There are 86 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. | |
|
|
|
|
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. | |
|
|
|
|
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 (HMO-POS)
| $0.00 |
$4,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H1045 -028 -0 | $3.00 | $10.00 | $45.00 | $45.00 | 3,604
2021 Formulary |
|
|
|
|
2022 AARP Medicare Advantage (HMO-POS)
| $0.00 |
$4,900 |
$0 | Yes, some additional gap coverage. | $3.00 | $10.00 | $45.00 | $45.00 | 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 Choice (PPO)
| $0.00 |
$5,500 |
$150 | No additional gap coverage, only the Donut Hole Discount |
H2406 -011 -0 | $3.00 | $10.00 | $45.00 | $45.00 | 3,604
2021 Formulary |
|
|
|
|
2022 AARP Medicare Advantage Choice (PPO)
| $0.00 |
$5,500 |
$150 | Yes, some additional gap coverage. | $3.00 | $10.00 | $45.00 | $45.00 | 3,654 2022 Formulary |
|
2021 AARP Medicare Advantage Choice Plan 2 (Regional PPO)
| $0.00 |
$6,700 |
$395 | No additional gap coverage, only the Donut Hole Discount |
R0759 -001 -0 | $3.00 | $14.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
-- |
|
|
2022 AARP Medicare Advantage Choice Plan 2 (Regional PPO)
| $0.00 |
$6,700 |
$395 | Yes, some additional gap coverage. | $3.00 | $14.00 | $47.00 | $47.00 | tbd |
|
2021 AARP Medicare Advantage Patriot (Regional PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
R0759 -002 -0 | This plan does NOT include Prescription Drug coverage. | |
|
-- |
|
|
2022 AARP Medicare Advantage Patriot (Regional PPO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2021 Advantage Care by Ultimate (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H2962 -019 -1 | $0.00 | $20.00 | $60.00 | $60.00 | 4,004
2021 Formulary |
|
|
|
|
2022 Advantage Care by Ultimate (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands | $0.00 | $20.00 | $60.00 | $60.00 | 4,020 2022 Formulary |
|
2021 Advantage Care CHF by Ultimate (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H2962 -024 -0 | $0.00 | $20.00 | $60.00 | $60.00 | 4,004
2021 Formulary |
|
|
|
|
2022 Advantage Care CHF by Ultimate (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands | $0.00 | $20.00 | $60.00 | $60.00 | 4,020 2022 Formulary |
|
2021 Advantage Care COPD by Ultimate (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H2962 -025 -0 | $0.00 | $20.00 | $60.00 | $60.00 | 4,004
2021 Formulary |
|
|
|
|
2022 Advantage Care COPD by Ultimate (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands | $0.00 | $20.00 | $60.00 | $60.00 | 4,020 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 --
|
H1609 -060 -0 | | | | | |
|
|
|
|
2022 Aetna Medicare Credit (HMO)
| $0.00 |
$3,450 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 Aetna Medicare Eagle (PPO)
| $0.00 |
$5,500 |
No Rx Coverage |
H5521 -308 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Aetna Medicare Eagle (PPO)
| $0.00 |
$5,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 Aetna Medicare Premier (PPO)
| $0.00 |
$6,700 |
$300 | Yes, some additional gap coverage. |
H5521 -033 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Premier (PPO)
| $0.00 |
$6,700 |
$300 | Yes, some additional gap coverage. | $0.00 | $0.00 | $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 Aetna Medicare Premier Plus (PPO)
| $0.00 |
$5,500 |
$150 | Yes, some additional gap coverage. |
H5521 -270 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Premier Plus (PPO)
| $0.00 |
$5,500 |
$150 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 Aetna Medicare Select (HMO)
| $0.00 |
$3,200 |
$0 | Yes, some additional gap coverage. |
H1609 -034 -0 | $0.00 | $0.00 | $35.00 | $35.00 | 3,682
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Select (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,701 2022 Formulary |
|
2021 BlueMedicare Classic (HMO)
| $0.00 |
$4,900 |
$0 | Yes, some additional gap coverage. |
H1035 -021 -0 | $0.00 | $8.00 | $40.00 | $40.00 | 3,450
2021 Formulary |
|
|
|
|
2022 BlueMedicare Classic (HMO)
| $0.00 |
$4,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $40.00 | $40.00 | 3,479 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 BlueMedicare Premier (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H1035 -034 -0 | $0.00 | $0.00 | $30.00 | $30.00 | 4,319
2021 Formulary |
|
|
|
|
2022 BlueMedicare Premier (HMO)
