There are 89 Medicare Advantage plans meeting your criteria.
2021 / 2022 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 |
2021 AARP Medicare Advantage Freedom Plus (HMO-POS)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. |
H0543 -216 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
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|
|
|
2022 AARP Medicare Advantage Freedom Plus (HMO-POS)
| $0.00 |
$800 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,654 2022 Formulary |
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-- This plan not offered in 2021 --
|
H0543 -221 -0 | | | | | |
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2022 AARP Medicare Advantage Harmony (HMO)
| $0.00 |
$800 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,654 2022 Formulary |
|
2021 AARP Medicare Advantage Patriot (HMO)
| $0.00 |
$4,900 |
No Rx Coverage |
H0543 -121 -0 | This plan does NOT include Prescription Drug coverage. | |
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2022 AARP Medicare Advantage Patriot (HMO)
| $0.00 |
$4,900 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2021 AARP Medicare Advantage SecureHorizons Focus (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. |
H0543 -170 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 AARP Medicare Advantage SecureHorizons Focus (HMO)
| $0.00 |
$800 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,654 2022 Formulary |
|
2021 AARP Medicare Advantage SecureHorizons Plan 2 (HMO)
| $0.00 |
$1,900 |
$0 | Yes, some additional gap coverage. |
H0543 -144 -0 | $0.00 | $14.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
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|
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2022 AARP Medicare Advantage SecureHorizons Plan 2 (HMO)
| $0.00 |
$1,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $14.00 | $47.00 | $47.00 | 3,654 2022 Formulary |
|
2021 Aetna Medicare Eagle Plan (HMO)
| $0.00 |
$4,200 |
No Rx Coverage |
H4982 -013 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
2022 Aetna Medicare Eagle Plan (HMO)
| $0.00 |
$4,200 |
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 |
2021 Aetna Medicare Plus Plan (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. |
H4982 -002 -0 | $0.00 | $0.00 | $37.00 | $37.00 | 3,679
2021 Formulary |
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|
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2022 Aetna Medicare Plus Plan (HMO)
| $0.00 |
$899 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $37.00 | $37.00 | 3,698 2022 Formulary |
|
2021 Aetna Medicare Select Plan (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H0523 -022 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
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|
|
|
2022 Aetna Medicare Select Plan (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H3274 -003 -0 | | | | | |
new |
new |
new |
|
2022 Align Connect (HMO C-SNP)
| $0.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $45.00 | $45.00 | 3,860 2022 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 2021 --
|
H3274 -002 -0 | | | | | |
new |
new |
new |
|
2022 Align Thrive (HMO I-SNP)
| $0.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $45.00 | $45.00 | 3,860 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H0544 -127 -0 | | | | | |
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2022 Anthem MediBlue Plus (HMO)
| $0.00 |
$5,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $15.00 | $42.00 | $42.00 | 3,604 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H0544 -066 -0 | | | | | |
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|
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2022 Anthem MediBlue Select (HMO)
| $0.00 |
$1,800 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 3,604 2022 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 |
2021 Blue Shield 65 Plus (HMO)
| $0.00 |
$2,799 |
$0 | Yes, some additional gap coverage. |
