Formulary |
|
|
|
|
2021 Memorial Hermann Advantage (HMO)
| $0.00 |
$3,900 |
$300 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $5.00 | $39.00 | $39.00 | 3,982 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 Dual Options (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H8197 -001 -0 | 0% | 0% | 0% | | 3,184
2020 Formulary |
-- |
-- |
-- |
|
2021 Molina Dual Options (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics, All Brands | | | | | 3,242 2021 Formulary |
|
2020 Oscar Easy Care (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5126 -001 -0 | $0.00 | $10.00 | $40.00 | $40.00 | 3,270
2020 Formulary |
new |
new |
new |
|
2021 Oscar Easy Care (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $40.00 | $40.00 | 3,339 2021 Formulary |
|
2020 UnitedHealthcare Connected (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H7833 -001 -0 | 0% | 0% | 0% | | 3,408
2020 Formulary |
-- |
-- |
-- |
|
2021 UnitedHealthcare Connected (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics, All Brands | | | | | 3,447 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 Dividend Prime (HMO)
| $0.00 |
$6,700 |
$300 | No additional gap coverage, only the Donut Hole Discount |
H0174 -007 -0 | $0.00 | $7.00 | $30.00 | $30.00 | 3,274
2020 Formulary |
|
-- |
|
|
2021 WellCare Dividend Prime (HMO)
| $0.00 |
$6,700 |
$300 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $7.00 | $30.00 | $30.00 | 3,348 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0174 -008 -0 | | | | | |
|
-- |
|
|
2021 WellCare Guardian (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 Premier (PPO)
| $0.00 |
$6,700 |
$200 | Yes, some additional gap coverage. |
H7323 -003 -0 | $0.00 | $8.00 | $45.00 | $45.00 | 3,274
2020 Formulary |
new |
new |
new |
|
2021 WellCare Premier (PPO)
| $0.00 |
$6,700 |
$200 | Yes, some additional gap coverage. | $0.00 | $8.00 | $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 |
-- This plan not offered in 2020 --
|
H7323 -006 -0 | | | | | |
new |
new |
new |
|
2021 WellCare Rx Plus (PPO)
| $0.00 |
$6,000 |
$300 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $45.00 | $45.00 | 3,348 2021 Formulary |
|
2020 WellCare TexanPlus Choice (HMO-POS)
| $0.00 |
$3,400 |
$250 | Yes, some additional gap coverage. |
H4506 -029 -0 | $0.00 | $5.00 | $40.00 | $40.00 | 3,274
2020 Formulary |
|
|
|
|
2021 WellCare TexanPlus Choice (HMO-POS)
| $0.00 |
$3,400 |
$250 | Yes, some additional gap coverage. | $0.00 | $5.00 | $40.00 | $40.00 | 3,348 2021 Formulary |
|
2020 WellCare TexanPlus Classic (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H4506 -003 -0 | $0.00 | $5.00 | $40.00 | $40.00 | 3,274
2020 Formulary |
|
|
|
|
2021 WellCare TexanPlus Classic (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $40.00 | $40.00 | 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 TexanPlus Value (HMO)
| $0.00 |
$3,000 |
No Rx Coverage |
H4506 -010 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2021 WellCare TexanPlus Value (HMO)
| $0.00 |
$3,000 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2020 --
|
H0174 -010 -0 | | | | | |
|
-- |
|
|
2021 WellCare Value (HMO)
| $0.00 |
$3,300 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $30.00 | $30.00 | 3,348 2021 Formulary |
|
2020 WellCare Value (HMO-POS)
| $0.00 |
$4,500 |
$0 | Yes, some additional gap coverage. |
H0174 -005 -0 | $0.00 | $5.00 | $30.00 | $30.00 | 3,274
2020 Formulary |
|
-- |
|
|
2021 WellCare Value (HMO-POS)
| $0.00 |
