There are 88 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 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. | |
|
2021 AARP Medicare Advantage SecureHorizons Plan 4 (HMO)
| $0.00 |
$3,400 |
$50 | Yes, some additional gap coverage. |
H0543 -152 -0 | $5.00 | $11.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
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|
|
|
2022 AARP Medicare Advantage SecureHorizons Plan 4 (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $5.00 | $11.00 | $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. | |
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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 Aetna Medicare Plus Plan (HMO)
| $0.00 |
$2,000 |
$0 | Yes, some additional gap coverage. |
H4982 -004 -0 | $0.00 | $0.00 | $37.00 | $37.00 | 3,679
2021 Formulary |
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|
|
|
2022 Aetna Medicare Plus Plan (HMO)
| $0.00 |
$2,000 |
$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 -052 -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 |
|
2021 Anthem MediBlue Plus (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H0544 -065 -0 | $0.00 | $7.00 | $42.00 | $42.00 | 3,639
2021 Formulary |
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|
2022 Anthem MediBlue Plus (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $7.00 | $42.00 | $42.00 | 3,626 2022 Formulary |
|
2021 Anthem MediBlue Select (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. |
H0544 -091 -0 | $0.00 | $7.00 | $42.00 | $42.00 | 3,621
2021 Formulary |
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|
|
2022 Anthem MediBlue Select (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $7.00 | $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 Astiva Health Advantage (HMO)
| $0.00 |
$3,000 |
$0 | Yes, some additional gap coverage. |
H1993 -003 -0 | $0.00 | $0.00 | $32.00 | $32.00 | 3,359
2021 Formulary |
|
new |
new |
|
2022 Astiva Health Advantage (HMO)
| $0.00 |
$845 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $32.00 | $32.00 | 3,315 2022 Formulary |
|
2021 AVA (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. |
H3815 -027 -0 | $0.00 | $3.00 | $40.00 | $40.00 | 3,417
2021 Formulary |
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2022 AVA (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $40.00 | $40.00 | 3,450 2022 Formulary |
|
2021 Blue Shield 65 Plus (HMO)
| $0.00 |
$3,399 |
$0 | Yes, some additional gap coverage. |
H0504 -028 -0 | $0.00 | $5.00 | $40.00 | $40.00 | 3,638
2021 Formulary |
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2022 Blue Shield 65 Plus (HMO)
| $0.00 |
$3,399 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $35.00 | $35.00 | 3,656 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 AdvantageOptimum Plan 1 (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H5928 -010 -0 | $0.00 | $5.00 | $40.00 | $40.00 | 3,202
2021 Formulary |
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2022 Blue Shield AdvantageOptimum Plan 1 (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $40.00 | $40.00 | 3,251 2022 Formulary |
|
2021 Blue Shield AdvantageOptimum Plan 2 (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H5928 -053 -0 | $0.00 | $10.00 | $40.00 | $40.00 | 3,202
2021 Formulary |
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2022 Blue Shield AdvantageOptimum Plan 2 (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $40.00 | $40.00 | 3,251 2022 Formulary |
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2021 Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics, All Brands |
H0148 -001 -0 | | | | | 3,202
2021 Formulary |
-- |
-- |
-- |
|
2022 Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics, All Brands | | | | | 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 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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-- |
|
|
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 |
|
-- |
|
|
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 II Plan (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0838 -043 -0 | $0.00 | $12.00 | $47.00 | $47.00 | 3,207
2021 Formulary |
|
-- |
|
|
2022 Brand New Day Select Care II Plan (HMO I-SNP)
| $0.00 |
n/a |
$0 | Some Generics | $0.00 | $12.00 | $47.00 | $47.00 | 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 |
|
|
|
|
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 |
