There are 72 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 MVP SmartFund (MSA)
| $0.00 |
n/a |
No Rx Coverage |
H5613 -002 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
|
|
2022 MVP SmartFund (MSA)
| $0.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 AARP Medicare Advantage (HMO)
| $0.00 |
$6,700 |
$195 | No additional gap coverage, only the Donut Hole Discount |
H3379 -039 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
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|
|
2022 AARP Medicare Advantage (HMO)
| $0.00 |
$7,550 |
$195 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | 3,654 2022 Formulary |
|
2021 Aetna Medicare Credit Plan (PPO)
| $0.00 |
$7,550 |
$250 | Yes, some additional gap coverage. |
H5521 -313 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
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|
|
|
2022 Aetna Medicare Credit Plan (PPO)
| $0.00 |
$7,550 |
$350 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
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Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2021 Aetna Medicare Eagle Plan (PPO)
| $0.00 |
$7,550 |
No Rx Coverage |
H5521 -323 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Aetna Medicare Eagle Plan (PPO)
| $0.00 |
$7,550 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 Aetna Medicare Premier Plan (PPO)
| $0.00 |
$7,550 |
$200 | Yes, some additional gap coverage. |
H5521 -077 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
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|
2022 Aetna Medicare Premier Plan (PPO)
| $0.00 |
$7,550 |
$250 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 Aetna Medicare Value Plan (HMO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H3312 -048 -0 | $2.00 | $5.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
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|
|
|
2022 Aetna Medicare Value Plan (HMO)
| $0.00 |
$7,550 |
$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 CDPHP $0 Medicare Rx (HMO)
| $0.00 |
$7,500 |
$300 | No additional gap coverage, only the Donut Hole Discount |
H3388 -014 -0 | $3.00 | $17.00 | $47.00 | $47.00 | 3,305
2021 Formulary |
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|
|
|
2022 CDPHP $0 Medicare Rx (HMO)
| $0.00 |
$7,500 |
$300 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $17.00 | $47.00 | $47.00 | 3,349 2022 Formulary |
|
2021 CDPHP Flex (PPO)
| $0.00 |
$5,500 |
No Rx Coverage |
H5042 -012 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
|
2022 CDPHP Flex (PPO)
| $0.00 |
$5,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 CDPHP Vital Rx (PPO)
| $0.00 |
$7,500 |
$350 | No additional gap coverage, only the Donut Hole Discount |
H5042 -009 -0 | $3.00 | $17.00 | $47.00 | $47.00 | 3,305
2021 Formulary |
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|
|
2022 CDPHP Vital Rx (PPO)
| $0.00 |
$7,500 |
$350 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $17.00 | $47.00 | $47.00 | 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 EmblemHealth VIP Rx Saver (HMO)
| $0.00 |
$7,550 |
$395 | No additional gap coverage, only the Donut Hole Discount |
H3330 -039 -2 | $2.00 | $15.00 | $42.00 | $42.00 | 3,429
2021 Formulary |
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-- |
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|
2022 EmblemHealth VIP Rx Saver (HMO)
| $0.00 |
$7,550 |
$395 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $42.00 | $42.00 | 3,453 2022 Formulary |
|
2021 Humana Gold Plus H3533-001 (HMO)
| $0.00 |
$7,200 |
$350 | No additional gap coverage, only the Donut Hole Discount |
H3533 -001 -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 H3533-001 (HMO)
| $0.00 |
$7,200 |
$350 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $9.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
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2021 Humana Honor (PPO)
| $0.00 |
$4,500 |
No Rx Coverage |
H5970 -016 -0 | This plan does NOT include Prescription Drug coverage. | |
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2022 Humana Honor (PPO)
| $0.00 |
$4,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2021 HumanaChoice H5970-015 (PPO)
| $0.00 |
$6,500 |
$250 | No additional gap coverage, only the Donut Hole Discount |
H5970 -015 -0 | $2.00 | $9.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
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2022 HumanaChoice H5970-015 (PPO)
| $0.00 |
$4,900 |