H0504 -026 -0 | $0.00 | $10.00 | $40.00 | $40.00 | 3,413
2021 Formulary |
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|
|
2022 Blue Shield 65 Plus (HMO)
| $0.00 |
$2,799 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $40.00 | $40.00 | 3,426 2022 Formulary |
|
2021 Blue Shield 65 Plus Choice Plan (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. |
H0504 -040 -0 | $0.00 | $3.00 | $35.00 | $35.00 | 3,638
2021 Formulary |
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2022 Blue Shield 65 Plus Choice Plan (HMO)
| $0.00 |
$799 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $35.00 | $35.00 | 3,656 2022 Formulary |
|
2021 Blue Shield Vital (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H0504 -045 -0 | $0.00 | $10.00 | $40.00 | $40.00 | 3,065
2021 Formulary |
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|
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2022 Blue Shield Vital (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $40.00 | $40.00 | 3,079 2022 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 |
2021 Brand New Day Bridges Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0838 -028 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,207
2021 Formulary |
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-- |
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2022 Brand New Day Bridges Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics | $0.00 | $5.00 | $45.00 | $45.00 | 3,133 2022 Formulary |
|
2021 Brand New Day Classic Care I Plan (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. |
H0838 -025 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,207
2021 Formulary |
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-- |
|
|
2022 Brand New Day Classic Care I Plan (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,133 2022 Formulary |
|
2021 Brand New Day Classic Care II Plan (HMO)
| $0.00 |
$999 |
$50 | Yes, some additional gap coverage. |
H0838 -037 -0 | $0.00 | $12.00 | $47.00 | $47.00 | 3,207
2021 Formulary |
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-- |
|
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2022 Brand New Day Classic Care II Plan (HMO)
| $0.00 |
$999 |
$50 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | 3,133 2022 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 |
2021 Brand New Day Embrace Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0838 -039 -1 | $0.00 | $9.00 | $47.00 | $47.00 | 3,207
2021 Formulary |
|
-- |
|
|
2022 Brand New Day Embrace Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics | $0.00 | $9.00 | $47.00 | $47.00 | 3,133 2022 Formulary |
|
2021 Brand New Day Harmony Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$100 | Yes, some additional gap coverage. |
H0838 -032 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,207
2021 Formulary |
|
-- |
|
|
2022 Brand New Day Harmony Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$100 | Some Generics | $0.00 | $0.00 | $45.00 | $45.00 | 3,133 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H0838 -049 -0 | | | | | |
|
-- |
|
|
2022 Brand New Day Part B Savings Plan (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | 3,133 2022 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 |
2021 Brand New Day Select Care I Plan (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0838 -042 -0 | $0.00 | $9.00 | $47.00 | $47.00 | 3,207
2021 Formulary |
|
-- |
|
|
2022 Brand New Day Select Care I Plan (HMO I-SNP)
| $0.00 |
n/a |
$0 | Some Generics | $0.00 | $0.00 | $0.00 | $0.00 | 3,133 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H0838 -048 -0 | | | | | |
|
-- |
|
|
2022 Brand New Day Valor Care Plan (HMO)
| $0.00 |
$4,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 CalPlus (HMO)
| $20.10 |
$4,900 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3815 -009 -0 | $0.00 | $14.00 | 23% | 23% | 3,417
2021 Formulary |
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|
|
|
2022 CalPlus (HMO)
| $0.00 |
