There are 62 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. | |
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|
|
|
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. | |
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|
|
|
2022 Lasso Healthcare Growth Plus (MSA)
| $0.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 Aetna Medicare Advantra Credit Value (PPO)
| $0.00 |
$7,550 |
$250 | Yes, some additional gap coverage. |
H5522 -017 -0 | $3.00 | $7.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
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|
|
|
2022 Aetna Medicare Advantra Credit Value (PPO)
| $0.00 |
$7,550 |
$250 | Yes, some additional gap coverage. | $3.00 | $7.00 | $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 Advantra Eagle (HMO)
| $0.00 |
$4,000 |
No Rx Coverage |
H3959 -041 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Aetna Medicare Advantra Eagle (HMO)
| $0.00 |
$4,000 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 Aetna Medicare Advantra Gold (HMO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H3959 -037 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
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|
|
|
2022 Aetna Medicare Advantra Gold (HMO-POS)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 Aetna Medicare Advantra Silver (PPO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H5522 -004 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
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|
|
|
2022 Aetna Medicare Advantra Silver (PPO)
| $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 Aetna Medicare Value (PPO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H5521 -263 -0 | $2.00 | $5.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Value (PPO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $2.00 | $5.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 BlueJourney Essential (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3962 -007 -0 | $0.00 | $5.00 | $40.00 | $40.00 | 3,471
2021 Formulary |
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|
|
|
2022 BlueJourney Essential (HMO)
| $0.00 |
$7,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $40.00 | $40.00 | 3,532 2022 Formulary |
|
2021 BlueJourney Select (PPO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3923 -028 -0 | $8.00 | $12.00 | $40.00 | $40.00 | 2,744
2021 Formulary |
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2022 BlueJourney Select (PPO)
| $0.00 |
$7,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $40.00 | $40.00 | 2,799 2022 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2021 Community Blue Medicare PPO Signature (PPO)
| $0.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3916 -037 -3 | $0.00 | $5.00 | $47.00 | $47.00 | 3,586
2021 Formulary |
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|
|
2022 Community Blue Medicare PPO Signature (PPO)
| $0.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $47.00 | $47.00 | 3,533 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H3954 -156 -21 | | | | | |
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2022 Geisinger Gold Classic Advantage (HMO)
| $0.00 |
$3,450 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2021 --
|
H3954 -161 -0 | | | | | |
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2022 Geisinger Gold Classic Essential Rx (HMO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $3.00 | $20.00 | $47.00 | $47.00 | 3,877 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 --
|
H3924 -065 -0 | | | | | |
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2022 Geisinger Gold Preferred Complete Rx (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $3.00 | $20.00 | $47.00 | $47.00 | 3,877 2022 Formulary |
|
2021 Humana Gold Choice H8145-055 (PFFS)
| $7.00 |
n/a |
No Rx Coverage |
H8145 -055 -0 | This plan does NOT include Prescription Drug coverage. | |
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2022 Humana Gold Choice H8145-055 (PFFS)
| $0.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 Humana Honor (PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
H5216 -221 -0 | This plan does NOT include Prescription Drug coverage. | |
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2022 Humana Honor (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 HumanaChoice H5216-116 (PPO)
| $0.00 |
$3,900 |
No Rx Coverage |
H5216 -116 -0 | This plan does NOT include Prescription Drug coverage. | |
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2022 HumanaChoice H5216-116 (PPO)
| $0.00 |
$3,900 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2021 --
|
H5525 -051 -1 | | | | | |
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|
|
2022 HumanaChoice H5525-051 (PPO)
| $0.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $15.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 HumanaChoice R0923-001 (Regional PPO)
| $0.00 |
$4,900 |
No Rx Coverage |
R0923 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
|
|
2022 HumanaChoice R0923-001 (Regional 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 UPMC for Life HMO No Rx (HMO)
| $0.00 |
$7,550 |
No Rx Coverage |
H3907 -002 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
|
|
2022 UPMC for Life HMO No Rx (HMO)
| $0.00 |
$7,550 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2021 --
|
H5533 -010 -0 | | | | | |
|
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|
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2022 UPMC for Life PPO Flex Rx (PPO)
| $0.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,703 2022 Formulary |
|
2021 Vibra Essential Advocate (PPO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H9408 -006 -2 | $0.00 | $0.00 | $40.00 | $40.00 | 3,450
2021 Formulary |
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|
|
2022 Vibra Essential Advocate (PPO)
| $0.00 |
$7,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $40.00 | $40.00 | 3,495 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 H8145-052 (PFFS)
| $8.00 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H8145 -052 -0 | $7.00 | $17.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
