There are 73 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 |
-- This plan not offered in 2021 --
|
H0294 -017 -0 | | | | | |
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2022 AARP Medicare Advantage Open Plan 1 (PPO)
| $0.00 |
$4,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | 3,654 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H0294 -022 -0 | | | | | |
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2022 AARP Medicare Advantage Patriot (PPO)
| $0.00 |
$5,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 Aetna Medicare Eagle (PPO)
| $0.00 |
$5,900 |
No Rx Coverage |
H5521 -286 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
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2022 Aetna Medicare Eagle (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 Premier (HMO)
| $0.00 |
$4,250 |
$0 | Yes, some additional gap coverage. |
H3192 -003 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
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|
|
|
2022 Aetna Medicare Premier (HMO-POS)
| $0.00 |
$3,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 Aetna Medicare Value (PPO)
| $0.00 |
$4,950 |
$0 | Yes, some additional gap coverage. |
H5521 -214 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
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|
|
|
2022 Aetna Medicare Value (PPO)
| $0.00 |
$4,950 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 Align Connect (HMO C-SNP)
| $0.00 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H6832 -002 -0 | $2.00 | $15.00 | $45.00 | $45.00 | 3,941
2021 Formulary |
|
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 |
2021 BCN Advantage Prime Value (HMO-POS)
| $0.00 |
$4,500 |
$50 | Yes, some additional gap coverage. |
H5883 -014 -5 | $3.00 | $11.00 | $42.00 | $42.00 | 3,459
2021 Formulary |
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|
|
|
2022 BCN Advantage HMO-POS Prime Value (HMO-POS)
| $0.00 |
$4,500 |
$50 | Yes, some additional gap coverage. | $0.00 | $11.00 | $42.00 | $42.00 | 3,487 2022 Formulary |
|
2021 HAP Primary Choice Medicare (HMO)
| $0.00 |
$4,300 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2354 -024 -0 | $0.00 | $10.00 | $42.00 | $42.00 | 3,788
2021 Formulary |
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|
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2022 HAP Primary Choice Medicare (HMO)
| $0.00 |
$4,300 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $42.00 | $42.00 | 3,694 2022 Formulary |
|
2021 HAP Senior Plus (HMO)
| $0.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2354 -015 -0 | $0.00 | $10.00 | $42.00 | $42.00 | 3,788
2021 Formulary |
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|
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2022 HAP Senior Plus (HMO)
| $0.00 |
$4,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $42.00 | $42.00 | 3,694 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 HAP Senior Plus Medical Only (HMO)
| $0.00 |
$4,000 |
No Rx Coverage |
H2354 -019 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
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2022 HAP Senior Plus Medical Only (HMO)
| $0.00 |
$4,000 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 HAP Senior Plus Option 1 (PPO)
| $0.00 |
$6,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2322 -011 -0 | $0.00 | $10.00 | $42.00 | $42.00 | 3,788
2021 Formulary |
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|
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2022 HAP Senior Plus Option 1 (PPO)
| $0.00 |
$6,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $42.00 | $42.00 | 3,694 2022 Formulary |
|
2021 Humana Gold Plus H8908-004 (HMO)
| $0.00 |
$5,200 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H8908 -004 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
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-- |
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2022 Humana Gold Plus H8908-004 (HMO)
| $0.00 |
$4,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $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 (PPO)
| $0.00 |
$5,500 |
No Rx Coverage |
H5216 -190 -0 | This plan does NOT include Prescription Drug coverage. | |
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2022 Humana Honor (PPO)
| $0.00 |
$5,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2021 --
|
H8087 -004 -0 | | | | | |
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2022 HumanaChoice H8087-004 (PPO)