$4,900 |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | 25% | 25% | 3,450 2022 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 |
2021 Central Health Medicare Plan (HMO)
| $0.00 |
$1,800 |
$0 | Yes, some additional gap coverage. |
H5649 -001 -0 | $0.00 | $0.00 | $35.00 | $35.00 | 3,560
2021 Formulary |
|
-- |
|
|
2022 Central Health Medicare Plan (HMO)
| $0.00 |
$990 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,510 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H5649 -019 -0 | | | | | |
|
-- |
|
|
2022 Central Health Savings Plan (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,510 2022 Formulary |
|
2021 Connected Care (HMO)
| $0.00 |
$1,499 |
$0 | Yes, some additional gap coverage. |
H2241 -013 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,560
2021 Formulary |
|
|
|
|
2022 Connected Care (HMO)
| $0.00 |
$1,499 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $45.00 | $45.00 | tbd |
|
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 |
2021 Connected Care Select (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H2241 -019 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,560
2021 Formulary |
|
|
|
|
2022 Connected Care Select (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands | $0.00 | $10.00 | $45.00 | $45.00 | tbd |
|
2021 Humana Community (HMO)
| $0.00 |
$1,500 |
$0 | Yes, some additional gap coverage. |
H7621 -002 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
|
|
|
|
2022 Humana Community (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 Humana Gold Plus H5619-039 (HMO)
| $0.00 |
$3,450 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5619 -039 -1 | $0.00 | $5.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
|
|
|
|
2022 Humana Gold Plus H5619-039 (HMO)
| $0.00 |
$3,450 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $47.00 | $47.00 | 3,408 2022 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 |
2021 Humana Honor (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H5619 -121 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Humana Honor (HMO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 IEHP DualChoice (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics, All Brands |
H5355 -001 -0 | | | | | 2,841
2021 Formulary |
-- |
-- |
-- |
|
2022 IEHP DualChoice (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics, All Brands | | | | | 2,834 2022 Formulary |
|
2021 Imperial Dynamic Plan (HMO)
| $0.00 |
$899 |
$0 | Yes, some additional gap coverage. |
H5496 -012 -0 | $0.00 | $3.00 | $30.00 | $30.00 | 3,359
2021 Formulary |
|
-- |
|
|
2022 Imperial Dynamic Plan (HMO)
| $0.00 |
$899 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $30.00 | $30.00 | 3,315 2022 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 |
2021 Imperial Senior Value (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5496 -005 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,404
2021 Formulary |
|
-- |
|
|
2022 Imperial Senior Value (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands | $0.00 | $5.00 | $45.00 | $45.00 | 3,364 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H5496 -014 -0 | | | | | |
|
-- |
|
|
2022 Imperial Strong (HMO)
| $0.00 |
$7,550 |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,315 2022 Formulary |
|
2021 Imperial Traditional (HMO)
| $0.00 |
$2,999 |
$0 | Yes, some additional gap coverage. |
H5496 -007 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,359
2021 Formulary |
|
-- |
|
|
2022 Imperial Traditional (HMO)
| $0.00 |
$2,999 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,315 2022 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 |
2021 Inter Valley Health Plan Desert Preferred Choice (HMO)
| $0.00 |
$1,500 |
$0 | Yes, some additional gap coverage. |
H0545 -012 -0 | $0.00 | $12.00 | $47.00 | $47.00 | 2,790
2021 Formulary |
|
|
|
|
2022 Inter Valley Health Plan Desert Preferred Choice (HMO)
| $0.00 |
$1,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | 2,882 2022 Formulary |
|
