See How Your 2021 Medicare Advantage Plan
is Changing in 2022
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| 2021 / 2022 Medicare Advantage Plan Information Click here to jump to the Chart Legend | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Plan Name | Monthly Premium |
Part A&B Maximum Out-Of |
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 |
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| 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 Patriot (PPO) | $0.00 | $4,500 | No Rx Coverage | H8768 -021 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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| 2022 AARP Medicare Advantage Patriot (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 |
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| 2021 AARP Medicare Advantage Plan 7 (HMO) | $0.00 | $4,500 | $175 | No additional gap coverage, only the Donut Hole Discount | H5253 -049 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,604 2021 Formulary | ||
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| 2022 AARP Medicare Advantage Plan 7 (HMO) | $0.00 | $4,500 | $175 | Yes, some additional gap coverage. | $3.00 | $12.00 | $47.00 | $47.00 | 3,654 2022 Formulary | |||
| 2021 AARP Medicare Advantage Walgreens (PPO) | $0.00 | $5,100 | $225 | No additional gap coverage, only the Donut Hole Discount | H8768 -014 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,604 2021 Formulary | ||
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| 2022 AARP Medicare Advantage Walgreens (PPO) | $0.00 | $5,100 | $225 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,654 2022 Formulary | |||
| 2021 Aetna Medicare Advantra Silver (PPO) | $0.00 | $5,900 | $150 | Yes, some additional gap coverage. | H1608 -029 -0 | $5.00 | $7.00 | $47.00 | $47.00 | 3,659 2021 Formulary | ||
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| 2022 Aetna Medicare Advantra Silver (PPO) | $0.00 | $4,900 | $0 | Yes, some additional gap coverage. | $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 |
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-- This plan not offered in 2021 -- |
H0628 -015 -0 | |||||||||||
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| 2022 Aetna Medicare Eagle (HMO) | $0.00 | $5,900 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
| 2021 Aetna Medicare Premier (HMO) | $0.00 | $5,900 | $0 | Yes, some additional gap coverage. | H0628 -005 -0 | $2.00 | $5.00 | $47.00 | $47.00 | 3,659 2021 Formulary | ||
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| 2022 Aetna Medicare Premier (HMO-POS) | $0.00 | $4,500 | $0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,698 2022 Formulary | |||
| 2021 Aetna Medicare Value Plan (PPO) | $0.00 | $5,900 | $150 | Yes, some additional gap coverage. | H5521 -088 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,659 2021 Formulary | ||
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| 2022 Aetna Medicare Value Plan (PPO) | $0.00 | $5,300 | $150 | Yes, some additional gap coverage. | $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 |
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| 2021 Anthem MediBlue Access Core (Regional PPO) | $0.00 | $4,900 | No Rx Coverage | R5941 -013 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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| 2022 Anthem MediBlue Access Core (Regional PPO) | $0.00 | $4,900 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
-- This plan not offered in 2021 -- |
H3655 -045 -4 | |||||||||||
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| 2022 Anthem MediBlue Preferred (HMO) | $0.00 | $3,800 | $0 | Yes, some additional gap coverage. | $4.00 | $10.00 | $42.00 | $42.00 | 3,626 2022 Formulary | |||
-- This plan not offered in 2021 -- |
H4036 -022 -0 | |||||||||||
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| 2022 Anthem MediBlue Service (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 |
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| 2021 CareSource Advantage Zero Premium (HMO) | $0.00 | $7,550 | $175 | No additional gap coverage, only the Donut Hole Discount | H6396 -004 -0 | $5.00 | $15.00 | $45.00 | $45.00 | 3,622 2021 Formulary | ||
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| 2022 CareSource Advantage Zero Premium (HMO) | $0.00 | $7,550 | $175 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $45.00 | $45.00 | 3,490 2022 Formulary | |||
