There are 58 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 Choice (PPO)
| $0.00 |
$6,700 |
$240 | No additional gap coverage, only the Donut Hole Discount |
H8768 -022 -0 | $0.00 | $12.00 | $45.00 | $45.00 | 3,604
2021 Formulary |
|
|
|
|
2022 AARP Medicare Advantage Choice (PPO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $12.00 | $45.00 | $45.00 | 3,654 2022 Formulary |
|
2021 AARP Medicare Advantage Patriot (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H0755 -037 -0 | This plan does NOT include Prescription Drug coverage. | |
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2022 AARP Medicare Advantage Patriot (HMO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2021 --
|
H0755 -043 -0 | | | | | |
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|
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2022 AARP Medicare Advantage Plan 1 (HMO)
| $0.00 |
$6,900 |
$240 | Yes, some additional gap coverage. | $0.00 | $12.00 | $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 Aetna Medicare Eagle (HMO)
| $0.00 |
$7,550 |
No Rx Coverage |
H3152 -045 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Aetna Medicare Eagle (HMO)
| $0.00 |
$7,550 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 Aetna Medicare Value 2 (HMO)
| $0.00 |
$7,550 |
$300 | Yes, some additional gap coverage. |
H3152 -088 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
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|
|
|
2022 Aetna Medicare Elite 3 (HMO)
| $0.00 |
$7,550 |
$350 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 Aetna Medicare Explorer Elite (HMO)
| $0.00 |
$7,550 |
$100 | Yes, some additional gap coverage. |
H3152 -084 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
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|
|
|
2022 Aetna Medicare Explorer Elite (HMO)
| $0.00 |
$7,550 |
$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 Explorer Elite 2 (HMO)
| $0.00 |
$7,550 |
$250 | Yes, some additional gap coverage. |
H3152 -092 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
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|
|
|
2022 Aetna Medicare Explorer Elite 2 (HMO)
| $0.00 |
$7,550 |
$350 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 Aetna Medicare Explorer Value (HMO)
| $0.00 |
$7,550 |
$195 | Yes, some additional gap coverage. |
H3152 -082 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Explorer Value (HMO)
| $0.00 |
$7,550 |
$350 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 Aetna Medicare Prime Credit (PPO)
| $0.00 |
$7,550 |
$300 | Yes, some additional gap coverage. |
H5521 -277 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
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|
|
|
2022 Aetna Medicare Prime Credit (PPO)
| $0.00 |
$7,550 |
$350 | 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 Prime Value (HMO)
| $0.00 |
$7,550 |
$195 | Yes, some additional gap coverage. |
H3152 -080 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Prime Value (HMO-POS)
| $0.00 |
$7,550 |
$250 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H8343 -007 -0 | | | | | |
|
new |
new |
|
2022 Amerivantage Choice (PPO)
| $0.00 |
$7,550 |
$95 | Yes, some additional gap coverage. | $4.00 | $13.00 | $42.00 | $42.00 | 3,626 2022 Formulary |
|
2021 Amerivantage Classic (HMO)
| $0.00 |
$6,950 |
$200 | Yes, some additional gap coverage. |
H3240 -022 -0 | $4.00 | $10.00 | $42.00 | $42.00 | 3,639
2021 Formulary |
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2022 Amerivantage Classic (HMO)
| $0.00 |
$6,950 |
$200 | Yes, some additional gap coverage. | $4.00 | $10.00 | $42.00 | $42.00 | 3,626 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 Braven Medicare Choice (PPO)
| $0.00 |
$6,700 |
$150 | No additional gap coverage, only the Donut Hole Discount |
H0885 -001 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 2,744
2021 Formulary |
|
new |
new |
|
2022 Braven Medicare Choice (PPO)
| $0.00 |
$6,700 |
$150 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 2,799 2022 Formulary |
|
2021 Braven Medicare Plus (HMO)
| $0.00 |
$6,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H4675 -001 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 2,744
2021 Formulary |
|
new |
new |
|
2022 Braven Medicare Plus (HMO)
| $0.00 |
$6,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 2,799 2022 Formulary |
|
2021 Cigna Preferred Medicare (HMO)
| $0.00 |
$7,100 |
$0 | Yes, some additional gap coverage. |
H3949 -034 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,446
2021 Formulary |