-- This plan not offered in 2021 --
|
H7607 -007 -3 | | | | | |
|
new |
new |
|
2022 Clever Care Fortune Medicare Advantage Plan (HMO)
| $0.00 |
$888 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,510 2022 Formulary |
|
2021 Clever Care Longevity Medicare Advantage (HMO)
| $0.00 |
$2,999 |
$0 | Yes, some additional gap coverage. |
H7607 -002 -3 | 0% | $5.00 | $35.00 | $35.00 | 3,560
2021 Formulary |
|
new |
new |
|
2022 Clever Care Longevity Medicare Advantage (HMO)
| $0.00 |
$1,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,510 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H7607 -008 -3 | | | | | |
|
new |
new |
|
2022 Clever Care Value Medicare Advantage Plan (HMO)
| $0.00 |
$3,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $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 CommuniCare Advantage Cal MediConnect Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics, All Brands |
H5172 -002 -0 | | | | | 3,207
2021 Formulary |
-- |
-- |
-- |
|
2022 CommuniCare Advantage Cal MediConnect Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics, All Brands | | | | | 3,133 2022 Formulary |
|
2021 Connected Care (HMO)
| $0.00 |
$3,000 |
$0 | Yes, some additional gap coverage. |
H2241 -017 -0 | $5.00 | $10.00 | $45.00 | $45.00 | 3,560
2021 Formulary |
|
|
|
|
2022 Connected Care (HMO)
| $0.00 |
$3,000 |
$0 | Yes, some additional gap coverage. | $5.00 | $10.00 | $45.00 | $45.00 | tbd |
|
2021 Harmony (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. |
H3815 -031 -0 | $0.00 | $3.00 | $40.00 | $40.00 | 3,417
2021 Formulary |
|
|
|
|
2022 Harmony (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $40.00 | $40.00 | 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 Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics, All Brands |
H3237 -002 -0 | | | | | 3,473
2021 Formulary |
-- |
-- |
-- |
|
2022 Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics, All Brands | | | | | 3,382 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H3815 -010 -0 | | | | | |
|
|
|
|
2022 Heart & Diabetes (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics | $0.00 | $5.00 | $30.00 | $30.00 | 3,450 2022 Formulary |
|
2021 Humana Gold Plus H5619-016 (HMO)
| $0.00 |
$3,200 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5619 -016 -0 | $5.00 | $15.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
|
|
|
|
2022 Humana Gold Plus H5619-016 (HMO)
| $0.00 |
$3,200 |
$0 | 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 Humana Honor (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H5619 -120 -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 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 |
|
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 |
|
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 --
|
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 |
|
2021 Kaiser Permanente Senior Advantage San Diego (HMO)
| $0.00 |
$4,000 |
$0 | Yes, some additional gap coverage. |
H0524 -037 -0 | $3.00 | $10.00 | $47.00 | $47.00 | 4,700
2021 Formulary |
|
|
|
|
2022 Kaiser Permanente Senior Advantage San Diego (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $7.00 | $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 Platinum (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. |
H3815 -016 -0 | $0.00 | $3.00 | $30.00 | $30.00 | 3,417
2021 Formulary |
|
|
|
|
2022 Platinum (HMO)
| $0.00 |
$998 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $30.00 | $30.00 | 3,450 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H5425 -082 -0 | | | | | |
|
|
|
|
2022 SCAN Alta (HMO)
| $0.00 |
$900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $30.00 | $30.00 | 3,425 2022 Formulary |
|
2021 Scripps Classic offered by SCAN Health Plan (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H5425 -005 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,383
2021 Formulary |
|
|
|
|
2022 Scripps Classic offered by SCAN Health Plan (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 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 Select (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H3815 -032 -0 | $0.00 | $3.00 | $40.00 | $40.00 | 3,417
2021 Formulary |
|
|
|
|
2022 Select (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $40.00 | $40.00 | 3,450 2022 Formulary |
|
2021 Sharp Direct Advantage Gold Card (HMO)
| $0.00 |