| 2021 CareSource MyCare Ohio (Medicare-Medicaid Plan) | $0.00 | n/a | $0 | All Generics, All Brands |
H8452 -001 -0 | 3,622 2021 Formulary | ||||||
| -- | -- | -- | ||||||||||
| 2022 CareSource MyCare Ohio (Medicare-Medicaid Plan) | $0.00 | n/a | $0 | All Generics, All Brands | 3,490 2022 Formulary | |||||||
-- This plan not offered in 2021 -- |
H2697 -001 -0 | |||||||||||
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new | new | ||||||||||
| 2022 Devoted Health Core (HMO) | $0.00 | $4,200 | $0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $42.00 | $42.00 | 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 |
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-- This plan not offered in 2021 -- |
H2697 -003 -0 | |||||||||||
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new | new | ||||||||||
| 2022 Devoted Health Saver (HMO) | $0.00 | $5,900 | $200 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,349 2022 Formulary | |||
| 2021 Humana Gold Plus H6622-014 (HMO) | $0.00 | $4,300 | $0 | No additional gap coverage, only the Donut Hole Discount | H6622 -014 -0 | $2.00 | $8.00 | $47.00 | $47.00 | 3,382 2021 Formulary | ||
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| 2022 Humana Gold Plus H6622-014 (HMO) | $0.00 | $4,000 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $8.00 | $47.00 | $47.00 | 3,408 2022 Formulary | |||
| 2021 Humana Honor (PPO) | $0.00 | $6,700 | No Rx Coverage | H5216 -218 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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| 2022 Humana Honor (PPO) | $0.00 | $5,900 | 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 -- |
H5216 -285 -0 | |||||||||||
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| 2022 HumanaChoice H5216-285 (PPO) | $0.00 | $5,300 | $200 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,413 2022 Formulary | |||
| 2021 HumanaChoice H5525-042 (PPO) | $0.00 | $7,550 | $250 | No additional gap coverage, only the Donut Hole Discount | H5525 -042 -0 | $7.00 | $17.00 | $47.00 | $47.00 | 3,386 2021 Formulary | ||
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| 2022 HumanaChoice H5525-042 (PPO) | $0.00 | $7,550 | $250 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $17.00 | $47.00 | $47.00 | 3,413 2022 Formulary | |||
| 2021 HumanaChoice R5495-001 (Regional PPO) | $0.00 | $7,550 | No Rx Coverage | R5495 -001 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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| 2022 HumanaChoice R5495-001 (Regional PPO) | $0.00 | $7,550 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
| Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
| Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
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-- This plan not offered in 2021 -- |
H4497 -005 -1 | |||||||||||
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| 2022 MedMutual Advantage Access (PPO) | $0.00 | $5,400 | $0 | Yes, some additional gap coverage. | $4.00 | $8.00 | $42.00 | $42.00 | 3,224 2022 Formulary | |||
| 2021 MedMutual Advantage Classic (HMO) | $0.00 | $4,500 | $95 | Yes, some additional gap coverage. | H6723 -001 -1 | $0.00 | $15.00 | $42.00 | $42.00 | 3,622 2021 Formulary | ||
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| 2022 MedMutual Advantage Classic (HMO) | $0.00 | $4,800 | $95 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 3,490 2022 Formulary | |||
| 2021 MedMutual Advantage Signature (HMO) | $0.00 | $4,200 | $0 | Yes, some additional gap coverage. | H6723 -006 -1 | $4.00 | $15.00 | $42.00 | $42.00 | 3,396 2021 Formulary | ||
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| 2022 MedMutual Advantage Signature (HMO) | $0.00 | $4,200 | $0 | Yes, some additional gap coverage. | $4.00 | $8.00 | $42.00 | $42.00 | 3,224 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 |
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-- This plan not offered in 2021 -- |
H9955 -002 -0 | |||||||||||
|
new | new | ||||||||||
| 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 | |||
| 2021 PrimeTime Health Plan Aultimate (HMO-POS) | $0.00 | $4,500 | $200 | No additional gap coverage, only the Donut Hole Discount | H3664 -021 -0 | $0.00 | $15.00 | $42.00 | $42.00 | 3,854 2021 Formulary | ||