| $0.00 |
$2,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $30.00 | $30.00 | 3,479 2022 Formulary |
|
2021 BlueMedicare Value (PPO)
| $0.00 |
$4,500 |
$150 | Yes, some additional gap coverage. |
H5434 -035 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 2,744
2021 Formulary |
|
|
|
|
2022 BlueMedicare Value (PPO)
| $0.00 |
$4,500 |
$150 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 2,713 2022 Formulary |
|
2021 Cigna Preferred Medicare (HMO)
| $0.00 |
$3,650 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5410 -029 -0 | $0.00 | $0.00 | $35.00 | $35.00 | 3,446
2021 Formulary |
|
|
|
|
2022 Cigna Preferred Medicare (HMO)
| $0.00 |
$3,650 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $35.00 | $35.00 | 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 Preferred Savings Medicare (HMO)
| $0.00 |
$3,950 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5410 -030 -0 | $0.00 | $4.00 | $42.00 | $42.00 | 3,446
2021 Formulary |
|
|
|
|
2022 Cigna Preferred Savings Medicare (HMO)
| $0.00 |
$3,950 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $4.00 | $42.00 | $42.00 | 3,459 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H7849 -048 -0 | | | | | |
|
|
|
|
2022 Cigna True Choice Medicare (PPO)
| $0.00 |
$5,650 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $4.00 | $40.00 | $40.00 | 3,459 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H1290 -036 -1 | | | | | |
|
|
|
|
2022 Devoted Health Core Greater Tampa Bay (HMO)
| $0.00 |
$1,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $8.00 | $8.00 | 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 |
2021 Devoted Health Essentials Greater Tampa Bay (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H1290 -016 -0 | $0.00 | $7.00 | $47.00 | $47.00 | 3,173
2021 Formulary |
|
|
|
|
2022 Devoted Health Essentials Greater Tampa Bay (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $47.00 | $47.00 | 3,349 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H9884 -005 -0 | | | | | |
new |
new |
new |
|
2022 Devoted Health Latitude Greater Tampa Bay (PPO)
| $0.00 |
$4,900 |
$150 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,349 2022 Formulary |
|
2021 Freedom Savings Plan (HMO)
| $0.00 |
$3,400 |
No Rx Coverage |
H5427 -052 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Freedom Savings Plan (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 Freedom VIP Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5427 -070 -0 | $0.00 | $20.00 | $60.00 | $60.00 | 3,327
2021 Formulary |
|
|
|
|
2022 Freedom VIP Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics, Some Brands | $0.00 | $20.00 | $60.00 | $60.00 | 3,313 2022 Formulary |
|
2021 Freedom VIP Savings (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5427 -072 -0 | $0.00 | $30.00 | $80.00 | $80.00 | 3,327
2021 Formulary |
|
|
|
|
2022 Freedom VIP Savings (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics, Some Brands | $0.00 | $25.00 | $70.00 | $70.00 | 3,313 2022 Formulary |
|
2021 Freedom VIP Savings COPD (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5427 -077 -0 | $0.00 | $20.00 | $60.00 | $60.00 | 3,322
2021 Formulary |
|
|
|
|
2022 Freedom VIP Savings COPD (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics, Few Brands | $0.00 | $20.00 | $60.00 | $60.00 | 3,313 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 - Diabetes (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H1036 -160 -0 | $0.00 | $0.00 | $5.00 | $5.00 | 3,382
2021 Formulary |
|
|
|
|
2022 Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics, Few Brands | $0.00 | $0.00 | $5.00 | $5.00 | 3,408 2022 Formulary |
|
2021 Humana Gold Plus H1036-025 (HMO)
| $0.00 |
$1,900 |
$0 | Yes, some additional gap coverage. |
H1036 -025 -0 | $0.00 | $0.00 | $5.00 | $5.00 | 3,382
2021 Formulary |
|
|
|
|
2022 Humana Gold Plus H1036-025 (HMO)
| $0.00 |
$1,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $5.00 | $5.00 | 3,408 2022 Formulary |
|
2021 Humana Gold Plus H1036-265 (HMO)
| $0.00 |
$2,750 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H1036 -265 -1 | $0.00 | $0.00 | $45.00 | $45.00 | 3,382
2021 Formulary |
|
|
|
|
2022 Humana Gold Plus H1036-265 (HMO)
| $0.00 |
$2,750 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $45.00 | $45.00 | 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 |
$4,500 |