2021 Inter Valley Health Plan Service To Seniors (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. |
H0545 -001 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 2,790
2021 Formulary |
|
|
|
|
2022 Inter Valley Health Plan Service To Seniors (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 2,882 2022 Formulary |
|
2021 Kaiser Permanente Senior Advantage Inland Empire (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H0524 -015 -0 | $3.00 | $10.00 | $47.00 | $47.00 | 4,700
2021 Formulary |
|
|
|
|
2022 Kaiser Permanente Senior Advantage Inland Empire (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 4,211 2022 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 |
2021 Molina Dual Options (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics, All Brands |
H8677 -001 -0 | | | | | 3,242
2021 Formulary |
-- |
-- |
-- |
|
2022 Molina Dual Options (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics, All Brands | | | | | 3,260 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H5810 -014 -0 | | | | | |
|
-- |
|
|
2022 Molina Medicare Choice Care (HMO)
| $0.00 |
$7,550 |
$125 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 3,218 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H5810 -015 -0 | | | | | |
|
-- |
|
|
2022 Molina Medicare Choice Care Select (HMO)
| $0.00 |
$7,550 |
$480 | No additional gap coverage, only the Donut Hole Discount | $15.00 | $20.00 | $47.00 | $47.00 | 3,218 2022 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 |
2021 My Choice (HMO)
| $0.00 |
$2,400 |
$0 | Yes, some additional gap coverage. |
H3815 -001 -0 | $0.00 | $5.00 | $30.00 | $30.00 | 3,417
2021 Formulary |
|
|
|
|
2022 My Choice (HMO)
| $0.00 |
$998 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $30.00 | $30.00 | 3,450 2022 Formulary |
|
2021 Platinum (HMO)
| $0.00 |
$2,400 |
$0 | Yes, some additional gap coverage. |
H3815 -015 -0 | $0.00 | $5.00 | $30.00 | $30.00 | 3,417
2021 Formulary |
|
|
|
|
2022 Platinum (HMO)
| $0.00 |
$998 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $30.00 | $30.00 | 3,450 2022 Formulary |
|
2021 SCAN Classic (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. |
H5425 -008 -0 | $0.00 | $7.00 | $37.00 | $37.00 | 3,383
2021 Formulary |
|
|
|
|
2022 SCAN Classic (HMO)
| $0.00 |
$699 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $30.00 | $30.00 | 3,425 2022 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 |
2021 SCAN Healthy at Home (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H9104 -006 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,383
2021 Formulary |
|
-- |
-- |
|
2022 SCAN Healthy at Home (HMO I-SNP)
| $0.00 |
n/a |
$0 | Some Generics | $0.00 | $0.00 | $42.00 | $42.00 | 3,425 2022 Formulary |
|
2021 SCAN Heart First (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5425 -033 -0 | $0.00 | $7.00 | $37.00 | $37.00 | 3,383
2021 Formulary |
|
|
|
|
2022 SCAN Heart First (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands | $0.00 | $0.00 | $37.00 | $37.00 | 3,425 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H5425 -085 -0 | | | | | |
|
|
|
|
2022 SCAN Venture (HMO)
| $0.00 |
$1,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $30.00 | $30.00 | 3,425 2022 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 2021 --
|
H3815 -034 -0 | | | | | |
|
|
|
|
2022 the ONE + Rite Aid (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $1.00 | $40.00 | $40.00 | 3,450 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H0543 -219 -0 | | | | | |
|
|
|
|
2022 UnitedHealthcare Chronic Complete (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics, Few Brands | $0.00 | $0.00 | $35.00 | $35.00 | 3,654 2022 Formulary |
|
2021 WellCare Dividend (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. |
H5087 -025 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
-- |
|
|
2022 Wellcare Giveback (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $37.00 | $37.00 | 3,375 2022 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 |