$2,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5386 -003 -0 | $2.00 | $8.00 | $40.00 | $40.00 | 3,168
2021 Formulary |
|
|
|
|
2022 Sharp Direct Advantage Gold Card (HMO)
| $0.00 |
$2,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $40.00 | $40.00 | 3,188 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H5386 -005 -0 | | | | | |
|
|
|
|
2022 Sharp Direct Advantage VIP Plan (HMO)
| $0.00 |
$2,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $40.00 | $40.00 | 3,188 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 Sharp SecureHorizons Plan by UnitedHealthcare (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H0543 -145 -0 | $4.00 | $10.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 Sharp SecureHorizons Plan by UnitedHealthcare (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $4.00 | $10.00 | $47.00 | $47.00 | 3,654 2022 Formulary |
|
2021 AARP Medicare Advantage Walgreens (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. |
H0543 -204 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 Sharp Walgreens by UnitedHealthcare (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,654 2022 Formulary |
|
-- 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 |
|
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 UC San Diego Health Humana (HMO)
| $0.00 |
$3,200 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5619 -131 -0 | $0.00 | $3.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
|
|
|
|
2022 UC San Diego Health Humana (HMO)
| $0.00 |
$2,800 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $3.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 UnitedHealthcare Chronic Complete Focus (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0543 -214 -0 | $4.00 | $10.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Chronic Complete Focus (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics | $4.00 | $10.00 | $47.00 | $47.00 | 3,654 2022 Formulary |
|
2021 Health Net Healthy Heart (HMO)
| $0.00 |
$3,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H0562 -012 -0 | $5.00 | $10.00 | $42.00 | $42.00 | 3,370
2021 Formulary |
|
|
|
|
2022 Wellcare No Premium (HMO)
| $0.00 |
$3,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $10.00 | $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 Jade (HMO C-SNP)
| $0.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H0562 -114 -0 | $0.00 | $10.00 | $42.00 | $42.00 | 3,370
2021 Formulary |
|
|
|
|
2022 Wellcare Specialty No Premium (HMO C-SNP)
| $0.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $37.00 | $37.00 | 3,373 2022 Formulary |
|
2021 Anthem MediBlue Coordination Plus (HMO)
| $4.20 |
$7,550 |
$445 | Yes, some additional gap coverage. |
H0544 -070 -0 | $0.00 | $9.00 | $47.00 | $47.00 | 3,621
2021 Formulary |
|
|
|
|
2022 Anthem MediBlue Coordination Plus (HMO)
| $3.70 |
$7,550 |
$480 | Yes, some additional gap coverage. | $0.00 | $9.00 | $47.00 | $47.00 | 3,604 2022 Formulary |
|
2021 Aetna Medicare Plus Plan 2 (HMO)
| $21.00 |
$7,550 |
$220 | No additional gap coverage, only the Donut Hole Discount |
H4982 -015 -0 | $0.00 | $0.00 | 25% | 25% | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Plus Plan 2 (HMO)
| $19.30 |
$7,550 |
$220 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | 25% | 25% | 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 |
-- This plan not offered in 2021 --
|
H4961 -007 -0 | | | | | |
|
new |
|
|
2022 AVA (PPO)
| $22.50 |
$3,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $40.00 | $40.00 | 3,450 2022 Formulary |
|
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 UnitedHealthcare Medicare Advantage Assure (HMO)
| $19.10 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0543 -172 -0 | | | | | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Medicare Advantage Assure (HMO)
| $24.00 |
$7,550 |
$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 AARP Medicare Advantage SecureHorizons Value (HMO)
| $25.00 |
$5,300 |
$0 | Yes, some additional gap coverage. |
H0543 -013 -0 | $4.00 | $10.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 AARP Medicare Advantage SecureHorizons Value (HMO)
| $25.00 |
$5,300 |
$0 | Yes, some additional gap coverage. | $4.00 | $10.00 | $47.00 | $47.00 | 3,654 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 |
|
2021 Scripps Heart First offered by SCAN Health Plan (HMO C-SNP)
| $26.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5425 -055 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,383