| $0.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,413 2022 Formulary |
|
2021 HumanaChoice R3887-001 (Regional PPO)
| $0.00 |
$5,500 |
No Rx Coverage |
R3887 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
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2022 HumanaChoice R3887-001 (Regional 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 |
-- This plan not offered in 2021 --
|
H6322 -001 -0 | | | | | |
new |
new |
new |
|
2022 McLaren Medicare Inspire (HMO)
| $0.00 |
$5,200 |
$100 | Yes, some additional gap coverage. | $3.50 | $12.50 | $47.00 | $47.00 | 3,133 2022 Formulary |
|
2021 Medicare Plus Blue PPO Essential (PPO)
| $0.00 |
$6,000 |
$100 | No additional gap coverage, only the Donut Hole Discount |
H9572 -004 -6 | $2.00 | $11.00 | $42.00 | $42.00 | 3,443
2021 Formulary |
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|
|
2022 Medicare Plus Blue PPO Essential (PPO)
| $0.00 |
$6,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $11.00 | $42.00 | $42.00 | 3,469 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H5926 -006 -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 |
|
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 --
|
H3653 -015 -0 | | | | | |
|
|
|
|
2022 Paramount Elite Standard (HMO)
| $0.00 |
$4,900 |
$50 | Yes, some additional gap coverage. | $0.00 | $20.00 | $45.00 | $45.00 | 3,193 2022 Formulary |
|
2021 PriorityMedicare Edge (PPO)
| $0.00 |
$5,300 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H4875 -020 -3 | $2.00 | $8.00 | $38.00 | $38.00 | 3,611
2021 Formulary |
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|
|
|
2022 PriorityMedicare Edge (PPO)
| $0.00 |
$5,300 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $38.00 | $38.00 | 3,567 2022 Formulary |
|
2021 PriorityMedicare Key (HMO-POS)
| $0.00 |
$5,500 |
$100 | No additional gap coverage, only the Donut Hole Discount |
H2320 -022 -5 | $4.00 | $15.00 | $42.00 | $42.00 | 3,611
2021 Formulary |
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|
|
|
2022 PriorityMedicare Key (HMO-POS)
| $0.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $15.00 | $42.00 | $42.00 | 3,567 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 PriorityMedicare Vital (PPO)
| $0.00 |
$6,000 |
$350 | No additional gap coverage, only the Donut Hole Discount |
H4875 -022 -5 | $1.00 | $4.00 | $42.00 | $42.00 | 3,611
2021 Formulary |
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|
|
|
2022 PriorityMedicare Vital (PPO)
| $0.00 |
$4,700 |
$350 | No additional gap coverage, only the Donut Hole Discount | $1.00 | $10.00 | $42.00 | $42.00 | 3,567 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H7646 -007 -0 | | | | | |
|
|
|
|
2022 U-M Health + St. Joe's Advantage (HMO-POS)
| $0.00 |
$3,800 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $40.00 | $40.00 | 3,490 2022 Formulary |
|
2021 WellCare Dividend (HMO)
| $0.00 |
$3,450 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5475 -031 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
|
|
|
2022 Wellcare Giveback (HMO)
| $0.00 |
$3,450 |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $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 WellCare Explore (HMO-POS)
| $0.00 |
$3,450 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5475 -026 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
|
|
|
2022 Wellcare No Premium (HMO-POS)
| $0.00 |
$3,450 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $37.00 | $37.00 | 3,375 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H2117 -001 -0 | | | | | |
new |
new |
new |
|
2022 Wellcare No Premium Open (PPO)
| $0.00 |
$5,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $37.00 | $37.00 | 3,375 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H2117 -003 -0 | | | | | |
new |
new |
new |
|
2022 Wellcare Patriot Giveback Open (PPO)
| $0.00 |
$5,000 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2021 WellCare Elite Smile (HMO-POS)
| $14.10 |
$3,450 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5475 -024 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,348
2021 Formulary |
|
|
|
|
2022 Wellcare Low Premium (HMO-POS)
| $15.00 |
$3,450 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $35.00 | $35.00 | 3,375 2022 Formulary |
|
2021 Humana Gold Plus SNP-DE H8908-005 (HMO D-SNP)
| $25.40 |
n/a |
$425 | No additional gap coverage, only the Donut Hole Discount |
