There are 97 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 Patriot (PPO)
| $0.00 |
$4,500 |
No Rx Coverage |
H8768 -021 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
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 |
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 |
|
|
|
|
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 |
|
|
|
|
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 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 |
|
|
|
|
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 |
|
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 Value Plan (HMO)
| $0.00 |
$7,550 |
$150 | Yes, some additional gap coverage. |
H3931 -107 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Value Plan (HMO-POS)
| $0.00 |
$7,550 |
$150 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,672 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 |
|
|
|
|
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 |
|
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. | |
|
|
|
|
2022 Anthem MediBlue Access Core (Regional PPO)
| $0.00 |
$4,900 |
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 --
|
H3655 -045 -4 | | | | | |
|
|
|
|
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 |
|
2021 Anthem MediBlue Prime Select (HMO)
| $0.00 |
$3,450 |
$0 | Yes, some additional gap coverage. |
H3655 -038 -0 | $2.00 | $12.00 | $42.00 | $42.00 | 3,639
2021 Formulary |
|
|
|
|
2022 Anthem MediBlue Prime Select (HMO)
| $0.00 |
$3,450 |
$0 | Yes, some additional gap coverage. | $2.00 | $12.00 | $42.00 | $42.00 | 3,626 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H4036 -022 -0 | | | | | |
|
|
|
|
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 |
2021 CareSource Advantage Zero Premium (HMO)
| $0.00 |
$7,550 |
$150 | No additional gap coverage, only the Donut Hole Discount |
H6396 -013 -0 | $5.00 | $15.00 | $45.00 | $45.00 | 3,622
2021 Formulary |
|
|
|
|
2022 CareSource Advantage Zero Premium (HMO)
| $0.00 |
$7,550 |
$150 | 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 |
|
2021 Devoted Health Core (HMO)
| $0.00 |
$4,500 |
$0 | Yes, some additional gap coverage. |
H2697 -001 -0 | $0.00 | $0.00 | $42.00 | $42.00 | 3,173
2021 Formulary |
|
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 |
2021 Devoted Health Saver (HMO)
| $0.00 |
$6,700 |
$200 | No additional gap coverage, only the Donut Hole Discount |
H2697 -003 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,173
2021 Formulary |
|
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 |
|
|
|
|
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. | |
|
|
|
|
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 | | | | | |
|
|
|
|
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 |
|
|
|
|
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. | |
|
|
|
|
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 |
-- This plan not offered in 2021 --
|
H4497 -005 -1 | | | | | |
|
|
|
|
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 |
|
|
|
|
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 |
|
-- This plan not offered in 2021 --
|
H6723 -006 -3 | | | | | |
|
|
|
|
2022 MedMutual Advantage Signature (HMO)
| $0.00 |
$3,900 |
$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 |
-- 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 |
|
|
|
|
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. | |
|
|
|
|
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 |
2021 SummaCare Medicare Amber (HMO)
| $0.00 |
$3,450 |
No Rx Coverage |
H3660 -052 -1 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
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 |
|
|
|
|
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. | |
|
|
|
|
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 |
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 |
|
|
|
|
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 |
|
2021 WellCare Dividend (HMO)
| $0.00 |
$3,450 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5475 -032 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
|
|
|
2022 Wellcare Dividend Giveback (HMO)
| $0.00 |
$3,450 |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $37.00 | $37.00 | 3,375 2022 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2021 --
|
H0908 -005 -0 | | | | | |
|
|
|
|
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 |
|
-- This plan not offered in 2021 --
|
H0724 -007 -0 | | | | | |
|
|
|
|
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 | | | | | |
|
|
|
|
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 |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2021 WellCare Essential (HMO-POS)
| $0.00 |
$3,450 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5475 -036 -0 | $0.00 | $15.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
|
|
|
2022 Wellcare No Premium Essential (HMO-POS)
| $0.00 |
$3,450 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $37.00 | $37.00 | 3,375 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H0724 -001 -0 | | | | | |
|
|
|
|
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 |
|
-- 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 |
|
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 --
|
H0724 -005 -0 | | | | | |
|
|
|
|
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 |
|
|
|
|
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 |
|
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 |
|
|
|
|
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 |
|
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 --
|
H0908 -004 -0 | | | | | |
|
|
|
|
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 |
|
-- This plan not offered in 2021 --
|
H0724 -006 -0 | | | | | |
|
|
|
|
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 |
|
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 |
|
|
|
|
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 |
|