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| 2022 PrimeTime Health Plan Aultimate (HMO-POS) | $0.00 | $4,500 | $200 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $42.00 | $42.00 | 3,861 2022 Formulary | |||
| 2021 PrimeTime Health Plan Basic - MA Only (HMO-POS) | $0.00 | $3,400 | No Rx Coverage | H3664 -014 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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| 2022 PrimeTime Health Plan Basic - MA Only (HMO-POS) | $0.00 | $3,400 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
| Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
| Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
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| 2021 SummaCare Medicare Amber (HMO) | $0.00 | $3,450 | No Rx Coverage | H3660 -052 -1 | This plan does NOT include Prescription Drug coverage. | |||||||
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| 2022 SummaCare Medicare Amber (HMO) | $0.00 | $3,450 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
| 2021 SummaCare Medicare Topaz (HMO) | $0.00 | $3,900 | $150 | Yes, some additional gap coverage. | H3660 -050 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,560 2021 Formulary | ||
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| 2022 SummaCare Medicare Topaz (HMO) | $0.00 | $3,900 | $150 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,510 2022 Formulary | |||
| 2021 The Health Plan SecureCare - Option I, MA Only (HMO) | $0.00 | $3,900 | No Rx Coverage | H3672 -014 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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| 2022 The Health Plan SecureCare - Option I, MA Only (HMO) | $0.00 | $3,900 | 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 |
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| 2021 The Health Plan SecureCare - Option II (HMO) | $35.00 | $3,900 | $100 | No additional gap coverage, only the Donut Hole Discount | H3672 -013 -0 | $3.00 | $10.00 | $47.00 | $47.00 | 3,396 2021 Formulary | ||
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| 2022 The Health Plan SecureCare - Option II (HMO) | $0.00 | $3,900 | $100 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $10.00 | $47.00 | $47.00 | 3,224 2022 Formulary | |||
| 2021 UnitedHealthcare Connected for MyCareOhio (Medicare-Medicaid Plan) | $0.00 | n/a | $0 | All Generics, All Brands |
H2531 -001 -0 | 3,447 2021 Formulary | ||||||
| -- | -- | -- | ||||||||||
| 2022 UnitedHealthcare Connected for MyCareOhio (Medicare-Medicaid Plan) | $0.00 | n/a | $0 | All Generics, All Brands | 3,528 2022 Formulary | |||||||
-- This plan not offered in 2021 -- |
H0908 -005 -0 | |||||||||||
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| 2022 Wellcare Giveback (HMO) | $0.00 | $5,500 | $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 |
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| 2021 Allwell Medicare Boost (HMO) | $0.00 | $7,550 | $75 | Yes, some additional gap coverage. | H0724 -007 -0 | $0.00 | $9.00 | $37.00 | $37.00 | 3,370 2021 Formulary | ||
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| 2022 Wellcare Giveback Boost (HMO) | $0.00 | $7,550 | $75 | Yes, some additional gap coverage. | $0.00 | $9.00 | $37.00 | $37.00 | 3,375 2022 Formulary | |||
-- This plan not offered in 2021 -- |
H0908 -003 -0 | |||||||||||
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| 2022 Wellcare No Premium (HMO) | $0.00 | $3,450 | $75 | Yes, some additional gap coverage. | $0.00 | $9.00 | $37.00 | $37.00 | 3,375 2022 Formulary | |||
| 2021 Allwell Medicare (HMO) | $0.00 | $4,700 | $75 | Yes, some additional gap coverage. | H0724 -001 -0 | $0.00 | $9.00 | $37.00 | $37.00 | 3,370 2021 Formulary | ||
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| 2022 Wellcare No Premium Medicare (HMO) | $0.00 | $3,450 | $75 | Yes, some additional gap coverage. | $0.00 | $9.00 | $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 |
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-- This plan not offered in 2021 -- |
H7169 -001 -0 | |||||||||||
| new | new | new | ||||||||||
| 2022 Wellcare No Premium Open (PPO) | $0.00 | $5,900 | $160 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $7.00 | $37.00 | $37.00 | 3,375 2022 Formulary | |||
| 2021 Allwell Medicare Essentials (HMO) | $0.00 | $3,450 | No Rx Coverage | H0724 -005 -0 | This plan does NOT include Prescription Drug coverage. | |||||||