No Rx Coverage |
H1036 -119 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Humana Honor (HMO)
| $0.00 |
$4,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 HumanaChoice Florida H5216-072 (PPO)
| $0.00 |
$4,900 |
$150 | No additional gap coverage, only the Donut Hole Discount |
H5216 -072 -0 | $2.00 | $10.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
|
|
|
2022 HumanaChoice Florida H5216-072 (PPO)
| $0.00 |
$5,000 |
$150 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $10.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 HumanaChoice R5826-018 (Regional PPO)
| $0.00 |
$7,550 |
No Rx Coverage |
R5826 -018 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 HumanaChoice R5826-018 (Regional PPO)
| $0.00 |
$7,550 |
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 Optimum Diamond Rewards (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5594 -028 -0 | $0.00 | $20.00 | $60.00 | $60.00 | 3,327
2021 Formulary |
|
|
|
|
2022 Optimum Diamond Rewards (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics, Some Brands | $0.00 | $15.00 | $55.00 | $55.00 | 3,313 2022 Formulary |
|
2021 Optimum Diamond Rewards COPD (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5594 -029 -0 | $0.00 | $20.00 | $60.00 | $60.00 | 3,322
2021 Formulary |
|
|
|
|
2022 Optimum Diamond Rewards COPD (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics, Few Brands | $0.00 | $15.00 | $55.00 | $55.00 | 3,313 2022 Formulary |
|
2021 Optimum Gold Plus Plan (HMO)
| $0.00 |
$1,900 |
$0 | Yes, some additional gap coverage. |
H5594 -032 -0 | $0.00 | $20.00 | $60.00 | $60.00 | 3,322
2021 Formulary |
|
|
|
|
2022 Optimum Gold Plus Plan (HMO)
| $0.00 |
$1,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $20.00 | $60.00 | $60.00 | 3,313 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 Optimum Gold Rewards Plan (HMO)
| $0.00 |
$1,900 |
$0 | Yes, some additional gap coverage. |
H5594 -001 -0 | $0.00 | $35.00 | $85.00 | $85.00 | 3,322
2021 Formulary |
|
|
|
|
2022 Optimum Gold Rewards Plan (HMO)
| $0.00 |
$1,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $30.00 | $70.00 | $70.00 | 3,313 2022 Formulary |
|
2021 Optimum Platinum Plan (HMO)
| $0.00 |
$1,500 |
$0 | Yes, some additional gap coverage. |
H5594 -002 -0 | $0.00 | $10.00 | $65.00 | $65.00 | 3,322
2021 Formulary |
|
|
|
|
2022 Optimum Platinum Plan (HMO)
| $0.00 |
$1,200 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $50.00 | $50.00 | 3,313 2022 Formulary |
|
2021 Premier by Ultimate (HMO)
| $0.00 |
$2,800 |
$0 | Yes, some additional gap coverage. |
H2962 -001 -0 | $0.00 | $35.00 | $60.00 | $60.00 | 4,004
2021 Formulary |
|
|
|
|
2022 Premier by Ultimate (HMO)
| $0.00 |
$2,800 |
$0 | Yes, some additional gap coverage. | $0.00 | $35.00 | $60.00 | $60.00 | 4,020 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 Premier Plus by Ultimate (HMO)
| $0.00 |
$1,500 |
$0 | Yes, some additional gap coverage. |
H2962 -014 -1 | $0.00 | $25.00 | $50.00 | $50.00 | 4,004
2021 Formulary |
|
|
|
|
2022 Premier Plus by Ultimate (HMO)
| $0.00 |
$1,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $25.00 | $50.00 | $50.00 | 4,020 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H5471 -092 -0 | | | | | |
|
|
|
|
2022 Simply Care (HMO I-SNP)
| $0.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $5.00 | 25% | 25% | 3,948 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H5471 -093 -0 | | | | | |
|
|
|
|
2022 Simply Comfort (HMO I-SNP)
| $0.00 |
n/a |
$480 | Some Generics, Few Brands | $0.00 | $5.00 | 25% | 25% | 3,948 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 --
|
H5471 -108 -0 | | | | | |
|
|
|
|
2022 Simply Extra (HMO)
| $0.00 |
$3,450 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,948 2022 Formulary |
|
2021 Simply Level (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5471 -075 -0 | $0.00 | $0.00 | $35.00 | $35.00 | 3,912
2021 Formulary |
|
|
|
|
2022 Simply Level (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands | $0.00 | $0.00 | $30.00 | $30.00 | 3,948 2022 Formulary |
|
2021 Simply More (HMO)
| $0.00 |
$3,450 |
$0 | Yes, some additional gap coverage. |
H5471 -078 -0 | $0.00 | $0.00 | $35.00 | $35.00 | 3,912
2021 Formulary |
|
|
|
|
2022 Simply More (HMO)
| $0.00 |
$3,450 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,948 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 Medicare Advantage Walgreens (HMO C-SNP)