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 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 |
|
|
|
|
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 |
|
|
|
|
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 |
|
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 |
|
|
|
|
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 |
|
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 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 |
|
-- 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 |
|
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 Advantage (HMO)
| $21.60 |
$5,600 |
$75 | No additional gap coverage, only the Donut Hole Discount |
H6396 -011 -0 | $4.00 | $10.00 | $45.00 | $45.00 | 3,622
2021 Formulary |
|
|
|
|
2022 CareSource Advantage (HMO)
| $25.00 |
$5,600 |
$75 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $45.00 | $45.00 | 3,490 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 SummaCare Medicare Garnet (HMO)
| $29.00 |
$3,800 |
$0 | Yes, some additional gap coverage. |
H3660 -053 -1 | $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 |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2021 WellCare Extra Plus (HMO-POS D-SNP)
| $29.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5475 -035 -0 | $0.00 | $17.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
|
|
|
2022 Wellcare Dual Access Extra (HMO-POS D-SNP)
| $29.10 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $16.00 | $47.00 | $47.00 | 3,375 2022 Formulary |
|
2021 Devoted Health Prime (HMO)
| $22.80 |
$3,700 |
$150 | Yes, some additional gap coverage. |
H2697 -002 -0 | $0.00 | $0.00 | $42.00 | $42.00 | 3,173
2021 Formulary |
|
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 |
|
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 |
|
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 (HMO-POS D-SNP)
| $29.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5322 -028 -0 | | | | | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Dual Complete (HMO-POS D-SNP)
| $33.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654 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 |
|
2021 CareSource Dual Advantage (HMO D-SNP)
| $29.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H6396 -014 -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 |
|
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 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 |
|
2021 UnitedHealthcare Dual Complete LP1 (HMO D-SNP)
| $29.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H8125 -002 -0 | | | | | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Dual Complete LP1 (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 |
|
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 Valor Health Plan (HMO I-SNP)
| $29.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H1119 -001 -0 | | | | | 3,578
2021 Formulary |
|
-- |
|
|
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 |
|
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 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 |
|
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 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 |
|
2021 HumanaChoice H5216-024 (PPO)
| $75.00 |
$6,700 |
$100 | No additional gap coverage, only the Donut Hole Discount |
H5216 -024 -0 | $7.00 | $17.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
|
|
|
2022 HumanaChoice H5216-024 (PPO)
| $76.00 |
$6,700 |
$100 | 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 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 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 |
|
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 |
|
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 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 |
|
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 |
|
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 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 |
|
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 |
|
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 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 |
|
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 |
|
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 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 --
| | | | | |
|
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 |
|
|
|
|
-- Members will be assigned to Anthem MediBlue Access (PPO) H4036-025 --
| | | | | |
|
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 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 |
|
|
|
|
-- 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 |
|
|
|
|
-- Members will be assigned to Anthem MediBlue Preferred (HMO) H3655-045 --
| | | | | |
|
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 |
|
new |
|
|
-- Members will be assigned to Molina Medicare Complete Care (HMO D-SNP) H9955-001 --
| | | | | |
|
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 Bright Advantage University Hospitals (HMO)
| $0.00 |
$3,900 |
$445 | Yes, some additional gap coverage. |
H1142 -003 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,364
2021 Formulary |
|
|
|
|
-- This plan not offered in 2022 --
|
| | | | |
|
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 |
|
|
|
|
-- This plan not offered in 2022 --
|
| | | | |
|
2021 Bright Advantage University Hospitals Choice (PPO)
| $0.00 |
$5,000 |
$445 | Yes, some additional gap coverage. |
H9878 -003 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,364
2021 Formulary |
|
|
|
|
-- This plan not offered in 2022 --
|
| | | | |
|
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 Bright Advantage University Hospitals Choice Plus (PPO)
| $34.00 |
$5,000 |
$445 | Yes, some additional gap coverage. |
H9878 -008 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,364
2021 Formulary |
|
|
|
|
-- This plan not offered in 2022 --
|
| | | | |
|