$250 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $9.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 HumanaChoice H5970-018 (PPO)
| $0.00 |
$7,550 |
$310 | No additional gap coverage, only the Donut Hole Discount |
H5970 -018 -0 | $6.00 | $16.00 | $47.00 | $47.00 | 3,172
2021 Formulary |
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2022 HumanaChoice H5970-018 (PPO)
| $0.00 |
$4,800 |
$310 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $16.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H3335 -055 -0 | | | | | |
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2022 Medicare BlueActive (PPO)
| $0.00 |
$7,550 |
$350 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $42.00 | $42.00 | 4,235 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 Medicare BlueBasic (PPO)
| $45.00 |
$4,500 |
No Rx Coverage |
H3335 -043 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Medicare BlueBasic (PPO)
| $0.00 |
$4,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 Medicare BlueEssential (PPO)
| $0.00 |
$7,550 |
$150 | No additional gap coverage, only the Donut Hole Discount |
H3335 -053 -0 | $0.00 | $10.00 | $42.00 | $42.00 | 4,287
2021 Formulary |
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|
|
|
2022 Medicare BlueEssential (PPO)
| $0.00 |
$7,550 |
$150 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $42.00 | $42.00 | 4,235 2022 Formulary |
|
2021 MVP Medicare WellSelect with Part D (PPO)
| $0.00 |
$7,550 |
$325 | No additional gap coverage, only the Donut Hole Discount |
H9615 -008 -0 | $0.00 | $12.00 | $47.00 | $47.00 | 3,471
2021 Formulary |
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|
|
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2022 MVP Medicare WellSelect with Part D (PPO)
| $0.00 |
$7,550 |
$300 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $12.00 | $47.00 | $47.00 | 3,546 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 Patriot (Regional PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
R5342 -002 -0 | This plan does NOT include Prescription Drug coverage. | |
|
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|
|
2022 UnitedHealthcare Medicare Advantage Patriot (Regional PPO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 WellCare Today's Options Premier 300 (PFFS)
| $0.00 |
n/a |
No Rx Coverage |
H2816 -038 -0 | This plan does NOT include Prescription Drug coverage. | |
|
-- |
|
|
2022 Wellcare Advantage No Premium (PFFS)
| $0.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 Fidelis Medicare $0 Premium (HMO)
| $0.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5599 -004 -0 | $5.00 | $20.00 | $47.00 | $47.00 | 3,168
2021 Formulary |
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|
|
2022 Wellcare Fidelis No Premium (HMO)
| $0.00 |
$7,550 |
$0 | 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 Fidelis Medicare Advantage without Rx (HMO-POS)
| $0.00 |
$7,550 |
No Rx Coverage |
H5599 -005 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Wellcare Fidelis Patriot No Premium (HMO-POS)
| $0.00 |
$7,550 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 WellCare Absolute (PPO)
| $0.00 |
$7,550 |
$150 | Yes, some additional gap coverage. |
H2775 -111 -0 | $0.00 | $12.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
|
|
|
2022 Wellcare Giveback Open (PPO)
| $0.00 |
$7,550 |
$325 | Yes, some additional gap coverage. | $1.00 | $7.00 | $37.00 | $37.00 | 3,375 2022 Formulary |
|
2021 WellCare Value (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H4868 -019 -0 | $0.00 | $12.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
-- |
|
|
2022 Wellcare No Premium (HMO)
| $0.00 |
$6,700 |
$0 | 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 Today's Options Advantage Plus 550B (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H2775 -106 -0 | $0.00 | $7.00 | $37.00 | $37.00 | 3,348
2021 Formulary |
|
|
|
|
2022 Wellcare No Premium Open (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $7.00 | $37.00 | $37.00 | 3,375 2022 Formulary |
|
2021 WellCare Patriot (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H4868 -003 -0 | This plan does NOT include Prescription Drug coverage. | |
|
-- |
|
|
2022 Wellcare Patriot No Premium (HMO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO)
| $16.00 |
$6,700 |
$300 | No additional gap coverage, only the Donut Hole Discount |
R5342 -001 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
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|
|