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| 2022 Wellcare Patriot No Premium (HMO) | $0.00 | $3,450 | No Rx Coverage | This plan does NOT include Prescription Drug coverage. | ||||||||
| 2021 HumanaChoice H5216-106 (PPO) | $15.00 | $3,900 | $125 | No additional gap coverage, only the Donut Hole Discount | H5216 -106 -0 | $2.00 | $8.00 | $47.00 | $47.00 | 3,386 2021 Formulary | ||
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| 2022 HumanaChoice H5216-106 (PPO) | $15.00 | $3,900 | $0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $8.00 | $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 Gold Plus - Diabetes and Heart (HMO C-SNP) | $15.00 | n/a | $200 | No additional gap coverage, only the Donut Hole Discount | H6622 -017 -0 | $7.00 | $17.00 | $47.00 | $47.00 | 3,382 2021 Formulary | ||
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| 2022 Humana Gold Plus - Diabetes and Heart (HMO C-SNP) | $16.00 | n/a | $200 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $17.00 | $47.00 | $47.00 | 3,408 2022 Formulary | |||
-- This plan not offered in 2021 -- |
H0908 -004 -0 | |||||||||||
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| 2022 Wellcare Assist (HMO) | $16.80 | $4,700 | $480 | Yes, some additional gap coverage. | $0.00 | $20.00 | $47.00 | $47.00 | 3,375 2022 Formulary | |||
| 2021 Allwell Medicare Complement (HMO) | $9.60 | $3,450 | $445 | Yes, some additional gap coverage. | H0724 -006 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,352 2021 Formulary | ||
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| 2022 Wellcare Assist Complement (HMO) | $17.60 | $3,450 | $480 | Yes, some additional gap coverage. | $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 AARP Medicare Advantage Plan 1 (HMO) | $21.00 | $3,900 | $150 | Yes, some additional gap coverage. | H5253 -050 -0 | $2.00 | $8.00 | $45.00 | $45.00 | 3,604 2021 Formulary | ||
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| 2022 AARP Medicare Advantage Plan 1 (HMO) | $19.00 | $4,200 | $0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $45.00 | $45.00 | 3,654 2022 Formulary | |||
| 2021 Anthem MediBlue Preferred Plus (HMO) | $19.00 | $3,650 | $0 | Yes, some additional gap coverage. | H3655 -042 -0 | $4.00 | $10.00 | $42.00 | $42.00 | 3,639 2021 Formulary | ||
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| 2022 Anthem MediBlue Preferred Plus (HMO) | $19.00 | $3,650 | $0 | Yes, some additional gap coverage. | $4.00 | $10.00 | $42.00 | $42.00 | 3,626 2022 Formulary | |||
| 2021 Humana Gold Plus H6622-070 (HMO) | $20.00 | $3,950 | $0 | No additional gap coverage, only the Donut Hole Discount | H6622 -070 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,382 2021 Formulary | ||
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| 2022 Humana Gold Plus H6622-070 (HMO) | $21.00 | $3,950 | $0 | No additional gap coverage, only the Donut Hole Discount | $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 Anthem MediBlue Extra (HMO) | $25.30 | $7,550 | $445 | Yes, some additional gap coverage. | H3655 -041 -0 | $0.00 | $7.00 | $47.00 | $47.00 | 3,639 2021 Formulary | ||
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||||||||||
| 2022 Anthem MediBlue Extra (HMO) | $22.00 | $7,550 | $480 | Yes, some additional gap coverage. | $0.00 | $7.00 | $47.00 | $47.00 | 3,626 2022 Formulary | |||
| 2021 MedMutual Advantage Secure (HMO) | $20.00 | $3,500 | $95 | Yes, some additional gap coverage. | H6723 -005 -1 | $0.00 | $15.00 | $42.00 | $42.00 | 3,622 2021 Formulary | ||
|
|
|
||||||||||
| 2022 MedMutual Advantage Secure (HMO) | $22.00 | $3,500 | $95 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 3,490 2022 Formulary | |||
| 2021 Aetna Medicare Assure 1 (HMO D-SNP) | $26.20 | n/a | $220 | No additional gap coverage, only the Donut Hole Discount | H0628 -013 -0 | $0.00 | $0.00 | 25% | 25% | 3,659 2021 Formulary | ||
|
|
|
||||||||||
| 2022 Aetna Medicare Assure 1 (HMO D-SNP) | $23.20 | n/a | $480 | 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 -- |
H5253 -115 -0 | |||||||||||
|
|
|
||||||||||
| 2022 AARP Medicare Advantage Plan 8 (HMO) | $25.00 | $3,900 | $0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,654 2022 Formulary | |||
| 2021 Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP) | $29.80 | n/a | $420 | No additional gap coverage, only the Donut Hole Discount | H6622 -015 -0 | $2.00 | $13.00 | $47.00 | $47.00 | 3,382 2021 Formulary | ||