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|
|
|
2022 Cigna Preferred Medicare (HMO)
| $0.00 |
$6,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 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 Clover Health Choice (PPO)
| $0.00 |
$7,550 |
$175 | No additional gap coverage, only the Donut Hole Discount |
H5141 -004 -0 | $2.00 | $10.00 | $40.00 | $40.00 | 3,372
2021 Formulary |
|
|
|
|
2022 Clover Health Choice (PPO)
| $0.00 |
$7,550 |
$150 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $37.00 | $37.00 | 3,372 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H5141 -054 -0 | | | | | |
|
|
|
|
2022 Clover Health Premier (PPO)
| $0.00 |
$7,550 |
$200 | No additional gap coverage, only the Donut Hole Discount | $0.00 | 22% | 22% | 22% | 3,372 2022 Formulary |
|
2021 Erickson Advantage Liberty with Drugs (HMO-POS)
| $0.00 |
$6,700 |
$400 | No additional gap coverage, only the Donut Hole Discount |
H5652 -008 -0 | $5.00 | $20.00 | $45.00 | $45.00 | 3,604
2021 Formulary |
|
|
|
|
2022 Erickson Advantage Liberty with Drugs (HMO-POS)
| $0.00 |
$6,700 |
$400 | Yes, some additional gap coverage. | $5.00 | $20.00 | $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 Erickson Advantage Liberty without Drugs (HMO-POS)
| $0.00 |
$6,700 |
No Rx Coverage |
H5652 -002 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Erickson Advantage Liberty without Drugs (HMO-POS)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 Humana Gold Plus H6622-063 (HMO)
| $0.00 |
$7,200 |
$275 | No additional gap coverage, only the Donut Hole Discount |
H6622 -063 -0 | $2.00 | $9.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
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|
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2022 Humana Gold Plus H6622-063 (HMO)
| $0.00 |
$6,500 |
$225 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $9.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 Humana Honor (PPO)
| $0.00 |
$4,500 |
No Rx Coverage |
H5216 -174 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Humana Honor (PPO)
| $0.00 |
$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 HumanaChoice H5216-169 (PPO)
| $0.00 |
$7,400 |
$275 | No additional gap coverage, only the Donut Hole Discount |
H5216 -169 -0 | $2.00 | $9.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
|
|
|
2022 HumanaChoice H5216-169 (PPO)
| $0.00 |
$7,400 |
$275 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $9.00 | $47.00 | $47.00 | 3,413 2022 Formulary |
|
2021 HumanaChoice H5216-172 (PPO)
| $0.00 |
$7,550 |
$295 | No additional gap coverage, only the Donut Hole Discount |
H5216 -172 -0 | $6.00 | $16.00 | $47.00 | $47.00 | 3,172
2021 Formulary |
|
|
|
|
2022 HumanaChoice H5216-172 (PPO)
| $0.00 |
$7,550 |
$295 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $16.00 | $47.00 | $47.00 | 3,217 2022 Formulary |
|
2021 WellCare Absolute (PPO)
| $0.00 |
$7,550 |
$200 | No additional gap coverage, only the Donut Hole Discount |
H8711 -002 -0 | $0.00 | $12.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
new |
new |
|
2022 Wellcare Giveback Open (PPO)
| $0.00 |
$7,550 |
$300 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $7.00 | $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 Value (HMO-POS)
| $0.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H0913 -002 -0 | $2.00 | $15.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
-- |
|
|
2022 Wellcare No Premium (HMO-POS)
| $0.00 |
$7,550 |
$350 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $37.00 | $37.00 | 3,375 2022 Formulary |
|
2021 WellCare Premier (PPO)
| $0.00 |
$7,550 |
$150 | No additional gap coverage, only the Donut Hole Discount |
H8711 -001 -0 | $0.00 | $15.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
new |
new |
|
2022 Wellcare No Premium Open (PPO)
| $0.00 |
$7,550 |
$175 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $37.00 | $37.00 | 3,375 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H0913 -020 -0 | | | | | |
|
-- |
|
|
2022 Wellcare Patriot No Premium (HMO)
| $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 WellCare Compass (HMO)
| $28.20 |
$6,700 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0913 -015 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
-- |
|
|
2022 Wellcare Assist (HMO)
| $18.20 |
$7,550 |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $47.00 | $47.00 | 3,375 2022 Formulary |
|
2021 Aetna Assure Premier Plus (HMO D-SNP)
| $24.30 |
n/a |
$190 | No additional gap coverage, only the Donut Hole Discount |
