There are 70 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)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. |
H0609 -028 -0 | $2.00 | $8.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
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|
|
|
2022 AARP Medicare Advantage (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. | $2.00 | $8.00 | $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 AARP Medicare Advantage Choice (PPO)
| $0.00 |
$6,700 |
$195 | Yes, some additional gap coverage. |
H7404 -018 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 AARP Medicare Advantage Choice (PPO)
| $0.00 |
$5,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,654 2022 Formulary |
|
2021 AARP Medicare Advantage Patriot (PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
H7404 -019 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 AARP Medicare Advantage Patriot (PPO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 AARP Medicare Advantage Walgreens Plan 1 (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. |
H0609 -038 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
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|
|
|
2022 AARP Medicare Advantage Walgreens Plan 1 (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $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 AARP Medicare Advantage Walgreens Plan 2 (PPO)
| $0.00 |
$6,700 |
$195 | No additional gap coverage, only the Donut Hole Discount |
H7404 -020 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 AARP Medicare Advantage Walgreens Plan 2 (PPO)
| $0.00 |
$6,700 |
$195 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,654 2022 Formulary |
|
2021 Aetna Medicare Choice Plan (PPO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H5521 -055 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Choice Plan (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H5521 -353 -0 | | | | | |
|
|
|
|
2022 Aetna Medicare Eagle Plan (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 Aetna Medicare Elite Plan (PPO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H5521 -299 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Elite Plan (PPO)
| $0.00 |
$6,300 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 Aetna Medicare Premier Plan (HMO)
| $0.00 |
$3,900 |
$0 | Yes, some additional gap coverage. |
H4711 -001 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Premier Plan (HMO-POS)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 Aetna Medicare Prime Plan (HMO)
| $0.00 |
$1,900 |
$0 | Yes, some additional gap coverage. |
H4711 -002 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Prime Plan (HMO-POS)
| $0.00 |
$999 |
$0 | 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 Select Plan (HMO)
| $0.00 |
$7,550 |
$100 | Yes, some additional gap coverage. |
H3931 -094 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Select Plan (HMO-POS)
| $0.00 |
$7,550 |
$100 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H9686 -004 -0 | | | | | |
|
new |
new |
|
2022 Alignment Health Plan Heart & Diabetes (HMO C-SNP)
| $0.00 |
n/a |
$0 | Few Generics | $0.00 | $0.00 | $40.00 | $40.00 | 3,450 2022 Formulary |
|
2021 Platinum (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. |
H9686 -001 -0 | $0.00 | $0.00 | $40.00 | $40.00 | 3,417
2021 Formulary |
|
new |
new |
|
2022 Alignment Health Plan Platinum (HMO)
| $0.00 |
$1,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $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 Anthem MediBlue Care On Site (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H4346 -010 -0 | $0.00 | $7.50 | $40.00 | $40.00 | 3,057
2021 Formulary |
|
|
|
|
2022 Anthem MediBlue Care On Site (HMO I-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands | $0.00 | $7.50 | $40.00 | $40.00 | 3,117 2022 Formulary |
|
2021 Anthem MediBlue Diabetes Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H4346 -006 -0 | $0.00 | $7.50 | $40.00 | $40.00 | 3,057