| $0.00 |
n/a |
$150 | No additional gap coverage, only the Donut Hole Discount |
H1045 -048 -3 | $0.00 | $0.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP)
| $0.00 |
n/a |
$150 | Some Generics | $0.00 | $0.00 | $47.00 | $47.00 | 3,654 2022 Formulary |
|
2021 WellCare Dividend Prime (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. |
H1032 -200 -0 | $0.00 | $5.00 | $35.00 | $35.00 | 3,348
2021 Formulary |
|
|
|
|
2022 Wellcare Giveback (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $25.00 | $25.00 | 3,375 2022 Formulary |
|
2021 WellCare Elite (HMO)
| $0.00 |
$1,200 |
$0 | Yes, some additional gap coverage. |
H1032 -201 -0 | $0.00 | $0.00 | $5.00 | $5.00 | 3,348
2021 Formulary |
|
|
|
|
2022 Wellcare No Premium (HMO)
| $0.00 |
$1,200 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $0.00 | $0.00 | 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 WellCare Premier (PPO)
| $0.00 |
$3,400 |
$100 | Yes, some additional gap coverage. |
H5199 -012 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
|
|
|
2022 Wellcare No Premium Open (PPO)
| $0.00 |
$3,400 |
$100 | Yes, some additional gap coverage. | $0.00 | $0.00 | $37.00 | $37.00 | 3,375 2022 Formulary |
|
2021 WellCare Champion (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H1032 -203 -0 | $0.00 | $5.00 | $10.00 | $10.00 | 3,348
2021 Formulary |
|
|
|
|
2022 Wellcare Specialty Giveback (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands | $0.00 | $0.00 | $0.00 | $0.00 | 3,373 2022 Formulary |
|
2021 WellCare Guardian (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H1032 -184 -0 | $0.00 | $0.00 | $10.00 | $10.00 | 3,348
2021 Formulary |
|
|
|
|
2022 Wellcare Specialty No Premium (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands | $0.00 | $0.00 | $0.00 | $0.00 | 3,373 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 R5826-074 (Regional PPO)
| $0.00 |
$7,550 |
$395 | No additional gap coverage, only the Donut Hole Discount |
R5826 -074 -0 | $6.00 | $20.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
|
|
|
2022 HumanaChoice R5826-074 (Regional PPO)
| $8.00 |
$7,550 |
$395 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $20.00 | $47.00 | $47.00 | 3,421 2022 Formulary |
|
2021 Humana Fully Integrated H1036-283 (HMO D-SNP)
| $19.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H1036 -283 -0 | $0.00 | $3.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
|
|
|
|
2022 Humana Fully Integrated H1036-283 (HMO D-SNP)
| $15.60 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $3.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 Cigna TotalCare (HMO D-SNP)
| $18.00 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5410 -032 -0 | $2.00 | $15.00 | 18% | 18% | 3,446
2021 Formulary |
|
|
|
|
2022 Cigna TotalCare Plus (HMO D-SNP)
| $21.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $1.00 | $12.00 | 18% | 18% | 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 Primary Medicare (HMO)
| $17.90 |
$3,500 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5410 -035 -0 | $2.00 | $15.00 | 18% | 18% | 3,446
2021 Formulary |
|
|
|
|
2022 Cigna Primary Medicare (HMO)
| $22.40 |
$3,500 |
$480 | No additional gap coverage, only the Donut Hole Discount | $1.00 | $12.00 | 18% | 18% | 3,459 2022 Formulary |
|
2021 Humana Gold Plus SNP-DE H1036-102 (HMO D-SNP)
| $24.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H1036 -102 -0 | $0.00 | $8.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
|
|
|
|
2022 Humana Gold Plus SNP-DE H1036-102 (HMO D-SNP)
| $24.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $8.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 Aetna Medicare Assure (HMO D-SNP)
| $30.80 |
n/a |
$250 | No additional gap coverage, only the Donut Hole Discount |
H1609 -019 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,682
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Assure (HMO D-SNP)
| $28.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $47.00 | $47.00 | 3,701 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 Assure Plus (HMO D-SNP)
| $28.00 |
n/a |
$250 | No additional gap coverage, only the Donut Hole Discount |
H1609 -044 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,682
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Assure Plus (HMO D-SNP)