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2022 UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO)
| $16.00 |
$7,200 |
$300 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | tbd |
|
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 H5970-001 (PPO)
| $16.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5970 -001 -0 | $2.00 | $8.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
|
|
|
2022 HumanaChoice H5970-001 (PPO)
| $17.00 |
$4,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 Fidelis Medicare Advantage Flex (HMO-POS)
| $7.40 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5599 -002 -0 | $0.00 | $15.00 | 24% | 24% | 3,168
2021 Formulary |
|
|
|
|
2022 Wellcare Fidelis Assist (HMO-POS)
| $17.10 |
$7,550 |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | 22% | 22% | 3,375 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H5970 -020 -0 | | | | | |
|
|
|
|
2022 HumanaChoice SNP-DE H5970-020 (PPO D-SNP)
| $19.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $19.00 | $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 Fidelis Dual Advantage Flex (HMO D-SNP)
| $21.60 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5599 -001 -0 | $0.00 | $10.00 | 24% | 24% | 3,168
2021 Formulary |
|
|
|
|
2022 Wellcare Fidelis Dual Access (HMO D-SNP)
| $20.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,375 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H5599 -008 -0 | | | | | |
|
|
|
|
2022 Wellcare Fidelis Dual Plus (HMO D-SNP)
| $23.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,375 2022 Formulary |
|
2021 Aetna Medicare Assure Plan (HMO D-SNP)
| $27.10 |
n/a |
$190 | No additional gap coverage, only the Donut Hole Discount |
H3312 -070 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Assure Plan (HMO D-SNP)
| $23.80 |
n/a |
$425 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $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 |
-- This plan not offered in 2021 --
|
H5521 -340 -0 | | | | | |
|
|
|
|
2022 Aetna Medicare Discover Value Plan (PPO)
| $25.00 |
$7,550 |
$300 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H3533 -013 -0 | | | | | |
|
-- |
|
|
2022 Humana Gold Plus H3533-013 (HMO)
| $26.00 |
$6,700 |
$275 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $12.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 Humana Gold Plus SNP-DE H3533-002 (HMO D-SNP)
| $28.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3533 -002 -0 | $2.00 | $15.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
|
-- |
|
|
2022 Humana Gold Plus SNP-DE H3533-002 (HMO D-SNP)
| $30.10 |
n/a |
$460 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $15.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2021 WellCare Summit (PPO)
| $5.10 |
$6,700 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H2775 -113 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
|
|
|
2022 Wellcare Assist Open (PPO)
| $30.70 |
$6,700 |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $45.00 | $45.00 | 3,375 2022 Formulary |
|
2021 WellCare Access (HMO D-SNP)
| $28.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H4868 -004 -0 | $0.00 | $3.00 | $42.00 | $42.00 | 3,348
2021 Formulary |
|
-- |
|
|
2022 Wellcare Dual Access (HMO D-SNP)
| $30.80 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $42.00 | $42.00 | 3,375 2022 Formulary |
|
2021 CDPHP Basic RX (HMO)
| $31.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3388 -013 -0 | $3.00 | $15.00 | $45.00 | $45.00 | 3,305
2021 Formulary |
|
|
|
|
2022 CDPHP Basic RX (HMO)
| $31.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $15.00 | $45.00 | $45.00 | 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 WellCare Imperial (PPO D-SNP)
| $12.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H2775 -112 -0 | $0.00 | $9.00 | $45.00 | $45.00 | 3,348
2021 Formulary |
|
|
|
|
2022 Wellcare Dual Access Open (PPO D-SNP)
| $37.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $42.00 | $42.00 | 3,375 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H3387 -015 -1 | | | | | |
|
|
|
|
2022 UnitedHealthcare Dual Complete Plan 2 (HMO D-SNP)
| $37.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654 2022 Formulary |
|
2021 Medicare BlueClassic (PPO)
| $38.00 |
$7,200 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3335 -038 -0 | $0.00 | $8.00 | $42.00 | $42.00 | 4,287
2021 Formulary |
|
|
|
|
2022 Medicare BlueClassic (PPO)
| $38.00 |
$7,200 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $8.00 | $42.00 | $42.00 | 4,235 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 CDPHP Choice (HMO)