2021 Formulary |
|
|
|
|
2022 Anthem MediBlue Diabetes Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands | $0.00 | $7.50 | $35.00 | $35.00 | 3,117 2022 Formulary |
|
2021 Anthem MediBlue Heart Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H4346 -008 -0 | $0.00 | $7.50 | $40.00 | $40.00 | 3,057
2021 Formulary |
|
|
|
|
2022 Anthem MediBlue Heart Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands | $0.00 | $7.50 | $40.00 | $40.00 | 3,117 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 Lung Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H4346 -005 -0 | $0.00 | $7.50 | $40.00 | $40.00 | 3,057
2021 Formulary |
|
|
|
|
2022 Anthem MediBlue Lung Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands | $0.00 | $7.50 | $40.00 | $40.00 | 3,117 2022 Formulary |
|
2021 Anthem MediBlue Plus (HMO)
| $0.00 |
$1,250 |
$0 | Yes, some additional gap coverage. |
H4346 -017 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,621
2021 Formulary |
|
|
|
|
2022 Anthem MediBlue Plus (HMO)
| $0.00 |
$1,250 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 3,604 2022 Formulary |
|
2021 Anthem MediBlue StartSmart Plus (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H4346 -009 -0 | $5.00 | $10.50 | $40.00 | $40.00 | 3,057
2021 Formulary |
|
|
|
|
2022 Anthem MediBlue StartSmart Plus (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $10.50 | $40.00 | $40.00 | 3,117 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 Value Plus (HMO)
| $0.00 |
$1,500 |
$0 | Yes, some additional gap coverage. |
H4346 -001 -0 | $0.00 | $7.50 | $40.00 | $40.00 | 3,057
2021 Formulary |
|
|
|
|
2022 Anthem MediBlue Value Plus (HMO)
| $0.00 |
$1,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $40.00 | $40.00 | 3,117 2022 Formulary |
|
2021 AVA (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. |
H9686 -003 -0 | $0.00 | $0.00 | $40.00 | $40.00 | 3,417
2021 Formulary |
|
new |
new |
|
2022 AVA (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $40.00 | $40.00 | 3,450 2022 Formulary |
|
2021 Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H6622 -029 -0 | $5.00 | $6.00 | $40.00 | $40.00 | 3,382
2021 Formulary |
|
|
|
|
2022 Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics, Few Brands | $5.00 | $6.00 | $40.00 | $40.00 | 3,408 2022 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2021 Humana Gold Plus H6622-028 (HMO)
| $0.00 |
$1,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H6622 -028 -0 | $2.00 | $8.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
|
|
|
2022 Humana Gold Plus H6622-028 (HMO)
| $0.00 |
$1,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 Humana Gold Plus H6622-056 (HMO)
| $0.00 |
$999 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H6622 -056 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
|
|
|
2022 Humana Gold Plus H6622-056 (HMO)
| $0.00 |
$999 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 Humana Gold Plus Lung (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H6622 -030 -0 | $1.00 | $2.00 | $40.00 | $40.00 | 3,382
2021 Formulary |
|
|
|
|
2022 Humana Gold Plus Lung (HMO C-SNP)
| $0.00 |
n/a |
$0 | Few Generics, Few Brands | $1.00 | $2.00 | $40.00 | $40.00 | 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 |
$6,700 |
No Rx Coverage |
H5216 -216 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Humana Honor (PPO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 HumanaChoice H5216-141 (PPO)
| $0.00 |
$7,550 |
$365 | No additional gap coverage, only the Donut Hole Discount |
H5216 -141 -0 | $5.00 | $13.00 | $47.00 | $47.00 | 3,172
2021 Formulary |
|
|
|
|
2022 HumanaChoice H5216-141 (PPO)
| $0.00 |
$7,550 |
$365 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $13.00 | $47.00 | $47.00 | 3,217 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H5216 -281 -0 | | | | | |
|
|
|
|
2022 HumanaChoice H5216-281 (PPO)
| $0.00 |
$6,700 |