2021 Health Net Gold Select (HMO)
| $0.00 |
$850 |
$0 | Yes, some additional gap coverage. |
H0562 -126 -0 | $0.00 | $1.00 | $42.00 | $42.00 | 3,370
2021 Formulary |
|
|
|
|
2022 Wellcare No Premium (HMO)
| $0.00 |
$850 |
$0 | Yes, some additional gap coverage. | $0.00 | $1.00 | $37.00 | $37.00 | 3,375 2022 Formulary |
|
2021 WellCare Best (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. |
H5087 -016 -0 | $0.00 | $8.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
-- |
|
|
2022 Wellcare No Premium Best (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $37.00 | $37.00 | 3,375 2022 Formulary |
|
2021 Health Net Green (HMO)
| $0.00 |
$3,400 |
No Rx Coverage |
H0562 -044 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Wellcare Patriot Giveback (HMO)
| $0.00 |
$3,400 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2021 WellCare Plus (HMO)
| $4.60 |
$2,500 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5087 -002 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
-- |
|
|
2022 Wellcare Plus (HMO)
| $0.00 |
$2,500 |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,375 2022 Formulary |
|
2021 Health Net Healthy Heart (HMO)
| $17.00 |
$2,400 |
$0 | Yes, some additional gap coverage. |
H0562 -123 -0 | $1.00 | $8.00 | $42.00 | $42.00 | 3,370
2021 Formulary |
|
|
|
|
2022 Wellcare Low Premium (HMO)
| $18.00 |
$2,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $37.00 | $37.00 | 3,375 2022 Formulary |
|
2021 Anthem MediBlue Coordination Plus (HMO)
| $18.70 |
$7,550 |
$445 | Yes, some additional gap coverage. |
H0544 -071 -0 | $0.00 | $12.00 | $47.00 | $47.00 | 3,621
2021 Formulary |
|
|
|
|
2022 Anthem MediBlue Coordination Plus (HMO)
| $18.20 |
$7,550 |
$480 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | 3,604 2022 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 |
2021 Humana Value Plus H5619-037 (HMO)
| $20.40 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5619 -037 -0 | $0.00 | $19.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
|
|
|
|
2022 Humana Value Plus H5619-037 (HMO)
| $22.60 |
$7,550 |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $19.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 SCAN Prime (HMO)
| $23.00 |
$699 |
$0 | Yes, some additional gap coverage. |
H5425 -067 -0 | $0.00 | $7.00 | $37.00 | $37.00 | 3,383
2021 Formulary |
|
|
|
|
2022 SCAN Prime (HMO)
| $23.00 |
$399 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $30.00 | $30.00 | 3,425 2022 Formulary |
|
2021 Anthem MediBlue Extra (HMO)
| $31.50 |
$900 |
$445 | Yes, some additional gap coverage. |
H0544 -081 -0 | $0.00 | $2.00 | $47.00 | $47.00 | 3,621
2021 Formulary |
|
|
|
|
2022 Anthem MediBlue Extra (HMO)
| $25.70 |
$900 |
$480 | Yes, some additional gap coverage. | $0.00 | $2.00 | $47.00 | $47.00 | 3,604 2022 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 2021 --
|
H3274 -001 -0 | | | | | |
new |
new |
new |
|
2022 Align Premier (HMO I-SNP)
| $26.70 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,712 2022 Formulary |
|
2021 AARP Medicare Advantage SecureHorizons Premier (HMO)
| $28.10 |
$1,000 |
$0 | Yes, some additional gap coverage. |
H0543 -166 -0 | $0.00 | $9.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 AARP Medicare Advantage SecureHorizons Premier (HMO)
| $29.70 |
$800 |
$0 | Yes, some additional gap coverage. | $0.00 | $9.00 | $47.00 | $47.00 | 3,654 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H0524 -030 -0 | | | | | |
|
|
|
|
2022 Kaiser Permanente Sr Adv Medicare Medi-Cal (HMO D-SNP)
| $31.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 4,211 2022 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 |
2021 Brand New Day Classic Choice Plan (HMO)
| $31.50 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0838 -033 -0 | 0% | 25% | 25% | 25% | 3,207
2021 Formulary |
|
-- |
|
|
2022 Brand New Day Classic Choice Plan (HMO)
| $32.20 |
$7,550 |
$480 | Yes, some additional gap coverage. | $0.00 | 25% | 25% | 25% | 3,133 2022 Formulary |
|