| $30.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $47.00 | $47.00 | 3,701 2022 Formulary |
|
2021 UnitedHealthcare Dual Complete RP (Regional PPO D-SNP)
| $30.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
R0759 -003 -0 | | | | | 3,604
2021 Formulary |
|
-- |
|
|
2022 UnitedHealthcare Dual Complete RP (Regional PPO D-SNP)
| $31.50 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,663 2022 Formulary |
|
2021 WellCare Reserve (HMO D-SNP)
| $28.60 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H1032 -202 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
|
|
|
2022 Wellcare Dual Reserve (HMO D-SNP)
| $31.60 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $40.00 | $40.00 | 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 WellCare Access (HMO D-SNP)
| $28.10 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H1032 -124 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
|
|
|
2022 Wellcare Dual Access (HMO D-SNP)
| $32.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $47.00 | $47.00 | 3,375 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H2962 -037 -0 | | | | | |
|
|
|
|
2022 Advantage Plus by Ultimate (Full) (HMO D-SNP)
| $34.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 4,020 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H2962 -038 -0 | | | | | |
|
|
|
|
2022 Advantage Plus by Ultimate (Partial) (HMO D-SNP)
| $34.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 4,020 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 BlueMedicare Complete (HMO D-SNP)
| $30.80 |
n/a |
$445 | Yes, some additional gap coverage. |
H1035 -032 -0 | $0.00 | $0.00 | $40.00 | $40.00 | 4,319
2021 Formulary |
|
|
|
|
2022 BlueMedicare Complete (HMO D-SNP)
| $34.30 |
n/a |
$480 | Some Generics, Few Brands | $0.00 | $0.00 | $40.00 | $40.00 | 3,479 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H1290 -024 -0 | | | | | |
|
|
|
|
2022 Devoted Health Dual Greater Tampa Bay (HMO D-SNP)
| $34.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,349 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H1290 -038 -2 | | | | | |
|
|
|
|
2022 Devoted Health Prime (HMO)
| $34.30 |
$2,900 |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | 25% | 25% | 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 |
2021 Freedom Medi-Medi Full (HMO D-SNP)
| $30.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5427 -087 -0 | $0.00 | $45.00 | $95.00 | $95.00 | 3,322
2021 Formulary |
|
|
|
|
2022 Freedom Medi-Medi Full (HMO D-SNP)
| $34.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $45.00 | $95.00 | $95.00 | 3,313 2022 Formulary |
|
2021 Freedom Medi-Medi Partial (HMO D-SNP)
| $30.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5427 -078 -0 | $0.00 | $45.00 | $95.00 | $95.00 | 3,322
2021 Formulary |
|
|
|
|
2022 Freedom Medi-Medi Partial (HMO D-SNP)
| $34.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $45.00 | $95.00 | $95.00 | 3,313 2022 Formulary |
|
2021 Optimum Emerald Full (HMO D-SNP)
| $30.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5594 -017 -0 | $0.00 | $45.00 | $95.00 | $95.00 | 3,322
2021 Formulary |
|
|
|
|
2022 Optimum Emerald Full (HMO D-SNP)
| $34.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $45.00 | $95.00 | $95.00 | 3,313 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 Optimum Emerald Partial (HMO D-SNP)
| $30.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5594 -016 -0 | $0.00 | $45.00 | $95.00 | $95.00 | 3,322
2021 Formulary |
|
|
|
|
2022 Optimum Emerald Partial (HMO D-SNP)
| $34.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $45.00 | $95.00 | $95.00 | 3,313 2022 Formulary |
|
2021 Simply Complete (HMO D-SNP)
| $30.80 |
n/a |
$445 | Yes, some additional gap coverage. |
H5471 -082 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,912
2021 Formulary |
|
|
|
|
2022 Simply Complete (HMO D-SNP)
| $34.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $20.00 | $47.00 | $47.00 | 3,948 2022 Formulary |
|
2021 UnitedHealthcare Assisted Living Plan (PPO I-SNP)
| $30.80 |
n/a |
$200 | No additional gap coverage, only the Donut Hole Discount |
H0710 -012 -0 | $2.00 | $12.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
-- |
|
|
2022 UnitedHealthcare Assisted Living Plan (PPO I-SNP)
| $34.30 |
n/a |