$175 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2021 Imperial Insurance Company Traditional (HMO)
| $0.00 |
$2,999 |
$0 | Yes, some additional gap coverage. |
H2793 -003 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,359
2021 Formulary |
|
-- |
|
|
2022 Imperial Insurance Company Traditional (HMO)
| $0.00 |
$2,999 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,315 2022 Formulary |
|
2021 Imperial Insurance Traditional Plus (HMO)
| $32.40 |
$2,999 |
$445 | Yes, some additional gap coverage. |
H2793 -007 -0 | 0% | 25% | 25% | 25% | 3,359
2021 Formulary |
|
-- |
|
|
2022 Imperial Insurance Traditional Plus (HMO)
| $0.00 |
$7,550 |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,315 2022 Formulary |
|
2021 Imperial Insurance Value (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H2793 -005 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,404
2021 Formulary |
|
-- |
|
|
2022 Imperial Insurance Value (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands | $0.00 | $5.00 | $45.00 | $45.00 | 3,364 2022 Formulary |
|
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 --
|
H0978 -002 -0 | | | | | |
new |
new |
new |
|
2022 SCAN Balance (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands | $0.00 | $0.00 | $37.00 | $37.00 | 3,425 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H0978 -001 -0 | | | | | |
new |
new |
new |
|
2022 SCAN Classic (HMO)
| $0.00 |
$900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $37.00 | $37.00 | 3,425 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H0978 -003 -0 | | | | | |
new |
new |
new |
|
2022 SCAN Heart First (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands | $0.00 | $0.00 | $37.00 | $37.00 | 3,425 2022 Formulary |
|
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 --
|
H0978 -004 -0 | | | | | |
new |
new |
new |
|
2022 SCAN Venture (HMO)
| $0.00 |
$1,800 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $40.00 | $40.00 | 3,425 2022 Formulary |
|
2021 SelectHealth Advantage (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. |
H1994 -012 -0 | $0.00 | $8.00 | $45.00 | $45.00 | 3,813
2021 Formulary |
|
|
|
|
2022 SelectHealth Advantage (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $45.00 | $45.00 | 3,863 2022 Formulary |
|
2021 Senior Care Plus Complete Plan (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. |
H2960 -019 -0 | $2.00 | $8.00 | $41.00 | $41.00 | 3,207
2021 Formulary |
|
|
|
|
2022 Senior Care Plus Complete Plan (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $2.00 | $8.00 | $41.00 | $41.00 | 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 Senior Care Plus Comprehensive plan (HMO)
| $0.00 |
$1,900 |
$0 | Yes, some additional gap coverage. |
H2960 -021 -0 | $2.00 | $8.00 | $41.00 | $41.00 | 3,207
2021 Formulary |
|
|
|
|
2022 Senior Care Plus Comprehensive plan (HMO)
| $0.00 |
$1,900 |
$0 | Yes, some additional gap coverage. | $2.00 | $8.00 | $41.00 | $41.00 | 3,133 2022 Formulary |
|
2021 Senior Care Plus Encompass Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H2960 -022 -0 | $0.00 | $5.00 | $37.00 | $37.00 | 3,207
2021 Formulary |
|
|
|
|
2022 Senior Care Plus Encompass Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands | $0.00 | $5.00 | $37.00 | $37.00 | 3,133 2022 Formulary |
|
2021 UnitedHealthcare Medicare Advantage Assist (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0609 -037 -0 | $0.00 | $8.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Medicare Advantage Assist (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics, Few Brands | $0.00 | $8.00 | $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 Medicare Advantage Focus (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. |
H0609 -032 -0 | $2.00 | $8.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Medicare Advantage Focus (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. | $2.00 | $8.00 | $47.00 | $47.00 | 3,654 2022 Formulary |
|
2021 Allwell Medicare Boost P3 (HMO)