2021 UnitedHealthcare Medicare Advantage Assure (HMO)
| $22.50 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0543 -153 -0 | | | | | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Medicare Advantage Assure (HMO)
| $32.70 |
$7,550 |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654 2022 Formulary |
|
2021 Brand New Day Dual Access Plan (HMO D-SNP)
| $31.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0838 -024 -0 | 0% | 25% | 25% | 25% | 3,207
2021 Formulary |
|
-- |
|
|
2022 Brand New Day Dual Access Plan (HMO D-SNP)
| $32.90 |
n/a |
$480 | Some Generics | $0.00 | 25% | 25% | 25% | 3,133 2022 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 |
2021 Blue Shield Coordinated Choice Plan (HMO)
| $31.50 |
$6,700 |
$445 | Yes, some additional gap coverage. |
H5928 -037 -0 | $0.00 | 25% | 25% | 25% | 3,202
2021 Formulary |
|
|
|
|
2022 Blue Shield Coordinated Choice Plan (HMO)
| $33.20 |
$6,700 |
$480 | Yes, some additional gap coverage. | $0.00 | 25% | 25% | 25% | 3,251 2022 Formulary |
|
2021 Brand New Day Bridges Choice Plan (HMO C-SNP)
| $31.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0838 -029 -0 | 0% | 25% | 25% | 25% | 3,207
2021 Formulary |
|
-- |
|
|
2022 Brand New Day Bridges Choice Plan (HMO C-SNP)
| $33.20 |
n/a |
$480 | Some Generics | $0.00 | 25% | 25% | 25% | 3,133 2022 Formulary |
|
2021 Brand New Day Embrace Choice Plan (HMO C-SNP)
| $31.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0838 -040 -1 | 0% | 25% | 25% | 25% | 3,207
2021 Formulary |
|
-- |
|
|
2022 Brand New Day Embrace Choice Plan (HMO C-SNP)
| $33.20 |
n/a |
$480 | Some Generics | $0.00 | 25% | 25% | 25% | 3,133 2022 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 |
2021 Brand New Day Harmony Choice Plan (HMO C-SNP)
| $31.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0838 -020 -0 | 0% | 25% | 25% | 25% | 3,207
2021 Formulary |
|
-- |
|
|
2022 Brand New Day Harmony Choice Plan (HMO C-SNP)
| $33.20 |
n/a |
$480 | Some Generics | $0.00 | 25% | 25% | 25% | 3,133 2022 Formulary |
|
2021 Brand New Day Select Choice I Plan (HMO I-SNP)
| $31.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0838 -044 -0 | 0% | 25% | 25% | 25% | 3,207
2021 Formulary |
|
-- |
|
|
2022 Brand New Day Select Choice I Plan (HMO I-SNP)
| $33.20 |
n/a |
$480 | Some Generics | $0.00 | $0.00 | 25% | 25% | 3,133 2022 Formulary |
|
2021 Central Health Premier Plan (HMO)
| $31.50 |
$6,700 |
$445 | Yes, some additional gap coverage. |
H5649 -004 -0 | $0.00 | $0.00 | 25% | 25% | 3,560
2021 Formulary |
|
-- |
|
|
2022 Central Health Premier Plan (HMO)
| $33.20 |
$6,700 |
$480 | Yes, some additional gap coverage. | $0.00 | $0.00 | 25% | 25% | 3,510 2022 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 |
2021 Imperial Traditional Plus (HMO)
| $31.50 |
$2,999 |
$445 | Yes, some additional gap coverage. |
H5496 -009 -0 | 0% | 25% | 25% | 25% | 3,359
2021 Formulary |
|
-- |
|
|
2022 Imperial Traditional Plus (HMO)
| $33.20 |
$2,999 |
$480 | Yes, some additional gap coverage. | 0% | 25% | 25% | 25% | 3,315 2022 Formulary |
|
2021 Inter Valley Health Plan Vitality Plus (HMO)
| $31.50 |
$5,900 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0545 -015 -0 | $0.00 | 25% | 25% | 25% | 2,790
2021 Formulary |
|
|
|
|
2022 Inter Valley Health Plan Vitality Plus (HMO)
| $33.20 |
$5,900 |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | 25% | 25% | 25% | 2,882 2022 Formulary |
|
2021 Molina Medicare Complete Care (HMO D-SNP)
| $31.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5810 -001 -0 | $0.00 | $14.00 | $40.00 | $40.00 | 3,245
2021 Formulary |
|
-- |
|
|
2022 Molina Medicare Complete Care (HMO D-SNP)
| $33.20 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $14.00 | $40.00 | $40.00 | 3,263 2022 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 |
2021 SCAN Connections (HMO D-SNP)
| $31.50 |
n/a |
$445 | Yes, some additional gap coverage. |
H5425 -010 -0 | $0.00 | 25% | 25% | 25% | 3,383
2021 Formulary |
|
|
|
|
2022 SCAN Connections (HMO D-SNP)
