There are 61 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 Lasso Healthcare Growth (MSA)
| $0.00 |
n/a |
No Rx Coverage |
H1924 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
|
|
2022 Lasso Healthcare Growth (MSA)
| $0.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 Lasso Healthcare Growth Plus (MSA)
| $0.00 |
n/a |
No Rx Coverage |
H1924 -004 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
|
|
2022 Lasso Healthcare Growth Plus (MSA)
| $0.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 AARP Medicare Advantage Plan 1 (HMO)
| $0.00 |
$3,900 |
$150 | No additional gap coverage, only the Donut Hole Discount |
H0609 -026 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,604
2021 Formulary |
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|
2022 AARP Medicare Advantage Plan 1 (HMO)
| $0.00 |
$3,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $45.00 | $45.00 | 3,654 2022 Formulary |
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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 Plan 2 (HMO)
| $0.00 |
$3,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H0609 -027 -0 | $0.00 | $8.00 | $45.00 | $45.00 | 3,604
2021 Formulary |
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|
|
|
2022 AARP Medicare Advantage Plan 2 (HMO)
| $0.00 |
$3,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $45.00 | $45.00 | 3,654 2022 Formulary |
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-- This plan not offered in 2021 --
|
H0609 -046 -0 | | | | | |
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2022 AARP Medicare Advantage Plan 4 (HMO)
| $0.00 |
$3,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $12.00 | $45.00 | $45.00 | 3,654 2022 Formulary |
|
2021 Aetna Medicare Eagle Plan (PPO)
| $0.00 |
$5,500 |
No Rx Coverage |
H5521 -329 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
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2022 Aetna Medicare Eagle Plan (PPO)
| $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 |
2021 Aetna Medicare Freedom Plan (PPO)
| $0.00 |
$7,350 |
$0 | Yes, some additional gap coverage. |
H5521 -100 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
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|
|
2022 Aetna Medicare Freedom Plan (PPO)
| $0.00 |
$5,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 Aetna Medicare Platinum Plan (HMO)
| $0.00 |
$7,550 |
$100 | Yes, some additional gap coverage. |
H3931 -129 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
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2022 Aetna Medicare Platinum Plan (HMO-POS)
| $0.00 |
$6,200 |
$100 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 Aetna Medicare Premier Plan (HMO)
| $0.00 |
$4,700 |
$0 | Yes, some additional gap coverage. |
H4835 -003 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
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|
|
|
2022 Aetna Medicare Premier Plan (HMO-POS)
| $0.00 |
$3,200 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,672 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 Banner Medicare Advantage Prime (HMO)
| $0.00 |
$4,450 |
$150 | Yes, some additional gap coverage. |
H5843 -001 -0 | $2.00 | $12.00 | $47.00 | $47.00 | 3,560
2021 Formulary |
|
new |
new |
|
2022 Banner Medicare Advantage Prime (HMO)
| $0.00 |
$2,775 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,490 2022 Formulary |
|
2021 Blue Medicare Advantage Classic (HMO)
| $0.00 |
$4,250 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H0302 -006 -0 | $0.00 | $9.00 | $47.00 | $47.00 | 3,560
2021 Formulary |
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|
2022 Blue Medicare Advantage Classic (HMO)
| $0.00 |
$4,250 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $9.00 | $47.00 | $47.00 | 3,510 2022 Formulary |
|
2021 Cigna Achieve Medicare (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0354 -027 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,446
2021 Formulary |
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2022 Cigna Achieve Medicare (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics, Few Brands | $0.00 | $5.00 | $47.00 | $47.00 | 3,459 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 Cigna Alliance Medicare (HMO)
| $0.00 |
$3,200 |
$0 | Yes, some additional gap coverage. |
H0354 -028 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,446
2021 Formulary |
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|
|
|