| $0.00 |
$7,550 |
$250 | No additional gap coverage, only the Donut Hole Discount |
H6446 -003 -0 | $3.00 | $10.00 | $47.00 | $47.00 | 3,370
2021 Formulary |
|
new |
|
|
2022 Wellcare Giveback P3 (HMO)
| $0.00 |
$7,550 |
$250 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $37.00 | $37.00 | 3,375 2022 Formulary |
|
2021 Allwell Medicare Boost USHS (HMO)
| $0.00 |
$7,550 |
$250 | No additional gap coverage, only the Donut Hole Discount |
H6446 -004 -0 | $3.00 | $10.00 | $47.00 | $47.00 | 3,370
2021 Formulary |
|
new |
|
|
2022 Wellcare Giveback USHS (HMO)
| $0.00 |
$7,550 |
$250 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $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 |
-- This plan not offered in 2021 --
|
H8458 -001 -0 | | | | | |
new |
new |
new |
|
2022 Wellcare No Premium Open (PPO)
| $0.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $7.00 | $37.00 | $37.00 | 3,375 2022 Formulary |
|
2021 Allwell Medicare Select P3 (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. |
H6446 -001 -0 | $0.00 | $2.00 | $47.00 | $47.00 | 3,370
2021 Formulary |
|
new |
|
|
2022 Wellcare No Premium P3 (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $37.00 | $37.00 | 3,375 2022 Formulary |
|
2021 Allwell Medicare Select USHS (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. |
H6446 -009 -0 | $0.00 | $2.00 | $47.00 | $47.00 | 3,370
2021 Formulary |
|
new |
|
|
2022 Wellcare No Premium USHS (HMO)
| $0.00 |
$1,000 |
$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 |
-- This plan not offered in 2021 --
|
H8458 -002 -0 | | | | | |
new |
new |
new |
|
2022 Wellcare Patriot Giveback Open (PPO)
| $0.00 |
$7,550 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2021 --
|
H6446 -017 -0 | | | | | |
|
new |
|
|
2022 Wellcare Specialty No Premium P3 (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands | $0.00 | $0.00 | $0.00 | $0.00 | 3,373 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H6446 -018 -0 | | | | | |
|
new |
|
|
2022 Wellcare Specialty No Premium USHS (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 |
-- This plan not offered in 2021 --
|
H9686 -005 -0 | | | | | |
|
new |
new |
|
2022 Alignment Health Plan the ONE (HMO D-SNP)
| $1.80 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | 25% | 25% | 3,450 2022 Formulary |
|
2021 Anthem MediBlue Connect (HMO D-SNP)
| $14.50 |
n/a |
$445 | Yes, some additional gap coverage. |
H4346 -026 -0 | $0.00 | $0.00 | 25% | 25% | 3,057
2021 Formulary |
|
|
|
|
2022 Anthem MediBlue Connect (HMO D-SNP)
| $7.30 |
n/a |
$480 | Many Generics, Some Brands | $0.00 | $0.00 | 20% | 20% | 3,117 2022 Formulary |
|
2021 Anthem MediBlue Dual Advantage (HMO D-SNP)
| $5.70 |
n/a |
$445 | Yes, some additional gap coverage. |
H4346 -025 -0 | $0.00 | $15.00 | $47.00 | $47.00 | 3,621
2021 Formulary |
|
|
|
|
2022 Anthem MediBlue Dual Advantage (HMO D-SNP)
| $11.30 |
n/a |
$480 | Few Generics | $0.00 | $15.00 | $47.00 | $47.00 | 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 Aetna Medicare Prime Plan (HMO D-SNP)
| $23.00 |
n/a |
$130 | No additional gap coverage, only the Donut Hole Discount |
H4711 -011 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Dual Prime Plan (HMO D-SNP)
| $20.80 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 Humana Value Plus H6622-064 (HMO)
| $26.50 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H6622 -064 -0 | $7.00 | $20.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
|
|
|
|
2022 Humana Value Plus H6622-064 (HMO)
| $23.60 |
$7,550 |
$480 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $10.00 | 22% | 22% | 3,408 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H6622 -079 -0 | | | | | |
|
|
|
|
2022 Humana Gold Plus SNP-DE H6622-079 (HMO D-SNP)
| $25.60 |
n/a |
$450 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $20.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2021 --
|
H5216 -302 -0 | | | | | |
|
|
|
|