H8908 -005 -0 | $0.00 | $15.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
|
-- |
|
|
2022 Humana Gold Plus SNP-DE H8908-005 (HMO D-SNP)
| $18.20 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $18.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 BCN Advantage Community Value (HMO-POS)
| $20.00 |
$4,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5883 -012 -2 | $0.00 | $10.00 | $45.00 | $45.00 | 3,362
2021 Formulary |
|
|
|
|
2022 BCN Advantage HMO-POS Community Value (HMO-POS)
| $20.00 |
$4,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $45.00 | $45.00 | 3,393 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 H8087-001 (PPO)
| $20.00 |
$5,900 |
$75 | No additional gap coverage, only the Donut Hole Discount |
H8087 -001 -0 | $2.00 | $8.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
|
|
|
2022 HumanaChoice H8087-001 (PPO)
| $20.00 |
$5,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $8.00 | $47.00 | $47.00 | 3,413 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H3653 -018 -0 | | | | | |
|
|
|
|
2022 Paramount Elite Enhanced Medical Only (HMO)
| $20.00 |
$3,400 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2021 --
|
H5475 -038 -0 | | | | | |
|
|
|
|
2022 Wellcare Assist (HMO)
| $20.60 |
$3,450 |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,375 2022 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2021 --
|
H3192 -007 -0 | | | | | |
|
|
|
|
2022 Aetna Medicare Assure Premier (HMO D-SNP)
| $23.50 |
n/a |
$425 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 PriorityMedicare Ideal (PPO)
| $20.00 |
$5,800 |
$125 | No additional gap coverage, only the Donut Hole Discount |
H4875 -018 -5 | $4.00 | $13.00 | $42.00 | $42.00 | 3,611
2021 Formulary |
|
|
|
|
2022 PriorityMedicare Ideal (PPO)
| $24.00 |
$5,800 |
$125 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $13.00 | $42.00 | $42.00 | 3,567 2022 Formulary |
|
2021 Align Thrive (HMO I-SNP)
| $30.10 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H6832 -001 -0 | | | | | 3,764
2021 Formulary |
|
new |
new |
|
2022 Align Thrive (HMO I-SNP)
| $24.80 |
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 --
|
H6322 -002 -0 | | | | | |
new |
new |
new |
|
2022 McLaren Medicare Inspire Plus (HMO)
| $25.00 |
$3,800 |
$0 | Yes, some additional gap coverage. | $3.50 | $12.50 | $47.00 | $47.00 | 3,133 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H7646 -008 -0 | | | | | |
|
|
|
|
2022 U-M Health + St. Joe's Advantage Plus (HMO-POS)
| $25.00 |
$3,800 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $40.00 | $40.00 | 3,490 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H0294 -018 -0 | | | | | |
|
|
|
|
2022 AARP Medicare Advantage Open Plan 2 (PPO)
| $28.00 |
$4,200 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $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 |
-- This plan not offered in 2021 --
|
H3653 -022 -0 | | | | | |
|
|
|
|
2022 Paramount Elite Prime (HMO)
| $28.00 |
$4,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $45.00 | $45.00 | 3,193 2022 Formulary |
|
2021 Aetna Medicare Premier Plus (PPO)
| $34.00 |
$5,100 |
$0 | Yes, some additional gap coverage. |
H5521 -217 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Premier Plus (PPO)
| $29.00 |
$5,100 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 BCN Advantage HMO-POS Elements (HMO-POS)
| $30.00 |
$4,500 |
No Rx Coverage |
H5883 -001 -5 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 BCN Advantage HMO-POS Elements (HMO-POS)
| $30.00 |
$4,500 |
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 WellCare Extra Plus (HMO-POS D-SNP)
| $30.10 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5475 -001 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
|
|
|
2022 Wellcare Dual Access (HMO-POS D-SNP)
| $30.60 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $36.00 | $36.00 | 3,375 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H2117 -002 -0 | | | | | |
new |
new |
new |
|
2022 Wellcare Dual Access Open (PPO D-SNP)
| $30.80 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $7.00 | $42.00 | $42.00 | 3,375 2022 Formulary |
|
2021 Longevity Health Plan (HMO I-SNP)
| $30.10 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H7557 -001 -0 | | | | | 3,764
2021 Formulary |
|
new |
new |
|
2022 Longevity Health Plan (HMO I-SNP)
| $31.50 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,678 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 --