| $39.90 |
$5,000 |
No Rx Coverage |
H3388 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 CDPHP Choice (HMO)
| $39.90 |
$5,000 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 MVP Medicare Secure with Part D (HMO-POS)
| $40.00 |
$7,550 |
$150 | No additional gap coverage, only the Donut Hole Discount |
H3305 -032 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,471
2021 Formulary |
|
|
|
|
2022 MVP Medicare Secure with Part D (HMO-POS)
| $40.00 |
$7,550 |
$150 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,546 2022 Formulary |
|
2021 CDPHP Flex Rx (PPO)
| $41.80 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5042 -011 -0 | $2.00 | $14.00 | $44.00 | $44.00 | 3,305
2021 Formulary |
|
|
|
|
2022 CDPHP Flex Rx (PPO)
| $42.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $14.00 | $44.00 | $44.00 | 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 EmblemHealth VIP Dual (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3330 -042 -3 | | | | | 3,429
2021 Formulary |
|
-- |
|
|
2022 EmblemHealth VIP Dual (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,453 2022 Formulary |
|
2021 EmblemHealth VIP Solutions (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5991 -002 -0 | | | | | 3,429
2021 Formulary |
|
-- |
|
|
2022 EmblemHealth VIP Solutions (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,453 2022 Formulary |
|
2021 Nascentia Dual Advantage (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H9066 -003 -0 | | | | | 3,359
2021 Formulary |
|
-- |
-- |
|
2022 Nascentia Dual Advantage (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,315 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 Nascentia Medicaid Advantage Plus (HMO D-SNP)
| $93.90 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H9066 -001 -0 | | | | | 3,359
2021 Formulary |
|
-- |
-- |
|
2022 Nascentia Medicaid Advantage Plus (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,315 2022 Formulary |
|
2021 Nascentia Skilled Nursing Facility (HMO I-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H9066 -002 -0 | | | | | 3,359
2021 Formulary |
|
-- |
-- |
|
2022 Nascentia Skilled Nursing Facility (HMO I-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,315 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H3387 -014 -1 | | | | | |
|
|
|
|
2022 UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP)
| $42.40 |
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 UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)
| $36.00 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3379 -022 -0 | | | | | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654 2022 Formulary |
|
2021 UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
| $34.10 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H2292 -001 -0 | | | | | 3,604
2021 Formulary |
|
-- |
|
|
2022 UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654 2022 Formulary |
|
2021 UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO)
| $46.00 |
$6,700 |
$275 | No additional gap coverage, only the Donut Hole Discount |
R5342 -005 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO)
| $46.00 |
$6,900 |
$250 | Yes, some additional gap coverage. | $0.00 | $14.00 | $47.00 | $47.00 | tbd |
|
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 Today's Options Premier Plus 650B (PFFS)
| $55.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2816 -019 -0 | $1.00 | $7.00 | $37.00 | $37.00 | 3,348
2021 Formulary |
|
-- |
|
|
2022 Wellcare Premium Enhanced (PFFS)
| $55.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $1.00 | $7.00 | $37.00 | $37.00 | 3,375 2022 Formulary |
|
2021 CDPHP Value Rx (HMO)
| $60.80 |
$5,800 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3388 -004 -0 | $2.00 | $13.00 | $42.00 | $42.00 | 3,305
2021 Formulary |
|
|
|
|
2022 CDPHP Value Rx (HMO)
| $60.80 |
$5,800 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $13.00 | $42.00 | $42.00 | 3,349 2022 Formulary |
|
2021 MVP Medicare Preferred Gold without Part D (HMO-POS)
| $62.00 |
$7,550 |
No Rx Coverage |
H3305 -020 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 MVP Medicare Preferred Gold without Part D (HMO-POS)
| $62.00 |
$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 Today's Options Premier 200 (PFFS)
| $71.00 |
n/a |
No Rx Coverage |
H2816 -037 -0 | This plan does NOT include Prescription Drug coverage. | |
|
-- |
|
|
2022 Wellcare Advantage Premium Enhanced (PFFS)