$200 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $12.00 | $47.00 | $47.00 | 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 UnitedHealthcare Dual Complete Choice (PPO D-SNP)
| $30.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H1889 -002 -1 | | | | | 3,604
2021 Formulary |
|
new |
|
|
2022 UnitedHealthcare Dual Complete Choice (PPO D-SNP)
| $34.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654 2022 Formulary |
|
2021 UnitedHealthcare Dual Complete LP (HMO D-SNP)
| $30.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H1045 -039 -0 | | | | | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Dual Complete LP (HMO D-SNP)
| $34.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654 2022 Formulary |
|
2021 UnitedHealthcare Nursing Home Plan (PPO I-SNP)
| $30.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0710 -010 -0 | | | | | 3,604
2021 Formulary |
|
-- |
|
|
2022 UnitedHealthcare Nursing Home Plan (PPO I-SNP)
| $34.30 |
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 WellCare Liberty (HMO D-SNP)
| $30.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H1032 -175 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
|
|
|
2022 Wellcare Dual Liberty (HMO D-SNP)
| $34.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $47.00 | $47.00 | 3,375 2022 Formulary |
|
2021 BlueMedicare Choice (Regional PPO)
| $47.90 |
$6,500 |
$250 | Yes, some additional gap coverage. |
R3332 -001 -0 | $0.00 | $10.00 | $40.00 | $40.00 | 3,450
2021 Formulary |
|
|
|
|
2022 BlueMedicare Choice (Regional PPO)
| $51.90 |
$6,500 |
$250 | Yes, some additional gap coverage. | $0.00 | $10.00 | $40.00 | $40.00 | 3,486 2022 Formulary |
|
2021 WellCare Prime (PPO)
| $75.00 |
$1,700 |
$0 | Yes, some additional gap coverage. |
H5199 -010 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
|
|
|
2022 Wellcare Premium Enhanced Open (PPO)
| $85.00 |
$1,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $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 Humana Gold Choice H8145-061 (PFFS)
| $101.00 |
n/a |
$200 | No additional gap coverage, only the Donut Hole Discount |
H8145 -061 -0 | $7.00 | $17.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
|
|
|
2022 Humana Gold Choice H8145-061 (PFFS)
| $102.00 |
n/a |
$200 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $17.00 | $47.00 | $47.00 | 3,413 2022 Formulary |
|
2021 HumanaChoice R5826-005 (Regional PPO)
| $105.00 |
$6,700 |
$100 | No additional gap coverage, only the Donut Hole Discount |
R5826 -005 -0 | $5.00 | $15.00 | $45.00 | $45.00 | 3,386
2021 Formulary |
|
|
|
|
2022 HumanaChoice R5826-005 (Regional PPO)
| $114.00 |
$6,700 |
$100 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $45.00 | $45.00 | 3,416 2022 Formulary |
|
2021 Devoted Health Core Greater Tampa Bay (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. |
H1290 -004 -0 | $0.00 | $0.00 | $8.00 | $8.00 | 3,173
2021 Formulary |
|
|
|
|
-- Members will be assigned to Devoted Health Core Greater Tampa Bay (HMO) H1290-036 --
| | | | | |
|
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 Devoted Health Prime Greater Tampa Bay (HMO)
| $30.80 |
$3,400 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H1290 -009 -0 | $0.00 | $0.00 | 25% | 25% | 3,173
2021 Formulary |
|
|
|
|
-- Members will be assigned to Devoted Health Prime (HMO) H1290-038 --
| | | | | |
|
2021 WellCare Select (HMO D-SNP)
| $29.40 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H1032 -229 -1 | $0.00 | $0.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
|
|
|
-- Members will be assigned to Wellcare Dual Reserve (HMO D-SNP) H1032-202 --
| | | | | |
|
2021 Simply Care (HMO I-SNP)
| $30.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5471 -094 -0 | $4.00 | $5.00 | 25% | 25% | 3,912
2021 Formulary |
|
|
|
|
-- This plan not offered in 2022 --
|
| | | | |
|
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 Simply Comfort (HMO I-SNP)
| $30.80 |
n/a |
$445 | Yes, some additional gap coverage. |
H5471 -095 -0 | $0.00 | $5.00 | 25% | 25% | 3,912
2021 Formulary |
|
|
|
|
-- This plan not offered in 2022 --
|
| | | | |
|
2021 Simply Select (HMO)
| $30.80 |
$3,450 |
$445 | Yes, some additional gap coverage. |
H5471 -099 -0 | $0.00 | $0.00 | 25% | 25% | 3,912
2021 Formulary |
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-- This plan not offered in 2022 --
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