| $33.20 |
n/a |
$480 | Some Generics | $0.00 | 25% | 25% | 25% | 3,425 2022 Formulary |
|
2021 SCAN Connections at Home (HMO D-SNP)
| $31.50 |
n/a |
$445 | Yes, some additional gap coverage. |
H5425 -030 -0 | $0.00 | 25% | 25% | 25% | 3,383
2021 Formulary |
|
|
|
|
2022 SCAN Connections at Home (HMO D-SNP)
| $33.20 |
n/a |
$480 | Some Generics | $0.00 | 25% | 25% | 25% | 3,425 2022 Formulary |
|
2021 SCAN Plus (HMO)
| $31.50 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5425 -045 -0 | $0.00 | 25% | 25% | 25% | 3,383
2021 Formulary |
|
|
|
|
2022 SCAN Plus (HMO)
| $33.20 |
$7,550 |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | 25% | 25% | 25% | 3,425 2022 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 |
2021 VillageHealth (HMO-POS C-SNP)
| $31.50 |
n/a |
$370 | No additional gap coverage, only the Donut Hole Discount |
H5943 -001 -0 | $0.00 | $3.00 | 25% | 25% | 3,383
2021 Formulary |
|
-- |
-- |
|
2022 VillageHealth (HMO-POS C-SNP)
| $33.20 |
n/a |
$370 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $3.00 | 25% | 25% | 3,425 2022 Formulary |
|
2021 Health Net Amber II (HMO D-SNP)
| $26.60 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0562 -121 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,352
2021 Formulary |
|
|
|
|
2022 Wellcare Dual Liberty (HMO D-SNP)
| $33.20 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,375 2022 Formulary |
|
2021 Health Net Sapphire (HMO)
| $28.50 |
$3,450 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0562 -122 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,370
2021 Formulary |
|
|
|
|
2022 Wellcare Plus Sapphire I (HMO)
| $33.20 |
$3,450 |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,375 2022 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 2021 --
|
H3561 -002 -0 | | | | | |
|
|
|
|
2022 Wellcare Plus Sapphire II (HMO)
| $33.20 |
$3,450 |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,375 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H5521 -333 -0 | | | | | |
|
|
|
|
2022 Aetna Medicare Choice Plan (PPO)
| $90.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 Anthem MediBlue Plus (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H0544 -060 -4 | $0.00 | $15.00 | $42.00 | $42.00 | 3,621
2021 Formulary |
|
|
|
|
-- Members will be assigned to Anthem MediBlue Plus (HMO) H0544-127 --
| | | | | |
|
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 |
2021 Anthem MediBlue Select (HMO)
| $0.00 |
$1,800 |
$0 | Yes, some additional gap coverage. |
H0544 -067 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,621
2021 Formulary |
|
|
|
|
-- Members will be assigned to Anthem MediBlue Select (HMO) H0544-066 --
| | | | | |
|
2021 Senior Advantage Medicare Medi-Cal Plan South (HMO D-SNP)
| $30.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0524 -029 -0 | | | | | 4,700
2021 Formulary |
|
|
|
|
-- Members will be assigned to Kaiser Permanente Sr Adv Medicare Medi-Cal (HMO D-SNP) H0524-030 --
| | | | | |
|
2021 Health Net Amber I (HMO D-SNP)
| $27.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0562 -055 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,352
2021 Formulary |
|
|
|
|
-- Members will be assigned to Wellcare Dual Liberty (HMO D-SNP) H0562-121 --
| | | | | |
|
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 |
2021 Health Net Sapphire Premier (HMO)
| $22.90 |
$3,450 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3561 -004 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,352
2021 Formulary |
|
|
|
|
-- Members will be assigned to Wellcare Plus Sapphire II (HMO) H3561-002 --
| | | | | |
|
2021 Health Net Sapphire Premier II (HMO)
| $23.90 |
$3,450 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3561 -006 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,352
2021 Formulary |
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-- Members will be assigned to Wellcare Plus Sapphire II (HMO) H3561-002 --
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