$4,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $30.00 | $30.00 | 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 Silver (Regional PPO C-SNP)
| $0.00 |
n/a |
$403 | No additional gap coverage, only the Donut Hole Discount |
R6801 -008 -0 | 25% | 25% | 25% | 25% | 3,601
2020 Formulary |
|
|
|
|
2021 UnitedHealthcare Medicare Silver (Regional PPO C-SNP)
| $4.90 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,604 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H4513 -060 -1 | | | | | |
|
|
|
|
2021 Cigna TotalCare (HMO D-SNP)
| $7.00 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,446 2021 Formulary |
|
2020 HumanaChoice H5216-043 (PPO)
| $18.00 |
$6,700 |
$295 | No additional gap coverage, only the Donut Hole Discount |
H5216 -043 -1 | $3.00 | $10.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
2021 HumanaChoice H5216-043 (PPO)
| $10.00 |
$6,700 |
$295 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $10.00 | $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 --
|
H1278 -014 -0 | | | | | |
|
new |
|
|
2021 AARP Medicare Advantage Choice (PPO)
| $15.00 |
$6,700 |
$245 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $10.00 | $47.00 | $47.00 | 3,604 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H8343 -001 -0 | | | | | |
new |
new |
new |
|
2021 Amerivantage Choice (PPO)
| $15.00 |
$6,500 |
$0 | Yes, some additional gap coverage. | $5.00 | $12.00 | $37.00 | $37.00 | 3,639 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H0174 -009 -0 | | | | | |
|
-- |
|
|
2021 WellCare Compass (HMO)
| $16.20 |
$3,450 |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $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 Access (HMO D-SNP)
| $20.80 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H0174 -004 -0 | $1.00 | $14.00 | $47.00 | $47.00 | 3,274
2020 Formulary |
|
-- |
|
|
2021 WellCare Access (HMO D-SNP)
| $17.70 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,348 2021 Formulary |
|
2020 Aetna Medicare Choice Plan (PPO)
| $15.00 |
$6,700 |
$300 | Yes, some additional gap coverage. |
H3288 -003 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,763
2020 Formulary |
new |
new |
new |
|
2021 Aetna Medicare Choice Plan (PPO)
| $19.00 |
$7,550 |
$300 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,659 2021 Formulary |
|
2020 WellCare Liberty (HMO D-SNP)
| $20.80 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H0174 -006 -0 | $1.00 | $16.00 | $47.00 | $47.00 | 3,274
2020 Formulary |
|
-- |
|
|
2021 WellCare Liberty (HMO D-SNP)
| $20.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $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 |
-- This plan not offered in 2020 --
|
H8849 -011 -1 | | | | | |
new |
new |
new |
|
2021 Amerivantage Dual Secure Plus (HMO D-SNP)
| $20.60 |
n/a |
$445 | Yes, some additional gap coverage. | $0.00 | $14.00 | $47.00 | $47.00 | 3,639 2021 Formulary |
|
2020 Amerivantage Dual Premier (HMO D-SNP)
| $20.80 |
n/a |
$435 | Yes, some additional gap coverage. |
H2593 -032 -0 | $0.00 | $14.00 | $47.00 | $47.00 | 3,780
2020 Formulary |
|
|
|
|
2021 Amerivantage Dual Secure (HMO D-SNP)
| $21.50 |
n/a |
$445 | Yes, some additional gap coverage. | $0.00 | $14.00 | $47.00 | $47.00 | 3,639 2021 Formulary |
|
2020 Aetna Medicare Dual Complete Plan (HMO D-SNP)
| $16.50 |
n/a |
$275 | No additional gap coverage, only the Donut Hole Discount |
H8597 -003 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,763
2020 Formulary |
new |
new |
new |
|
2021 Aetna Medicare Dual Complete Plan (HMO D-SNP)
| $22.50 |
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 |