|
|
|
||||||||||
| 2022 Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP) | $27.60 | n/a | $480 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $18.00 | $47.00 | $47.00 | 3,408 2022 Formulary | |||
| 2021 Perennial Advantage Strive (HMO I-SNP) | $29.80 | n/a | $445 | No additional gap coverage, only the Donut Hole Discount | H8797 -001 -0 | n/a | ||||||
|
new | new | ||||||||||
| 2022 Perennial Advantage Strive (HMO I-SNP) | $28.20 | n/a | $480 | No additional gap coverage, only the Donut Hole Discount | 3,712 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 SummaCare Medicare Garnet (HMO) | $29.00 | $3,800 | $0 | Yes, some additional gap coverage. | H3660 -053 -2 | $0.00 | $8.00 | $44.00 | $44.00 | 3,560 2021 Formulary | ||
|
|
|
||||||||||
| 2022 SummaCare Medicare Garnet (HMO) | $29.00 | $3,800 | $0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $44.00 | $44.00 | 3,510 2022 Formulary | |||
| 2021 CareSource Advantage (HMO) | $26.60 | $7,550 | $100 | No additional gap coverage, only the Donut Hole Discount | H6396 -001 -0 | $4.00 | $10.00 | $45.00 | $45.00 | 3,622 2021 Formulary | ||
|
|
|
||||||||||
| 2022 CareSource Advantage (HMO) | $30.00 | $7,550 | $100 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $45.00 | $45.00 | 3,490 2022 Formulary | |||
-- This plan not offered in 2021 -- |
H2697 -002 -0 | |||||||||||
|
new | new | ||||||||||
| 2022 Devoted Health Prime (HMO) | $31.00 | $4,100 | $0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $42.00 | $42.00 | 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 Perennial Advantage Concierge (HMO C-SNP) | $29.80 | n/a | $445 | No additional gap coverage, only the Donut Hole Discount | H8797 -002 -0 | $2.00 | $15.00 | $45.00 | $45.00 | n/a | ||
|
new | new | ||||||||||
| 2022 Perennial Advantage Concierge (HMO C-SNP) | $31.30 | n/a | $480 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $45.00 | $45.00 | 3,860 2022 Formulary | |||
| 2021 Allwell Dual Medicare (HMO D-SNP) | $21.10 | n/a | $150 | Yes, some additional gap coverage. | H0908 -001 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,352 2021 Formulary | ||
|
|
|
||||||||||
| 2022 Wellcare Dual Access (HMO D-SNP) | $32.00 | n/a | $480 | Some Generics | $0.00 | $9.00 | $40.00 | $40.00 | 3,375 2022 Formulary | |||
| 2021 Anthem MediBlue Dual Advantage (HMO D-SNP) | $29.80 | n/a | $445 | Yes, some additional gap coverage. | H3655 -033 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,639 2021 Formulary | ||
|
|
|
||||||||||
| 2022 Anthem MediBlue Dual Advantage (HMO D-SNP) | $33.50 | n/a | $480 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $20.00 | $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 CareSource Dual Advantage (HMO D-SNP) | $29.80 | n/a | $445 | No additional gap coverage, only the Donut Hole Discount | H6396 -005 -0 | 25% | 25% | 25% | 25% | 3,622 2021 Formulary | ||
|
|
|
||||||||||
| 2022 CareSource Dual Advantage (HMO D-SNP) | $33.50 | n/a | $480 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,490 2022 Formulary | |||
| 2021 CommuniCare Advantage ISNP (HMO I-SNP) | $27.20 | n/a | $445 | No additional gap coverage, only the Donut Hole Discount | H3727 -002 -3 | n/a | ||||||
|
new | new | ||||||||||
| 2022 CommuniCare Advantage ISNP (HMO I-SNP) | $33.50 | n/a | $480 | No additional gap coverage, only the Donut Hole Discount | 3,497 2022 Formulary | |||||||
| 2021 Molina Medicare Complete Care (HMO D-SNP) | $29.80 | n/a | $445 | No additional gap coverage, only the Donut Hole Discount | H9955 -001 -0 | $0.00 | $4.00 | $44.00 | $44.00 | 3,245 2021 Formulary | ||
|
new | new | ||||||||||
| 2022 Molina Medicare Complete Care (HMO D-SNP) | $33.50 | n/a | $480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $4.00 | $44.00 | $44.00 | 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 UnitedHealthcare Dual Complete LP (HMO D-SNP) | $29.80 | n/a | $445 | No additional gap coverage, only the Donut Hole Discount | H5253 -059 -0 | 3,604 2021 Formulary | ||||||
|
|
|
||||||||||
| 2022 UnitedHealthcare Dual Complete LP (HMO D-SNP) | $33.50 | n/a | $480 | No additional gap coverage, only the Donut Hole Discount | 3,654 2022 Formulary | |||||||
| 2021 UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP) | $29.80 | n/a | $445 | No additional gap coverage, only the Donut Hole Discount | H0710 -027 -0 | 3,604 2021 Formulary | ||||||