2022 Cigna Alliance Medicare (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,459 2022 Formulary |
|
2021 Cigna Preferred Medicare (HMO)
| $0.00 |
$3,450 |
$0 | Yes, some additional gap coverage. |
H0354 -001 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,446
2021 Formulary |
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|
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2022 Cigna Preferred Medicare (HMO)
| $0.00 |
$3,100 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,459 2022 Formulary |
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-- This plan not offered in 2021 --
|
H8173 -004 -0 | | | | | |
|
new |
new |
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2022 Devoted Health Advance (HMO C-SNP)
| $0.00 |
n/a |
$0 | Few Generics | $0.00 | $0.00 | $45.00 | $45.00 | 3,349 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 --
|
H8173 -001 -0 | | | | | |
|
new |
new |
|
2022 Devoted Health Core (HMO)
| $0.00 |
$3,200 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,349 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H8173 -005 -0 | | | | | |
|
new |
new |
|
2022 Devoted Health Liberty (HMO)
| $0.00 |
$4,400 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 Humana Gold Plus H0028-021 (HMO)
| $0.00 |
$2,800 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H0028 -021 -0 | $2.00 | $10.00 | $42.00 | $42.00 | 3,382
2021 Formulary |
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|
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2022 Humana Gold Plus H0028-021 (HMO)
| $0.00 |
$2,800 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $10.00 | $42.00 | $42.00 | 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 Gold Plus H2463-001 (HMO)
| $0.00 |
$4,900 |
$225 | No additional gap coverage, only the Donut Hole Discount |
H2463 -001 -0 | $5.00 | $15.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
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-- |
|
|
2022 Humana Gold Plus H2463-001 (HMO)
| $0.00 |
$4,900 |
$225 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 Humana Honor (PPO)
| $0.00 |
$4,400 |
No Rx Coverage |
H5216 -213 -0 | This plan does NOT include Prescription Drug coverage. | |
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2022 Humana Honor (PPO)
| $0.00 |
$4,400 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2021 --
|
H5216 -137 -0 | | | | | |
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|
|
2022 HumanaChoice H5216-137 (PPO)
| $0.00 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $17.00 | $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 |
-- This plan not offered in 2021 --
|
H5216 -265 -0 | | | | | |
|
|
|
|
2022 HumanaChoice H5216-265 (PPO)
| $0.00 |
$4,700 |
$250 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 HumanaChoice R7220-001 (Regional PPO)
| $0.00 |
$6,000 |
No Rx Coverage |
R7220 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 HumanaChoice R7220-001 (Regional PPO)
| $0.00 |
$6,000 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 Imperial Insurance Company Traditional (HMO)
| $0.00 |
$2,999 |
$0 | Yes, some additional gap coverage. |
H2793 -003 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,359
2021 Formulary |
|
-- |
|
|
2022 Imperial Insurance Company 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 Imperial Insurance Traditional Plus (HMO)
| $32.40 |
$2,999 |
$445 | Yes, some additional gap coverage. |
H2793 -007 -0 | 0% | 25% | 25% | 25% | 3,359
2021 Formulary |
|
-- |
|
|
2022 Imperial Insurance Traditional Plus (HMO)
| $0.00 |
$7,550 |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,315 2022 Formulary |
|
2021 Imperial 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 | 3,404
2021 Formulary |
|
-- |
|
|
2022 Imperial Insurance 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 --
|
H1822 -002 -0 | | | | | |
new |
new |
new |
|
2022 SCAN Balance (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands | $0.00 | $0.00 | $37.00 | $37.00 | 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 --
|
H1822 -001 -0 | | | | | |
new |
new |
new |
|
2022 SCAN Classic (HMO)
| $0.00 |
$2,800 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $37.00 | $37.00 | 3,425 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H1822 -003 -0 | | | | | |
new |
new |
new |
|
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 --
|
H1822 -004 -0 | | | | | |
new |
new |
new |
|
2022 SCAN Venture (HMO)
| $0.00 |
$2,999 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $40.00 | $40.00 | 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 --