H6399 -001 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
new |
new |
|
2022 Aetna Assure Premier Plus (HMO D-SNP)
| $27.30 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 Horizon NJ TotalCare (HMO D-SNP)
| $34.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H8298 -001 -0 | | | | | 2,764
2021 Formulary |
|
|
|
|
2022 Horizon NJ TotalCare (HMO D-SNP)
| $29.70 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 2,820 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 True Choice Plus Medicare (PPO)
| $39.00 |
$7,250 |
$0 | Yes, some additional gap coverage. |
H7849 -030 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,446
2021 Formulary |
|
|
|
|
2022 Cigna True Choice Plus Medicare (PPO)
| $30.00 |
$7,250 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 3,459 2022 Formulary |
|
2021 WellCare Liberty (HMO D-SNP)
| $31.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0913 -013 -0 | $0.00 | $7.00 | $43.00 | $43.00 | 3,348
2021 Formulary |
|
-- |
|
|
2022 Wellcare Dual Liberty (HMO D-SNP)
| $31.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $18.00 | $45.00 | $45.00 | 3,375 2022 Formulary |
|
2021 Erickson Advantage Guardian (HMO-POS I-SNP)
| $28.80 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5652 -003 -0 | $0.00 | $0.00 | $28.00 | $28.00 | 3,604
2021 Formulary |
|
|
|
|
2022 Erickson Advantage Guardian (HMO-POS I-SNP)
| $32.30 |
n/a |
$0 | Some Generics | $0.00 | $0.00 | $28.00 | $28.00 | 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 HumanaChoice H5216-170 (PPO)
| $33.00 |
$6,500 |
$250 | No additional gap coverage, only the Donut Hole Discount |
H5216 -170 -0 | $2.00 | $8.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
|
|
|
2022 HumanaChoice H5216-170 (PPO)
| $33.00 |
$6,500 |
$250 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 Amerivantage Balance (HMO)
| $37.30 |
$7,550 |
$445 | Yes, some additional gap coverage. |
H3240 -021 -0 | $0.00 | $13.00 | $47.00 | $47.00 | 3,639
2021 Formulary |
|
|
|
|
2022 Amerivantage Balance (HMO)
| $34.40 |
$7,550 |
$480 | Yes, some additional gap coverage. | $0.00 | $13.00 | $47.00 | $47.00 | 3,626 2022 Formulary |
|
2021 Braven Medicare Freedom (PPO)
| $35.00 |
$6,500 |
$100 | No additional gap coverage, only the Donut Hole Discount |
H0885 -002 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 2,744
2021 Formulary |
|
new |
new |
|
2022 Braven Medicare Freedom (PPO)
| $35.00 |
$6,500 |
$100 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 2,799 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 ONE (HMO D-SNP)
| $33.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3113 -005 -0 | | | | | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Dual Complete ONE (HMO D-SNP)
| $35.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654 2022 Formulary |
|
2021 UnitedHealthcare Nursing Home Plan (PPO I-SNP)
| $36.20 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0710 -026 -0 | | | | | 3,604
2021 Formulary |
|
-- |
|
|
2022 UnitedHealthcare Nursing Home Plan (PPO I-SNP)
| $36.70 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654 2022 Formulary |
|
2021 Amerivantage Dual Coordination (HMO D-SNP)
| $37.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3240 -013 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,639
2021 Formulary |
|
|
|
|
2022 Amerivantage Dual Coordination (HMO D-SNP)
| $37.10 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $47.00 | $47.00 | 3,626 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 Amerivantage Dual Secure (HMO-POS D-SNP)
| $37.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3240 -024 -0 | $0.00 | $4.00 | $43.00 | $43.00 | 3,639
2021 Formulary |
|
|
|
|
2022 Amerivantage Dual Secure (HMO-POS D-SNP)
| $37.10 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $4.00 | $43.00 | $43.00 | 3,626 2022 Formulary |
|
2021 Amerivantage ESRD Care (HMO-POS C-SNP)
| $27.10 |
n/a |
$160 | No additional gap coverage, only the Donut Hole Discount |
H3240 -017 -0 | $3.00 | $10.00 | $42.00 | $42.00 | 3,639
2021 Formulary |
|
|
|
|
2022 Amerivantage ESRD Care (HMO-POS C-SNP)
| $37.10 |
n/a |
$160 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $10.00 | $42.00 | $42.00 | 3,603 2022 Formulary |
|
2021 Clover Health Choice Value (PPO)
| $37.30 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5141 -007 -0 | $2.00 | 22% | 22% | 22% | 3,372
2021 Formulary |
|
|
|
|
2022 Clover Health Choice Value (PPO)
| $37.10 |
$7,550 |
$480 | No additional gap coverage, only the Donut Hole Discount | $2.00 | 22% | 22% | 22% | 3,372 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 --