2020 Amerivantage Dual Coordination (HMO D-SNP)
| $20.30 |
n/a |
$435 | Yes, some additional gap coverage. |
H2593 -030 -1 | $0.00 | $14.00 | $47.00 | $47.00 | 3,780
2020 Formulary |
|
|
|
|
2021 Amerivantage Dual Coordination (HMO D-SNP)
| $22.50 |
n/a |
$445 | Yes, some additional gap coverage. | $0.00 | $14.00 | $47.00 | $47.00 | 3,639 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H8849 -010 -1 | | | | | |
new |
new |
new |
|
2021 Amerivantage Dual Coordination Plus (HMO D-SNP)
| $22.50 |
n/a |
$445 | Yes, some additional gap coverage. | $0.00 | $14.00 | $47.00 | $47.00 | 3,639 2021 Formulary |
|
2020 Community Health Choice (HMO D-SNP)
| $20.80 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H9826 -001 -0 | $0.00 | | | | 3,741
2020 Formulary |
new |
new |
new |
|
2021 Community Health Choice (HMO D-SNP)
| $22.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,779 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 Prime Greater Houston (HMO)
| $20.80 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H7993 -002 -0 | $0.00 | $0.00 | $30.00 | $30.00 | 3,275
2020 Formulary |
new |
new |
new |
|
2021 Devoted Health Prime Greater Houston (HMO)
| $22.50 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $30.00 | $30.00 | 3,173 2021 Formulary |
|
2020 Humana Gold Plus SNP-DE H0028-031 (HMO D-SNP)
| $20.70 |
n/a |
$430 | No additional gap coverage, only the Donut Hole Discount |
H0028 -031 -0 | $0.00 | $12.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
2021 Humana Gold Plus SNP-DE H0028-031 (HMO D-SNP)
| $22.50 |
n/a |
$425 | No additional gap coverage, only the Donut Hole Discount | $1.00 | $14.00 | $47.00 | $47.00 | 3,382 2021 Formulary |
|
2020 Humana Gold Plus SNP-DE H0028-033 (HMO D-SNP)
| $20.70 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H0028 -033 -0 | $0.00 | $18.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
2021 Humana Gold Plus SNP-DE H0028-033 (HMO D-SNP)
| $22.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $1.00 | $18.00 | $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 Imperial Health Insurance Dual (HMO D-SNP)
| $20.80 |
n/a |
$435 | Yes, some additional gap coverage. |
H2793 -004 -0 | 0% | 25% | 25% | 25% | 3,305
2020 Formulary |
new |
new |
|
|
2021 Imperial Insurance Company Dual (HMO D-SNP)
| $22.50 |
n/a |
$445 | Yes, some additional gap coverage. | 0% | 25% | 25% | 25% | 3,359 2021 Formulary |
|
2020 Molina Medicare Complete Care (HMO D-SNP)
| $20.80 |
n/a |
$435 | Yes, some additional gap coverage. |
H7678 -001 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,185
2020 Formulary |
|
|
|
|
2021 Molina Medicare Complete Care (HMO D-SNP)
| $22.50 |
n/a |
$445 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 3,245 2021 Formulary |
|
2020 ProCare Advantage (HMO I-SNP)
| $20.80 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H3467 -001 -0 | 25% | | | | 3,717
2020 Formulary |
new |
new |
new |
|
2021 ProCare Advantage (HMO I-SNP)
| $22.50 |
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 |
-- This plan not offered in 2020 --
|
H4514 -013 -1 | | | | | |
|
|
|
|
2021 UnitedHealthcare Dual Complete (HMO D-SNP)
| $22.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,604 2021 Formulary |
|
2020 UnitedHealthcare Dual Complete Choice (Regional PPO D-SNP)
| $20.40 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
R6801 -011 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,601
2020 Formulary |
|
|
|
|
2021 UnitedHealthcare Dual Complete Choice (Regional PPO D-SNP)