|
-- | |
||||||||||
| 2022 UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP) | $33.50 | n/a | $480 | No additional gap coverage, only the Donut Hole Discount | 3,654 2022 Formulary | |||||||
-- This plan not offered in 2021 -- |
H1119 -001 -0 | |||||||||||
|
-- | |
||||||||||
| 2022 Valor Health Plan (HMO I-SNP) | $33.50 | n/a | $480 | No additional gap coverage, only the Donut Hole Discount | 3,497 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) | $22.20 | n/a | $445 | No additional gap coverage, only the Donut Hole Discount | H5322 -001 -0 | 3,604 2021 Formulary | ||||||
|
|
|
||||||||||
| 2022 UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP) | $33.90 | n/a | $480 | No additional gap coverage, only the Donut Hole Discount | 3,654 2022 Formulary | |||||||
| 2021 PrimeTime Health Plan Classic (HMO-POS) | $39.00 | $4,200 | $150 | No additional gap coverage, only the Donut Hole Discount | H3664 -020 -0 | $0.00 | $8.00 | $42.00 | $42.00 | 3,854 2021 Formulary | ||
|
|
|
||||||||||
| 2022 PrimeTime Health Plan Classic (HMO-POS) | $39.00 | $4,200 | $150 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $8.00 | $42.00 | $42.00 | 3,861 2022 Formulary | |||
| 2021 MedMutual Advantage Choice (HMO) | $34.00 | $4,000 | $55 | Yes, some additional gap coverage. | H6723 -002 -1 | $0.00 | $10.00 | $42.00 | $42.00 | 3,622 2021 Formulary | ||
|
|
|
||||||||||
| 2022 MedMutual Advantage Choice (HMO) | $40.00 | $4,300 | $55 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 3,490 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 The Health Plan SecureCare SNP (HMO D-SNP) | $37.00 | n/a | $445 | No additional gap coverage, only the Donut Hole Discount | H3672 -019 -0 | 3,396 2021 Formulary | ||||||
|
|
|
||||||||||
| 2022 The Health Plan SecureCare SNP (HMO D-SNP) | $40.40 | n/a | $480 | No additional gap coverage, only the Donut Hole Discount | 3,224 2022 Formulary | |||||||
| 2021 SummaCare Medicare Ruby (HMO) | $43.00 | $3,600 | $0 | Yes, some additional gap coverage. | H3660 -044 -0 | $0.00 | $8.00 | $44.00 | $44.00 | 3,560 2021 Formulary | ||
|
|
|
||||||||||
| 2022 SummaCare Medicare Ruby (HMO) | $43.00 | $3,700 | $0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $44.00 | $44.00 | 3,510 2022 Formulary | |||
| 2021 HumanaChoice H5216-051 (PPO) | $43.00 | $6,300 | $0 | No additional gap coverage, only the Donut Hole Discount | H5216 -051 -0 | $7.00 | $17.00 | $47.00 | $47.00 | 3,386 2021 Formulary | ||
|
|
|
||||||||||
| 2022 HumanaChoice H5216-051 (PPO) | $44.00 | $6,300 | $0 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $17.00 | $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 MedMutual Advantage Select (PPO) | $38.00 | $5,900 | $95 | Yes, some additional gap coverage. | H4497 -001 -1 | $0.00 | $15.00 | $42.00 | $42.00 | 3,622 2021 Formulary | ||
|
|
|
||||||||||
| 2022 MedMutual Advantage Select (PPO) | $44.00 | $5,900 | $95 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 3,490 2022 Formulary | |||
| 2021 Anthem MediBlue Plus (HMO) | $55.00 | $4,100 | $0 | Yes, some additional gap coverage. | H3655 -034 -0 | $2.00 | $10.00 | $37.00 | $37.00 | 3,639 2021 Formulary | ||
|
|
|
||||||||||
| 2022 Anthem MediBlue Plus (HMO) | $55.00 | $4,100 | $0 | Yes, some additional gap coverage. | $2.00 | $10.00 | $37.00 | $37.00 | 3,626 2022 Formulary | |||
-- This plan not offered in 2021 -- |
H4036 -025 -0 | |||||||||||
|
|
|
||||||||||
| 2022 Anthem MediBlue Access (PPO) | $56.00 | $5,500 | $0 | Yes, some additional gap coverage. | $4.00 | $15.00 | $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 SummaCare Medicare Sapphire (HMO-POS) | $76.00 | $3,600 | $0 | Yes, some additional gap coverage. | H3660 -029 -0 | $0.00 | $8.00 | $44.00 | $44.00 | 3,560 2021 Formulary | ||
|
|
|
||||||||||
| 2022 SummaCare Medicare Sapphire (HMO-POS) | $76.00 | $3,600 | $0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $44.00 | $44.00 | 3,510 2022 Formulary | |||
| 2021 MedMutual Advantage Preferred (PPO) | $74.00 | $5,700 | $55 | Yes, some additional gap coverage. | H4497 -002 -1 | $0.00 | $10.00 | $42.00 | $42.00 | 3,622 2021 Formulary | ||
|
|
|
||||||||||
| 2022 MedMutual Advantage Preferred (PPO) | $80.00 | $5,700 | $55 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 3,490 2022 Formulary | |||