|
H5141 -055 -0 | | | | | |
|
|
|
|
2022 Clover Health Premier Value (PPO)
| $37.10 |
$7,550 |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | 22% | 22% | 22% | 3,372 2022 Formulary |
|
2021 Longevity Health Plan (PPO I-SNP)
| $37.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H9942 -001 -0 | | | | | 3,764
2021 Formulary |
|
new |
|
|
2022 Longevity Health Plan (PPO I-SNP)
| $37.10 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,678 2022 Formulary |
|
2021 UnitedHealthcare Nursing Home Plan (HMO I-SNP)
| $37.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3113 -001 -0 | | | | | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Nursing Home Plan (HMO I-SNP)
| $37.10 |
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 --
|
H0755 -044 -0 | | | | | |
|
|
|
|
2022 AARP Medicare Advantage Plan 3 (HMO)
| $39.00 |
$6,900 |
$200 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,654 2022 Formulary |
|
2021 Aetna Medicare Prime Premier (PPO)
| $49.00 |
$7,550 |
$250 | Yes, some additional gap coverage. |
H5521 -275 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Prime Premier (PPO)
| $49.00 |
$7,550 |
$350 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 Erickson Advantage Freedom (HMO-POS)
| $70.00 |
$4,300 |
$200 | No additional gap coverage, only the Donut Hole Discount |
H5652 -006 -0 | $5.00 | $15.00 | $45.00 | $45.00 | 3,604
2021 Formulary |
|
|
|
|
2022 Erickson Advantage Freedom (HMO-POS)
| $70.00 |
$4,300 |
$200 | Yes, some additional gap coverage. | $5.00 | $15.00 | $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 |
-- This plan not offered in 2021 --
|
H0755 -045 -0 | | | | | |
|
|
|
|
2022 AARP Medicare Advantage Plan 4 (HMO)
| $81.00 |
$6,900 |
$150 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,654 2022 Formulary |
|
2021 Aetna Medicare Explorer Premier Plus (HMO)
| $99.00 |
$7,550 |
$100 | Yes, some additional gap coverage. |
H3152 -048 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Explorer Premier Plus (HMO-POS)
| $99.00 |
$7,550 |
$195 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 Aetna Medicare Explorer Premier (PPO)
| $104.00 |
$7,550 |
$100 | Yes, some additional gap coverage. |
H5521 -037 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Explorer Premier (PPO)
| $105.00 |
$7,550 |
$250 | 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 (Regional PPO)
| $98.00 |
$7,550 |
$100 | Yes, some additional gap coverage. |
R6694 -006 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Premier (Regional PPO)
| $115.00 |
$7,550 |
$350 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,680 2022 Formulary |
|
2021 Erickson Advantage Champion (HMO-POS C-SNP)
| $199.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5652 -004 -0 | $5.00 | $15.00 | $45.00 | $45.00 | 3,604
2021 Formulary |
|
|
|
|
2022 Erickson Advantage Champion (HMO-POS C-SNP)
| $199.00 |
n/a |
$0 | Some Generics | $5.00 | $15.00 | $45.00 | $45.00 | 3,654 2022 Formulary |
|
2021 Erickson Advantage Signature with Drugs (HMO-POS)
| $199.00 |
$2,600 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5652 -001 -0 | $5.00 | $10.00 | $45.00 | $45.00 | 3,604
2021 Formulary |
|
|
|
|
2022 Erickson Advantage Signature with Drugs (HMO-POS)
| $199.00 |
$2,600 |
$0 | Yes, some additional gap coverage. | $5.00 | $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 Plan 1 (HMO)
| $0.00 |
$6,700 |
$240 | No additional gap coverage, only the Donut Hole Discount |
H0755 -040 -1 | $2.00 | $12.00 | $45.00 | $45.00 | 3,604
2021 Formulary |
|
|
|
|
-- Members will be assigned to AARP Medicare Advantage Plan 1 (HMO) H0755-043 --
| | | | | |
|
2021 AARP Medicare Advantage Plan 3 (HMO)
| $39.00 |
$6,700 |
$200 | No additional gap coverage, only the Donut Hole Discount |
H0755 -041 -1 | $2.00 | $10.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
-- Members will be assigned to AARP Medicare Advantage Plan 3 (HMO) H0755-044 --
| | | | | |
|
2021 AARP Medicare Advantage Plan 4 (HMO)
| $81.00 |
$6,700 |
$150 | No additional gap coverage, only the Donut Hole Discount |
H0755 -042 -1 | $2.00 | $10.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
-- Members will be assigned to AARP Medicare Advantage Plan 4 (HMO) H0755-045 --
| | | | | |
|
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 Horizon Medicare Blue Advantage (HMO)
| $26.00 |
$6,700 |
$250 | No additional gap coverage, only the Donut Hole Discount |
H3154 -029 -0 | $1.00 | $9.00 | $40.00 | $40.00 | 3,003
2021 Formulary |
|
|
|
|
-- This plan not offered in 2022 --
|
| | | | |
|