| $22.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,604 2021 Formulary |
|
2020 UnitedHealthcare Nursing Home Plan (PPO I-SNP)
| $20.80 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H0710 -020 -0 | 25% | 25% | 25% | 25% | 3,601
2020 Formulary |
|
-- |
|
|
2021 UnitedHealthcare Nursing Home Plan (PPO I-SNP)
| $22.50 |
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 |
-- This plan not offered in 2020 --
|
H7323 -005 -0 | | | | | |
new |
new |
new |
|
2021 WellCare Imperial (PPO D-SNP)
| $22.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,348 2021 Formulary |
|
2020 Erickson Advantage Guardian (HMO-POS I-SNP)
| $29.30 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5652 -003 -0 | $0.00 | $0.00 | $28.00 | $28.00 | 3,601
2020 Formulary |
|
|
|
|
2021 Erickson Advantage Guardian (HMO-POS I-SNP)
| $28.80 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $28.00 | $28.00 | 3,604 2021 Formulary |
|
2020 UnitedHealthcare Medicare Gold (Regional PPO C-SNP)
| $29.00 |
n/a |
$295 | No additional gap coverage, only the Donut Hole Discount |
R6801 -009 -0 | $4.00 | $12.00 | $47.00 | $47.00 | 3,601
2020 Formulary |
|
|
|
|
2021 UnitedHealthcare Medicare Gold (Regional PPO C-SNP)
| $29.00 |
n/a |
$295 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $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 |
2020 Humana Gold Choice H8145-126 (PFFS)
| $69.00 |
n/a |
No Rx Coverage |
H8145 -126 -0 | This plan does NOT include Prescription Drug coverage. | |
|
-- |
|
|
2021 Humana Gold Choice H8145-126 (PFFS)
| $30.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2020 UnitedHealthcare Medicare Advantage Choice (Regional PPO)
| $42.00 |
$6,700 |
$395 | No additional gap coverage, only the Donut Hole Discount |
R6801 -012 -0 | $4.00 | $12.00 | $47.00 | $47.00 | 3,601
2020 Formulary |
|
|
|
|
2021 UnitedHealthcare Medicare Advantage Choice (Regional PPO)
| $49.00 |
$7,550 |
$395 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $12.00 | $47.00 | $47.00 | 3,604 2021 Formulary |
|
-- This plan not offered in 2020 --
|
H7115 -003 -0 | | | | | |
|
|
|
|
2021 Memorial Hermann Advantage Plus (HMO)
| $50.00 |
$3,900 |
$300 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $5.00 | $39.00 | $39.00 | 3,982 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 R4182-004 (Regional PPO)
| $54.00 |
$6,700 |
$175 | No additional gap coverage, only the Donut Hole Discount |
R4182 -004 -0 | $6.00 | $13.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
2021 HumanaChoice R4182-004 (Regional PPO)
| $55.00 |
$7,200 |
$175 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $13.00 | $47.00 | $47.00 | 3,386 2021 Formulary |
|
2020 Erickson Advantage Freedom (HMO-POS)
| $60.00 |
$4,200 |
$200 | No additional gap coverage, only the Donut Hole Discount |
H5652 -006 -0 | $5.00 | $15.00 | $45.00 | $45.00 | 3,601
2020 Formulary |
|
|
|
|
2021 Erickson Advantage Freedom (HMO-POS)
| $70.00 |
$4,300 |
$200 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $45.00 | $45.00 | 3,604 2021 Formulary |
|
2020 KelseyCare Advantage Rx+Choice (HMO-POS)
| $77.00 |
$3,400 |
$100 | Yes, some additional gap coverage. |
H0332 -004 -0 | $3.00 | $5.00 | $40.00 | $40.00 | 3,667
2020 Formulary |
|
|
|
|
2021 KelseyCare Advantage Rx+Choice (HMO-POS)
| $77.00 |
$3,450 |
$100 | Yes, some additional gap coverage. | $0.00 | $5.00 | $40.00 | $40.00 | 3,339 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 Blue Cross Medicare Advantage Choice Premier (PPO)
| $90.00 |
$5,900 |
$435 | Yes, some additional gap coverage. |