| 2021 Anthem MediBlue Access Basic (Regional PPO) | $83.00 | $6,000 | $200 | Yes, some additional gap coverage. | R5941 -014 -0 | $6.00 | $15.00 | $42.00 | $42.00 | 3,639 2021 Formulary | ||
|
|
|
||||||||||
| 2022 Anthem MediBlue Access Basic (Regional PPO) | $83.00 | $6,000 | $200 | Yes, some additional gap coverage. | $6.00 | $15.00 | $42.00 | $42.00 | 3,635 2022 Formulary | |||
| Plan Name | Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing | Total Drugs | |||||
| Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
||||||
| 2021 Humana Gold Choice H8145-032 (PFFS) | $82.00 | n/a | $225 | No additional gap coverage, only the Donut Hole Discount | H8145 -032 -0 | $7.00 | $17.00 | $47.00 | $47.00 | 3,386 2021 Formulary | ||
|
|
|
||||||||||
| 2022 Humana Gold Choice H8145-032 (PFFS) | $83.00 | n/a | $225 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $17.00 | $47.00 | $47.00 | 3,413 2022 Formulary | |||
| 2021 PrimeTime Health Plan Plus (HMO-POS) | $89.00 | $3,900 | $100 | No additional gap coverage, only the Donut Hole Discount | H3664 -017 -0 | $0.00 | $6.00 | $42.00 | $42.00 | 3,854 2021 Formulary | ||
|
|
|
||||||||||
| 2022 PrimeTime Health Plan Plus (HMO-POS) | $89.00 | $3,900 | $100 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $8.00 | $42.00 | $42.00 | 3,861 2022 Formulary | |||
| 2021 Humana Gold Plus H6622-019 (HMO) | $90.00 | $3,900 | $125 | No additional gap coverage, only the Donut Hole Discount | H6622 -019 -0 | $1.00 | $4.00 | $47.00 | $47.00 | 3,382 2021 Formulary | ||
|
|
|
||||||||||
| 2022 Humana Gold Plus H6622-019 (HMO) | $91.00 | $3,900 | $125 | No additional gap coverage, only the Donut Hole Discount | $1.00 | $4.00 | $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 MedMutual Advantage Plus (HMO) | $95.00 | $3,450 | $55 | Yes, some additional gap coverage. | H6723 -003 -1 | $0.00 | $10.00 | $42.00 | $42.00 | 3,622 2021 Formulary | ||
|
|
|
||||||||||
| 2022 MedMutual Advantage Plus (HMO) | $97.00 | $3,450 | $55 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 3,490 2022 Formulary | |||
| 2021 The Health Plan SecureChoice - Option II (PPO) | $79.00 | $6,700 | $100 | No additional gap coverage, only the Donut Hole Discount | H8604 -010 -0 | $3.00 | $10.00 | $47.00 | $47.00 | 3,396 2021 Formulary | ||
|
|
|
||||||||||
| 2022 The Health Plan SecureChoice - Option II (PPO) | $100.00 | $6,700 | $100 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $10.00 | $47.00 | $47.00 | 3,224 2022 Formulary | |||
| 2021 AARP Medicare Advantage Plan 3 (HMO) | $111.00 | $3,400 | $0 | Yes, some additional gap coverage. | H5253 -051 -0 | $0.00 | $8.00 | $45.00 | $45.00 | 3,604 2021 Formulary | ||
|
|
|
||||||||||
| 2022 AARP Medicare Advantage Plan 3 (HMO) | $111.00 | $3,400 | $0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $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 HumanaChoice R5495-002 (Regional PPO) | $99.00 | $6,700 | $380 | No additional gap coverage, only the Donut Hole Discount | R5495 -002 -0 | $16.00 | $19.00 | $47.00 | $47.00 | 3,386 2021 Formulary | ||
|
|
|
||||||||||
| 2022 HumanaChoice R5495-002 (Regional PPO) | $114.00 | $6,700 | $480 | No additional gap coverage, only the Donut Hole Discount | $16.00 | $20.00 | 17% | 17% | 3,421 2022 Formulary | |||
| 2021 Aetna Medicare Premier 2 (PPO) | $124.00 | $4,800 | $0 | Yes, some additional gap coverage. | H5521 -020 -0 | $2.00 | $5.00 | $47.00 | $47.00 | 3,659 2021 Formulary | ||
|
|
|
||||||||||
| 2022 Aetna Medicare Premier 2 (PPO) | $118.00 | $4,800 | $0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,672 2022 Formulary | |||
| 2021 MedMutual Advantage Premium (PPO) | $128.00 | $3,450 | $55 | Yes, some additional gap coverage. | H4497 -003 -1 | $0.00 | $10.00 | $42.00 | $42.00 | 3,622 2021 Formulary | ||
|
|
|
||||||||||
| 2022 MedMutual Advantage Premium (PPO) | $134.00 | $3,450 | $55 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 3,490 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 1 (PPO) | $140.00 | $6,100 | $150 | Yes, some additional gap coverage. | H5521 -134 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,659 2021 Formulary | ||
|
|
|
||||||||||
| 2022 Aetna Medicare Premier 1 (PPO) | $149.00 | $5,500 | $150 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,672 2022 Formulary | |||