|
H0609 -042 -0 | | | | | |
|
|
|
|
2022 UnitedHealthcare Chronic Complete (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics | $0.00 | $8.00 | $45.00 | $45.00 | 3,654 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H0351 -056 -0 | | | | | |
|
|
|
|
2022 Wellcare Giveback (HMO)
| $0.00 |
$3,450 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $37.00 | $37.00 | 3,375 2022 Formulary |
|
2021 Allwell Medicare Premier II (HMO)
| $0.00 |
$3,450 |
$0 | Yes, some additional gap coverage. |
H0351 -052 -0 | $0.00 | $15.00 | $37.00 | $37.00 | 3,370
2021 Formulary |
|
|
|
|
2022 Wellcare No Premium (HMO)
| $0.00 |
$3,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $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 Allwell Medicare Essentials (HMO)
| $0.00 |
$3,450 |
$0 | Yes, some additional gap coverage. |
H5590 -005 -0 | $0.00 | $15.00 | $37.00 | $37.00 | 3,370
2021 Formulary |
|
-- |
|
|
2022 Wellcare No Premium Essentials (HMO)
| $0.00 |
$3,450 |
$0 | Yes, some additional gap coverage. | $0.00 | $15.00 | $37.00 | $37.00 | 3,375 2022 Formulary |
|
2021 Allwell CHF/Diabetes Medicare (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0351 -038 -0 | $5.00 | $15.00 | $37.00 | $37.00 | 3,370
2021 Formulary |
|
|
|
|
2022 Wellcare Specialty No Premium (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands | $0.00 | $5.00 | $37.00 | $37.00 | 3,373 2022 Formulary |
|
2021 HumanaChoice H5216-224 (PPO)
| $16.00 |
$4,500 |
$195 | No additional gap coverage, only the Donut Hole Discount |
H5216 -224 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
|
|
|
2022 HumanaChoice H5216-224 (PPO)
| $17.00 |
$4,500 |
$195 | 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 Banner Medicare Advantage Plus (PPO)
| $40.00 |
$6,500 |
$150 | Yes, some additional gap coverage. |
H7273 -001 -0 | $2.00 | $12.00 | $47.00 | $47.00 | 3,560
2021 Formulary |
|
new |
new |
|
2022 Banner Medicare Advantage Plus (PPO)
| $25.00 |
$4,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,490 2022 Formulary |
|
2021 Banner - University Care Advantage (HMO D-SNP)
| $36.10 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H4931 -007 -0 | | | | | 3,207
2021 Formulary |
|
-- |
|
|
2022 Banner Medicare Advantage Dual (HMO D-SNP)
| $26.30 |
n/a |
$480 | Few Generics | 25% | 25% | 25% | 25% | 3,490 2022 Formulary |
|
2021 Humana Value Plus H5216-197 (PPO)
| $20.90 |
$7,550 |
$435 | No additional gap coverage, only the Donut Hole Discount |
H5216 -197 -0 | $5.00 | $16.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
|
|
|
|
2022 Humana Value Plus H5216-197 (PPO)
| $29.60 |
$7,550 |
$450 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $18.00 | $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 |
-- This plan not offered in 2021 --
|
H0609 -044 -0 | | | | | |
|
|
|
|
2022 AARP Medicare Advantage Plan 3 (HMO)
| $30.00 |
$2,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $45.00 | $45.00 | 3,654 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H0351 -055 -0 | | | | | |
|
|
|
|
2022 Wellcare Assist (HMO)
| $35.00 |
$3,400 |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $45.00 | $45.00 | 3,375 2022 Formulary |
|
2021 Banner - University Care Advantage (HMO D-SNP)
| $36.10 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H4931 -015 -0 | | | | | 3,207
2021 Formulary |
|
-- |
|
|
2022 Banner Medicare Advantage Dual (HMO D-SNP)
| $37.30 |
n/a |
$480 | Few Generics | 25% | 25% | 25% | 25% | 3,490 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 --
|
H8173 -002 -0 | | | | | |
|
new |
new |
|
2022 Devoted Health Select (HMO)
| $39.70 |
$3,200 |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | 25% | 25% | 3,349 2022 Formulary |
|
2021 Health Choice Pathway (HMO D-SNP)
| $30.70 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5587 -002 -0 | | | | | 3,233
2021 Formulary |
|
|
|
|
2022 Health Choice Pathway (HMO D-SNP)
| $40.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,251 2022 Formulary |
|
2021 Mercy Care Advantage (HMO D-SNP)
| $33.00 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5580 -001 -0 | | | | | 3,234
2021 Formulary |
|
|
|
|
2022 Mercy Care Advantage (HMO D-SNP)
| $40.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,251 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 Mercy Care Advantage (HMO D-SNP)
| $33.00 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5580 -004 -0 | | | | | 3,234
2021 Formulary |
|
|
|
|
2022 Mercy Care Advantage (HMO D-SNP)