H1666 -003 -0 | $0.00 | $14.00 | $42.00 | $42.00 | 3,487
2020 Formulary |
|
|
|
|
2021 Blue Cross Medicare Advantage Choice Premier (PPO)
| $90.00 |
$7,550 |
$295 | Yes, some additional gap coverage. | $0.00 | $13.00 | $40.00 | $40.00 | 3,563 2021 Formulary |
|
2020 HumanaChoice H5216-042 (PPO)
| $92.00 |
$6,700 |
$175 | No additional gap coverage, only the Donut Hole Discount |
H5216 -042 -0 | $7.00 | $12.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
2021 HumanaChoice H5216-042 (PPO)
| $93.00 |
$6,700 |
$175 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $12.00 | $47.00 | $47.00 | 3,386 2021 Formulary |
|
2020 HumanaChoice R4182-003 (Regional PPO)
| $95.00 |
$6,700 |
$175 | No additional gap coverage, only the Donut Hole Discount |
R4182 -003 -0 | $7.00 | $12.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
|
|
|
2021 HumanaChoice R4182-003 (Regional PPO)
| $93.00 |
$7,200 |
$175 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $12.00 | $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 Humana Gold Choice H8145-084 (PFFS)
| $134.00 |
n/a |
$250 | No additional gap coverage, only the Donut Hole Discount |
H8145 -084 -0 | $6.00 | $12.00 | $47.00 | $47.00 | 3,369
2020 Formulary |
|
-- |
|
|
2021 Humana Gold Choice H8145-084 (PFFS)
| $96.00 |
n/a |
$250 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $12.00 | $47.00 | $47.00 | 3,386 2021 Formulary |
|
2020 Erickson Advantage Champion (HMO-POS C-SNP)
| $195.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5652 -004 -0 | $5.00 | $10.00 | $45.00 | $45.00 | 3,601
2020 Formulary |
|
|
|
|
2021 Erickson Advantage Champion (HMO-POS C-SNP)
| $199.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $45.00 | $45.00 | 3,604 2021 Formulary |
|
2020 Erickson Advantage Signature with Drugs (HMO-POS)
| $195.00 |
$2,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5652 -001 -0 | $5.00 | $15.00 | $45.00 | $45.00 | 3,601
2020 Formulary |
|
|
|
|
2021 Erickson Advantage Signature with Drugs (HMO-POS)
| $199.00 |
$2,600 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $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 Cigna-HealthSpring Preferred (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H4513 -025 -0 | $0.00 | $4.00 | $40.00 | $40.00 | 3,383
2020 Formulary |
|
|
|
|
-- Members will be assigned to Cigna Preferred Medicare (HMO) H4513-061-1 --
| | | | | |
|
2020 Cigna-HealthSpring TotalCare (HMO D-SNP)
| $15.90 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H4513 -010 -0 | 15% | 15% | 15% | 15% | 3,383
2020 Formulary |
|
|
|
|
-- Members will be assigned to Cigna TotalCare (HMO D-SNP) H4513-060-1 --
| | | | | |
|
2020 UnitedHealthcare Dual Complete (HMO D-SNP)
| $19.80 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H4514 -001 -0 | 15% | 15% | 15% | 15% | 3,601
2020 Formulary |
|
|
|
|
-- Members will be assigned to UnitedHealthcare Dual Complete (HMO D-SNP) H4514-013-1 --
| | | | | |
|
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 WellCare TexanPlus Star (HMO D-SNP)
| $20.80 |
n/a |
$435 | No additional gap coverage, only the Donut Hole Discount |
H0174 -001 -0 | $2.00 | $8.00 | $47.00 | $47.00 | 3,274
2020 Formulary |
|
-- |
|
|
-- Members will be assigned to WellCare Access (HMO D-SNP) H0174-004-0 --
| | | | | |
|
2020 Aetna Medicare Plus Plan (PPO)
| $0.00 |
$6,700 |
$350 | Yes, some additional gap coverage. |
H3288 -014 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,763
2020 Formulary |
new |
new |
new |
|
-- This plan not offered in 2021 --
|
| | | | |
|