|
H6322 -004 -0 | | | | | |
new |
new |
new |
|
2022 McLaren Medicare Inspire Duals (HMO D-SNP)
| $31.50 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,133 2022 Formulary |
|
2021 Molina Medicare Complete Care (HMO D-SNP)
| $30.10 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5926 -001 -0 | $0.00 | $0.00 | $42.00 | $42.00 | 3,245
2021 Formulary |
|
-- |
|
|
2022 Molina Medicare Complete Care (HMO D-SNP)
| $31.50 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $42.00 | $42.00 | 3,263 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H5926 -005 -0 | | | | | |
|
-- |
|
|
2022 Molina Medicare Complete Care Select (HMO D-SNP)
| $31.50 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $42.00 | $42.00 | 3,263 2022 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2021 PriorityMedicare D-SNP (HMO D-SNP)
| $30.10 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H8379 -001 -0 | | | | | 3,611
2021 Formulary |
|
|
|
|
2022 PriorityMedicare D-SNP (HMO D-SNP)
| $31.50 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $13.00 | $47.00 | $47.00 | 3,567 2022 Formulary |
|
2021 UnitedHealthcare Dual Complete (HMO D-SNP)
| $30.10 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H2247 -001 -0 | | | | | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Dual Complete (HMO D-SNP)
| $31.50 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H0271 -028 -0 | | | | | |
|
|
|
|
2022 UnitedHealthcare Dual Complete Choice (PPO D-SNP)
| $31.50 |
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 |
-- This plan not offered in 2021 --
|
H2117 -004 -0 | | | | | |
new |
new |
new |
|
2022 Wellcare Community Assist (PPO)
| $31.50 |
$5,000 |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $37.00 | $37.00 | 3,375 2022 Formulary |
|
2021 Humana Gold Plus H8908-001 (HMO)
| $45.00 |
$3,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H8908 -001 -0 | $4.00 | $12.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
|
-- |
|
|
2022 Humana Gold Plus H8908-001 (HMO)
| $46.00 |
$3,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $12.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H6322 -003 -2 | | | | | |
new |
new |
new |
|
2022 McLaren Medicare Inspire Flex (HMO-POS)
| $49.00 |
$3,800 |
$0 | Yes, some additional gap coverage. | $3.50 | $12.50 | $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 PriorityMedicare Value (HMO-POS)
| $45.00 |
$4,900 |
$75 | No additional gap coverage, only the Donut Hole Discount |
H2320 -029 -5 | $2.00 | $10.00 | $42.00 | $42.00 | 3,611
2021 Formulary |
|
|
|
|
2022 PriorityMedicare Value (HMO-POS)
| $50.00 |
$4,900 |
$75 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $10.00 | $42.00 | $42.00 | 3,567 2022 Formulary |
|
2021 BCN Advantage HMO ConnectedCare (HMO)
| $57.00 |
$3,800 |
$0 | Yes, some additional gap coverage. |
H5883 -007 -0 | $1.00 | $10.00 | $42.00 | $42.00 | 3,459
2021 Formulary |
|
|
|
|
2022 BCN Advantage HMO ConnectedCare (HMO)
| $58.00 |
$3,800 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $42.00 | $42.00 | 3,487 2022 Formulary |
|
2021 HAP Senior Plus Option 2 (PPO)
| $60.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2322 -012 -0 | $0.00 | $10.00 | $42.00 | $42.00 | 3,788
2021 Formulary |
|
|
|
|
2022 HAP Senior Plus Option 2 (PPO)
| $65.00 |
$5,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $42.00 | $42.00 | 3,694 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 --
|
H3653 -004 -0 | | | | | |
|
|
|
|
2022 Paramount Elite Enhanced (HMO)
| $68.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $15.00 | $45.00 | $45.00 | 4,209 2022 Formulary |
|
2021 Medicare Plus Blue PPO Vitality (PPO)
| $77.00 |
$5,000 |
$100 | Yes, some additional gap coverage. |
H9572 -002 -6 | $2.00 | $11.00 | $42.00 | $42.00 | 3,443
2021 Formulary |
|
|
|
|
2022 Medicare Plus Blue PPO Vitality (PPO)
| $77.00 |
$5,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $11.00 | $42.00 | $42.00 | 3,469 2022 Formulary |
|
2021 HAP Senior Plus Option 1 (HMO-POS)
| $85.00 |
$4,200 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2354 -021 -0 | $0.00 | $10.00 | $42.00 | $42.00 | 3,788
2021 Formulary |
|
|
|
|
2022 HAP Senior Plus Option 1 (HMO-POS)
| $90.00 |
$4,200 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $42.00 | $42.00 | 3,694 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 PriorityMedicare Merit (PPO)
| $90.00 |