| $40.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,251 2022 Formulary |
|
2021 Mercy Care Advantage (HMO D-SNP)
| $33.00 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5580 -005 -0 | | | | | 3,234
2021 Formulary |
|
|
|
|
2022 Mercy Care Advantage (HMO D-SNP)
| $40.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,251 2022 Formulary |
|
2021 Magellan Complete Care of Arizona (HMO D-SNP)
| $36.10 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H8845 -001 -0 | | | | | 3,655
2021 Formulary |
|
new |
new |
|
2022 Molina Medicare Complete Care (HMO D-SNP)
| $40.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 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 UnitedHealthcare Dual Complete LP (HMO D-SNP)
| $36.10 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0321 -002 -0 | | | | | 3,604
2021 Formulary |
|
-- |
|
|
2022 UnitedHealthcare Dual Complete LP (HMO D-SNP)
| $40.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654 2022 Formulary |
|
2021 UnitedHealthcare Dual Complete ONE (HMO D-SNP)
| $36.10 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0321 -004 -0 | | | | | 3,604
2021 Formulary |
|
-- |
|
|
2022 UnitedHealthcare Dual Complete ONE (HMO D-SNP)
| $40.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654 2022 Formulary |
|
2021 UnitedHealthcare Nursing Home Plan (PPO I-SNP)
| $36.10 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0710 -005 -0 | | | | | 3,604
2021 Formulary |
|
-- |
|
|
2022 UnitedHealthcare Nursing Home Plan (PPO I-SNP)
| $40.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654 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 Allwell Dual Medicare (HMO D-SNP)
| $36.10 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5590 -008 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,352
2021 Formulary |
|
-- |
|
|
2022 Wellcare Dual Liberty (HMO D-SNP)
| $40.00 |
n/a |
$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 --
|
H8173 -003 -0 | | | | | |
|
new |
new |
|
2022 Devoted Health Flex (HMO)
| $45.00 |
$4,200 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,349 2022 Formulary |
|
2021 Blue Medicare Advantage Plus (HMO)
| $43.00 |
$4,250 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H0302 -001 -0 | $0.00 | $9.00 | $40.00 | $40.00 | 3,560
2021 Formulary |
|
|
|
|
2022 Blue Medicare Advantage Plus (HMO)
| $48.00 |
$4,250 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $9.00 | $47.00 | $47.00 | 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 HumanaChoice R7220-002 (Regional PPO)
| $52.00 |
$6,700 |
$420 | No additional gap coverage, only the Donut Hole Discount |
R7220 -002 -0 | $7.00 | $15.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
|
|
|
2022 HumanaChoice R7220-002 (Regional PPO)
| $60.00 |
$6,700 |
$440 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $15.00 | 24% | 24% | 3,421 2022 Formulary |
|
2021 Aetna Medicare Platinum Plan (PPO)
| $59.00 |
$6,500 |
$0 | Yes, some additional gap coverage. |
H5521 -184 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Platinum Plan (PPO)
| $85.00 |
$6,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 HumanaChoice H5216-034 (PPO)
| $120.00 |
$7,550 |
$225 | No additional gap coverage, only the Donut Hole Discount |
H5216 -034 -0 | $5.00 | $15.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
|
|
|
2022 HumanaChoice H5216-034 (PPO)
| $119.00 |
$7,550 |
$225 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $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 WellCare Compass (HMO)
| $15.50 |
$3,400 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H6439 -003 -0 | $1.00 | $20.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
|
|
|
-- Members will be assigned to Wellcare Assist (HMO) H0351-055 --
| | | | | |
|
2021 WellCare Dividend (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H6439 -004 -0 | $0.00 | $15.00 | $45.00 | $45.00 | 3,348
2021 Formulary |
|
|
|
|
-- Members will be assigned to Wellcare Giveback (HMO) H0351-056 --
| | | | | |
|
2021 WellCare Value (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H6439 -002 -0 | $0.00 | $15.00 | $45.00 | $45.00 | 3,348
2021 Formulary |
|
|
|
|
-- Members will be assigned to Wellcare No Premium (HMO) H0351-052 --
| | | | | |
|
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 Liberty (HMO D-SNP)
| $18.10 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5430 -001 -0 | $0.00 | $7.00 | $45.00 | $45.00 | 3,348
2021 Formulary |
|
|
|
|
-- This plan not offered in 2022 --
|
| | | | |
|