| 2021 HumanaChoice H5525-030 (PPO) | $155.00 | $3,400 | $100 | No additional gap coverage, only the Donut Hole Discount | H5525 -030 -0 | $1.00 | $4.00 | $47.00 | $47.00 | 3,386 2021 Formulary | ||
|
|
|
||||||||||
| 2022 HumanaChoice H5525-030 (PPO) | $151.00 | $3,400 | $100 | No additional gap coverage, only the Donut Hole Discount | $1.00 | $4.00 | $47.00 | $47.00 | 3,413 2022 Formulary | |||
| 2021 Aetna Medicare Premier Plus 2 (Regional PPO) | $199.00 | $5,100 | $190 | No additional gap coverage, only the Donut Hole Discount | R6694 -005 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,659 2021 Formulary | ||
|
|
|
||||||||||
| 2022 Aetna Medicare Premier Plus 2 (Regional PPO) | $179.00 | $5,100 | $260 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,680 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 SummaCare Medicare Emerald (HMO-POS) | $180.00 | $3,400 | $0 | Yes, some additional gap coverage. | H3660 -028 -0 | $0.00 | $8.00 | $39.00 | $39.00 | 3,560 2021 Formulary | ||
|
|
|
||||||||||
| 2022 SummaCare Medicare Emerald (HMO-POS) | $180.00 | $3,400 | $0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $39.00 | $39.00 | 3,510 2022 Formulary | |||
| 2021 Aetna Medicare Premier Plus 1 (Regional PPO) | $225.00 | $4,900 | $0 | Yes, some additional gap coverage. | R6694 -003 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,659 2021 Formulary | ||
|
|
|
||||||||||
| 2022 Aetna Medicare Premier Plus 1 (Regional PPO) | $217.00 | $4,900 | $0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $42.00 | $42.00 | 3,706 2022 Formulary | |||
| 2021 Aetna Medicare Assure (HMO D-SNP) | $27.50 | n/a | $130 | No additional gap coverage, only the Donut Hole Discount | H5337 -001 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,659 2021 Formulary | ||
-- Members will be assigned to Aetna Medicare Assure 1 (HMO D-SNP) H0628-013 -- | ||||||||||||
| 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 |
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| 2021 Anthem MediBlue Access (PPO) | $65.00 | $4,900 | $0 | Yes, some additional gap coverage. | H4036 -010 -2 | $4.00 | $15.00 | $42.00 | $42.00 | 3,639 2021 Formulary | ||
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-- Members will be assigned to Anthem MediBlue Access (PPO) H4036-025 -- | ||||||||||||
| 2021 Anthem MediBlue Essential (HMO) | $0.00 | $4,900 | $60 | Yes, some additional gap coverage. | H3655 -032 -0 | $4.00 | $15.00 | $42.00 | $42.00 | 3,639 2021 Formulary | ||
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-- Members will be assigned to Anthem MediBlue Preferred (HMO) H3655-045 -- | ||||||||||||
| 2021 Anthem MediBlue Preferred (HMO) | $0.00 | $4,200 | $0 | Yes, some additional gap coverage. | H3655 -040 -0 | $4.00 | $10.00 | $42.00 | $42.00 | 3,639 2021 Formulary | ||
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-- Members will be assigned to Anthem MediBlue Preferred (HMO) H3655-045 -- | ||||||||||||
| 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 |
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| 2021 Molina Medicare Complete Care (HMO D-SNP) | $29.80 | n/a | $445 | No additional gap coverage, only the Donut Hole Discount | H8176 -002 -0 | $0.00 | $4.00 | $44.00 | $44.00 | 3,245 2021 Formulary | ||
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new | |
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-- Members will be assigned to Molina Medicare Complete Care (HMO D-SNP) H9955-001 -- | ||||||||||||
| 2021 Bright Advantage (HMO) | $0.00 | $5,500 | $0 | Yes, some additional gap coverage. | H1142 -001 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,364 2021 Formulary | ||
-- This plan not offered in 2022 -- |
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| 2021 Bright Advantage Plus (HMO) | $33.00 | $3,800 | $0 | Yes, some additional gap coverage. | H1142 -002 -0 | $0.00 | $8.00 | $47.00 | $47.00 | 3,364 2021 Formulary | ||
-- This plan not offered in 2022 -- |
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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 |
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| 2021 Bright Advantage Choice (PPO) | $0.00 | $5,000 | $50 | Yes, some additional gap coverage. | H9878 -001 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,364 2021 Formulary | ||
-- This plan not offered in 2022 -- |
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| 2021 Bright Advantage Choice Plus (PPO) | $49.00 | |||||||||||