$4,100 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H4875 -016 -3 | $2.00 | $10.00 | $42.00 | $42.00 | 3,611
2021 Formulary |
|
|
|
|
2022 PriorityMedicare Merit (PPO)
| $98.00 |
$4,100 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $10.00 | $42.00 | $42.00 | 3,567 2022 Formulary |
|
2021 HumanaChoice R3887-002 (Regional PPO)
| $111.00 |
$5,300 |
$380 | No additional gap coverage, only the Donut Hole Discount |
R3887 -002 -0 | $7.00 | $13.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
|
|
|
2022 HumanaChoice R3887-002 (Regional PPO)
| $112.00 |
$5,300 |
$480 | No additional gap coverage, only the Donut Hole Discount | $9.00 | $20.00 | $47.00 | $47.00 | 3,421 2022 Formulary |
|
2021 PriorityMedicare (HMO-POS)
| $120.00 |
$4,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2320 -028 -5 | $1.00 | $8.00 | $38.00 | $38.00 | 3,611
2021 Formulary |
|
|
|
|
2022 PriorityMedicare (HMO-POS)
| $127.00 |
$4,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $1.00 | $8.00 | $38.00 | $38.00 | 3,567 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 BCN Advantage HMO-POS Classic (HMO-POS)
| $129.00 |
$3,800 |
$0 | Yes, some additional gap coverage. |
H5883 -002 -7 | $1.00 | $7.00 | $38.00 | $38.00 | 3,459
2021 Formulary |
|
|
|
|
2022 BCN Advantage HMO-POS Classic (HMO-POS)
| $129.00 |
$3,800 |
$0 | Yes, some additional gap coverage. | $0.00 | $7.00 | $38.00 | $38.00 | 3,487 2022 Formulary |
|
2021 Medicare Plus Blue PPO Signature (PPO)
| $135.00 |
$4,700 |
$0 | Yes, some additional gap coverage. |
H9572 -001 -6 | $1.00 | $10.00 | $42.00 | $42.00 | 3,443
2021 Formulary |
|
|
|
|
2022 Medicare Plus Blue PPO Signature (PPO)
| $135.00 |
$4,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $42.00 | $42.00 | 3,469 2022 Formulary |
|
2021 HAP Senior Plus Option 3 (PPO)
| $160.00 |
$4,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2322 -008 -0 | $0.00 | $10.00 | $42.00 | $42.00 | 3,788
2021 Formulary |
|
|
|
|
2022 HAP Senior Plus Option 3 (PPO)
| $165.00 |
$4,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $42.00 | $42.00 | 3,694 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 HAP Senior Plus Option 2 (HMO-POS)
| $190.00 |
$4,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2354 -022 -0 | $0.00 | $10.00 | $42.00 | $42.00 | 3,788
2021 Formulary |
|
|
|
|
2022 HAP Senior Plus Option 2 (HMO-POS)
| $190.00 |
$4,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $42.00 | $42.00 | 3,694 2022 Formulary |
|
2021 HAP Senior Plus Option 4 (PPO)
| $200.00 |
$4,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2322 -004 -0 | $0.00 | $10.00 | $42.00 | $42.00 | 3,788
2021 Formulary |
|
|
|
|
2022 HAP Senior Plus Option 4 (PPO)
| $200.00 |
$4,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $42.00 | $42.00 | 3,694 2022 Formulary |
|
2021 PriorityMedicare Select (PPO)
| $206.00 |
$3,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H4875 -017 -5 | $1.00 | $7.00 | $37.00 | $37.00 | 3,611
2021 Formulary |
|
|
|
|
2022 PriorityMedicare Select (PPO)
| $214.00 |
$3,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $1.00 | $7.00 | $37.00 | $37.00 | 3,567 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 BCN Advantage HMO-POS Prestige (HMO-POS)
| $264.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H5883 -003 -5 | $1.00 | $7.00 | $38.00 | $38.00 | 3,459
2021 Formulary |
|
|
|
|
2022 BCN Advantage HMO-POS Prestige (HMO-POS)
| $265.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $7.00 | $38.00 | $38.00 | 3,487 2022 Formulary |
|
2021 Medicare Plus Blue PPO Assure (PPO)
| $299.00 |
$3,425 |
$0 | Yes, some additional gap coverage. |
H9572 -003 -6 | $1.00 | $7.00 | $37.00 | $37.00 | 3,443
2021 Formulary |
|
|
|
|
2022 Medicare Plus Blue PPO Assure (PPO)
| $300.00 |
$3,425 |
$0 | Yes, some additional gap coverage. | $0.00 | $7.00 | $37.00 | $37.00 | 3,469 2022 Formulary |
|
2021 WellCare Elite (HMO-POS)
| $47.00 |
$3,450 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5475 -003 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,348
2021 Formulary |
|
|
|
|
-- Members will be assigned to Wellcare Low Premium (HMO-POS) H5475-024 --
| | | | | |
|
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 Essential (HMO-POS)
| $0.00 |
$3,450 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5475 -006 -0 | $0.00 | $15.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
|
|
|
-- Members will be assigned to Wellcare No Premium (HMO-POS) H5475-026 --
| | | | | |
|