2021 Formulary |
|
|
|
|
2022 Scripps Heart First offered by SCAN Health Plan (HMO C-SNP)
| $26.00 |
n/a |
$0 | Some Generics | $0.00 | $5.00 | $42.00 | $42.00 | 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 --
|
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 |
|
-- 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 |
|
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 |
|
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 ESRD Care (PPO C-SNP)
| $31.50 |
n/a |
$130 | Yes, some additional gap coverage. |
H8552 -028 -0 | $1.00 | $6.00 | $42.00 | $42.00 | 3,639
2021 Formulary |
|
|
|
|
2022 Anthem MediBlue ESRD Care (PPO C-SNP)
| $33.20 |
n/a |
$130 | Few Generics | $1.00 | $6.00 | $42.00 | $42.00 | 3,603 2022 Formulary |
|
2021 Astiva Health Value (HMO)
| $31.50 |
$7,550 |
$445 | Yes, some additional gap coverage. |
H1993 -004 -0 | $0.00 | $0.00 | 25% | 25% | 3,359
2021 Formulary |
|
new |
new |
|
2022 Astiva Health Value (HMO)
| $33.20 |
$7,550 |
$480 | Yes, some additional gap coverage. | $0.00 | $0.00 | 25% | 25% | 3,315 2022 Formulary |
|
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 |
|
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 TotalDual Plan (HMO D-SNP)
| $31.50 |
n/a |
$445 | Yes, some additional gap coverage. |
H5928 -005 -0 | $0.00 | 25% | 25% | 25% | 3,202
2021 Formulary |
|
|
|
|
2022 Blue Shield TotalDual Plan (HMO D-SNP)
| $33.20 |
n/a |
$480 | Few Generics | $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 II Plan (HMO I-SNP)
| $31.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0838 -045 -0 | 0% | 25% | 25% | 25% | 3,207
2021 Formulary |
|
-- |
|
|
2022 Brand New Day Select Choice II Plan (HMO I-SNP)
| $33.20 |
n/a |
$480 | Some Generics | $0.00 | 25% | 25% | 25% | 3,133 2022 Formulary |
|
2021 Clever Care Balance Medicare Advantage (HMO)
| $31.50 |
$7,550 |
$435 | Yes, some additional gap coverage. |
H7607 -003 -3 | 0% | 25% | 25% | 25% | 3,560
2021 Formulary |
|
new |
new |
|
2022 Clever Care Balance Medicare Advantage (HMO)
| $33.20 |
$5,999 |
$480 | Yes, some additional gap coverage. | $0.00 | 25% | 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 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 |
|
2021 Scripps Plus offered by SCAN Health Plan (HMO)
| $31.50 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5425 -040 -0 | $0.00 | 25% | 25% | 25% | 3,383
2021 Formulary |
|
|
|
|
2022 Scripps Plus offered by SCAN Health Plan (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 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 |
|
2021 Health Net Sapphire Premier (HMO)
| $25.40 |
$3,450 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3561 -002 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,352
2021 Formulary |
|
|
|
|
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 |
|
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 Sharp Direct Advantage Platinum Card (HMO)
| $58.00 |
$2,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5386 -004 -0 | $2.00 | $8.00 | $40.00 | $40.00 | 3,168
2021 Formulary |
|
|
|
|
2022 Sharp Direct Advantage Platinum Card (HMO)
| $58.00 |
$2,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $40.00 | $40.00 | 3,188 2022 Formulary |
|
2021 AARP Medicare Advantage SecureHorizons Premier (HMO)
| $69.00 |
$4,300 |
$0 | Yes, some additional gap coverage. |
H0543 -060 -0 | $4.00 | $10.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 AARP Medicare Advantage SecureHorizons Premier (HMO)
| $69.00 |
$4,300 |
$0 | Yes, some additional gap coverage. | $4.00 | $10.00 | $47.00 | $47.00 | 3,654 2022 Formulary |
|
2021 Scripps Signature offered by SCAN Health Plan (HMO)
| $74.00 |
$2,500 |
$0 | Yes, some additional gap coverage. |
H5425 -004 -0 | $0.00 | $3.00 | $37.00 | $37.00 | 3,383
2021 Formulary |
|
|
|
|
2022 Scripps Signature offered by SCAN Health Plan (HMO)
| $74.00 |
$2,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $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 |
2021 Aetna Medicare Choice Plan (PPO)
| $89.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H5521 -053 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
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 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 II (HMO)
| $26.70 |
$3,450 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3561 -005 -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 --
| | | | | |
|