2022 HumanaChoice SNP-DE H5216-302 (PPO D-SNP)
| $26.80 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $19.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 Allwell Medicare Complement P3 (HMO)
| $21.00 |
$3,450 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H6446 -011 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,352
2021 Formulary |
|
new |
|
|
2022 Wellcare Assist P3 (HMO)
| $28.40 |
$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 Allwell Medicare Complement USHS (HMO)
| $19.60 |
$3,450 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H6446 -012 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,352
2021 Formulary |
|
new |
|
|
2022 Wellcare Assist USHS (HMO)
| $29.80 |
$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 Allwell Dual Medicare Harmony P3 (HMO D-SNP)
| $26.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H6446 -014 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,352
2021 Formulary |
|
new |
|
|
2022 Wellcare Dual Access P3 (HMO D-SNP)
| $31.10 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $13.00 | $42.00 | $42.00 | 3,375 2022 Formulary |
|
2021 AARP Medicare Advantage Premier (HMO)
| $26.50 |
$1,000 |
$0 | Yes, some additional gap coverage. |
H0609 -031 -0 | $2.00 | $8.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 AARP Medicare Advantage Premier (HMO)
| $31.70 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $47.00 | $47.00 | 3,654 2022 Formulary |
|
2021 UnitedHealthcare Dual Complete (HMO D-SNP)
| $26.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H1360 -001 -0 | | | | | 3,604
2021 Formulary |
|
new |
new |
|
2022 UnitedHealthcare Dual Complete (HMO D-SNP)
| $31.70 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654 2022 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2021 Allwell Dual Medicare Harmony USHS (HMO D-SNP)
| $26.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H6446 -015 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,352
2021 Formulary |
|
new |
|
|
2022 Wellcare Dual Access USHS (HMO D-SNP)
| $31.70 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $13.00 | $42.00 | $42.00 | 3,375 2022 Formulary |
|
2021 HumanaChoice H5216-037 (PPO)
| $34.00 |
$6,700 |
$225 | No additional gap coverage, only the Donut Hole Discount |
H5216 -037 -0 | $2.00 | $5.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
|
|
|
2022 HumanaChoice H5216-037 (PPO)
| $35.00 |
$6,700 |
$225 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $5.00 | $47.00 | $47.00 | 3,413 2022 Formulary |
|
2021 Aetna Medicare Select Plan (PPO)
| $67.00 |
$7,000 |
$0 | Yes, some additional gap coverage. |
H5521 -022 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Select Plan (PPO)
| $49.00 |
$5,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2021 HumanaChoice H5216-036 (PPO)
| $151.00 |
$6,700 |
$225 | No additional gap coverage, only the Donut Hole Discount |
H5216 -036 -0 | $4.00 | $7.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
|
|
|
2022 HumanaChoice H5216-036 (PPO)
| $152.00 |
$6,700 |
$225 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $7.00 | $47.00 | $47.00 | 3,413 2022 Formulary |
|
2021 Anthem MediBlue Coordination Plus (HMO)
| $5.30 |
$7,550 |
$445 | Yes, some additional gap coverage. |
H4346 -018 -0 | $0.00 | $15.00 | $47.00 | $47.00 | 3,621
2021 Formulary |
|
|
|
|
-- Members will be assigned to Anthem MediBlue Plus (HMO) H4346-017 --
| | | | | |
|
2021 Anthem MediBlue Connect Plus (HMO)
| $18.20 |
$7,550 |
$445 | Yes, some additional gap coverage. |
H4346 -011 -0 | 25% | 25% | 25% | 25% | 3,057
2021 Formulary |
|
|
|
|
-- Members will be assigned to Anthem MediBlue Value Plus (HMO) H4346-001 --
| | | | | |
|
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 NVPlus (HMO)
| $15.20 |
$2,900 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H9686 -002 -0 | $0.00 | $14.00 | 23% | 23% | 3,417
2021 Formulary |
|
new |
new |
|
-- This plan not offered in 2022 --
|
| | | | |
|