| $62.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 UnitedHealthcare Medicare Advantage Choice Plan 4 (Regional PPO)
| $84.00 |
$6,700 |
$150 | No additional gap coverage, only the Donut Hole Discount |
R5342 -006 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Medicare Advantage Choice Plan 4 (Regional PPO)
| $84.00 |
$6,700 |
$150 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | tbd |
|
2021 MVP Medicare Secure Plus with Part D (HMO-POS)
| $90.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H3305 -022 -0 | $0.00 | $15.00 | $45.00 | $45.00 | 3,471
2021 Formulary |
|
|
|
|
2022 MVP Medicare Secure Plus with Part D (HMO-POS)
| $90.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $15.00 | $45.00 | $45.00 | 3,546 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 Medicare BlueSecure (PPO)
| $101.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3335 -014 -0 | $0.00 | $8.00 | $42.00 | $42.00 | 4,287
2021 Formulary |
|
|
|
|
2022 Medicare BlueSecure (PPO)
| $92.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $8.00 | $42.00 | $42.00 | 4,235 2022 Formulary |
|
2021 WellCare Today's Options Advantage Plus 150A (PPO)
| $121.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2775 -105 -0 | $0.00 | $5.00 | $35.00 | $35.00 | 3,348
2021 Formulary |
|
|
|
|
2022 Wellcare Premium Ultra Open (PPO)
| $121.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $35.00 | $35.00 | 3,375 2022 Formulary |
|
2021 Medicare BlueEnhanced (PPO)
| $138.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3335 -015 -0 | $0.00 | $6.00 | $42.00 | $42.00 | 4,287
2021 Formulary |
|
|
|
|
2022 Medicare BlueEnhanced (PPO)
| $124.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $6.00 | $42.00 | $42.00 | 4,235 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 MVP Medicare WellSelect Plus with Part D (PPO)
| $116.00 |
$6,500 |
$0 | Yes, some additional gap coverage. |
H9615 -007 -0 | $0.00 | $10.00 | $35.00 | $35.00 | 3,471
2021 Formulary |
|
|
|
|
2022 MVP Medicare WellSelect Plus with Part D (PPO)
| $125.00 |
$6,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $35.00 | $35.00 | 3,546 2022 Formulary |
|
2021 CDPHP Choice Rx (HMO)
| $130.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3388 -002 -0 | $0.00 | $11.00 | $40.00 | $40.00 | 3,305
2021 Formulary |
|
|
|
|
2022 CDPHP Choice Rx (HMO)
| $131.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $11.00 | $40.00 | $40.00 | 3,349 2022 Formulary |
|
2021 MVP Medicare Preferred Gold with Part D (HMO-POS)
| $140.00 |
$5,800 |
$0 | Yes, some additional gap coverage. |
H3305 -021 -0 | $0.00 | $10.00 | $35.00 | $35.00 | 3,471
2021 Formulary |
|
|
|
|
2022 MVP Medicare Preferred Gold with Part D (HMO-POS)
| $140.00 |
$5,800 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $35.00 | $35.00 | 3,546 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 Today's Options Premier Plus 250A (PFFS)
| $156.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2816 -013 -0 | $0.00 | $5.00 | $35.00 | $35.00 | 3,348
2021 Formulary |
|
-- |
|
|
2022 Wellcare Premium Ultra (PFFS)
| $156.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $35.00 | $35.00 | 3,375 2022 Formulary |
|
2021 UnitedHealthcare Dual Complete (HMO D-SNP)
| $42.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3387 -010 -0 | | | | | 3,604
2021 Formulary |
|
|
|
|
-- Members will be assigned to UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP) H3387-014 --
| | | | | |
|
2021 WellCare Liberty (HMO D-SNP)
| $27.40 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H4868 -002 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,348
2021 Formulary |
|
-- |
|
|
-- Members will be assigned to Wellcare Dual Access (HMO D-SNP) H4868-004 --
| | | | | |
|
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 Fidelis Dual Advantage (HMO D-SNP)
| $22.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5599 -006 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,168
2021 Formulary |
|
|
|
|
-- Members will be assigned to Wellcare Fidelis Dual Access (HMO D-SNP) H5599-001 --
| | | | | |
|
2021 EmblemHealth VIP Part B Saver (HMO)
| $0.00 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3330 -040 -0 | $2.00 | $15.00 | $42.00 | $42.00 | 3,429
2021 Formulary |
|
-- |
|
|
-- This plan not offered in 2022 --
|
| | | | |
|
2021 EmblemHealth VIP Go (HMO-POS)
| $72.00 |
$7,550 |
$250 | No additional gap coverage, only the Donut Hole Discount |
H3330 -041 -1 | $2.00 | $15.00 | $42.00 | $42.00 | 3,429
2021 Formulary |
|
-- |
|
|
-- This plan not offered in 2022 --
|
| | | | |
|