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|
|
|
2022 Humana Gold Choice H8145-052 (PFFS)
| $7.00 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $17.00 | $47.00 | $47.00 | 3,413 2022 Formulary |
|
2021 Aetna Medicare Advantra Premier (HMO)
| $25.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H3959 -039 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Advantra Premier (HMO-POS)
| $17.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,698 2022 Formulary |
|
2021 UPMC for Life HMO Deductible with Rx (HMO)
| $22.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3907 -037 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,574
2021 Formulary |
|
|
|
|
2022 UPMC for Life HMO Deductible Rx (HMO)
| $22.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,703 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 --
|
H3959 -036 -0 | | | | | |
|
|
|
|
2022 Aetna Medicare Advantra Cares (HMO D-SNP)
| $22.10 |
n/a |
$375 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 Community Blue Medicare PPO Distinct (PPO)
| $35.00 |
$6,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3916 -034 -4 | $0.00 | $5.00 | $47.00 | $47.00 | 3,586
2021 Formulary |
|
|
|
|
2022 Community Blue Medicare PPO Distinct (PPO)
| $25.00 |
$6,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $47.00 | $47.00 | 3,533 2022 Formulary |
|
2021 Vibra Health Plan Enhanced Complete (PPO)
| $26.00 |
$5,800 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H9408 -005 -0 | $0.00 | $0.00 | $40.00 | $40.00 | 3,450
2021 Formulary |
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|
|
|
2022 Vibra Health Plan Enhanced Complete (PPO)
| $27.00 |
$6,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $40.00 | $40.00 | 3,495 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 D-SNP)
| $30.10 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3113 -009 -0 | | | | | 3,604
2021 Formulary |
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|
|
|
2022 UnitedHealthcare Dual Complete (HMO D-SNP)
| $33.90 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654 2022 Formulary |
|
2021 UPMC for Life PPO High Deductible with Rx (PPO)
| $35.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5533 -003 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,574
2021 Formulary |
|
|
|
|
2022 UPMC for Life PPO High Deductible Rx (PPO)
| $35.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,703 2022 Formulary |
|
2021 Humana Value Plus H5216-117 (PPO)
| $26.90 |
$6,700 |
$420 | No additional gap coverage, only the Donut Hole Discount |
H5216 -117 -0 | $1.00 | $20.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
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|
|
|
2022 Humana Value Plus H5216-117 (PPO)
| $36.50 |
$6,700 |
$480 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $20.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2021 Geisinger Gold Classic Complete Rx (HMO)
| $38.00 |
$4,900 |
$0 | Yes, some additional gap coverage. |
H3954 -158 -14 | $3.00 | $20.00 | $47.00 | $47.00 | 3,838
2021 Formulary |
|
|
|
|
2022 Geisinger Gold Classic Complete Rx (HMO)
| $38.00 |
$4,900 |
$0 | Yes, some additional gap coverage. | $3.00 | $20.00 | $47.00 | $47.00 | 3,877 2022 Formulary |
|
2021 UPMC for Life HMO Rx Choice (HMO)
| $40.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3907 -049 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,574
2021 Formulary |
|
|
|
|
2022 UPMC for Life HMO Rx Choice (HMO)
| $38.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,703 2022 Formulary |
|
2021 AmeriHealth Caritas VIP Care (HMO D-SNP)
| $37.40 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H4227 -002 -0 | $5.00 | 25% | | | 3,407
2021 Formulary |
|
|
|
|
2022 AmeriHealth Caritas VIP Care (HMO D-SNP)
| $40.70 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $6.50 | 25% | | | 3,477 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 Geisinger Gold Secure Rx (HMO D-SNP)
| $37.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3954 -097 -0 | | | | | 3,838
2021 Formulary |
|
|
|
|
2022 Geisinger Gold Secure Rx (HMO D-SNP)
| $40.70 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,877 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H3113 -014 -0 | | | | | |
|
|
|
|
2022 UnitedHealthcare Dual Complete Select (HMO D-SNP)
| $40.70 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654 2022 Formulary |
|
2021 UPMC for Life Complete Care (HMO D-SNP)
| $37.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H4279 -001 -0 | $5.00 | $10.00 | $18.00 | $18.00 | 3,547
2021 Formulary |
|
|
|
|
2022 UPMC for Life Complete Care (HMO D-SNP)
| $40.70 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $10.00 | $25.00 | $25.00 | 3,703 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 Geisinger Gold Preferred Enhanced Rx (PPO)
| $45.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H3924 -062 -22 | $0.00 | $5.00 | $47.00 | $47.00 | 3,838
2021 Formulary |
|
|
|
|
2022 Geisinger Gold Preferred Enhanced Rx (PPO)
| $45.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,877 2022 Formulary |
|
2021 Aetna Medicare Advantra Premier Plus (PPO)
| $47.00 |
$4,900 |
$0 | Yes, some additional gap coverage. |
H5522 -002 -0 | $0.00 | $0.00 | $37.00 | $37.00 | 3,679
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Advantra Premier Plus (PPO)
| $48.00 |
$4,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $37.00 | $37.00 | 3,698 2022 Formulary |
|
2021 BlueJourney Classic (PPO)
| $49.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3923 -013 -0 | $0.00 | $5.00 | $40.00 | $40.00 | 3,471
2021 Formulary |
|
|
|
|
2022 BlueJourney Classic (PPO)
| $50.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $40.00 | $40.00 | 3,532 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 H5525-007 (PPO)
| $54.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5525 -007 -0 | $5.00 | $15.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
|
|
|
2022 HumanaChoice H5525-007 (PPO)
| $55.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 BlueJourney Value (HMO)
| $51.00 |
$4,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3962 -004 -0 | $0.00 | $5.00 | $40.00 | $40.00 | 3,471
2021 Formulary |
|
|
|
|
2022 BlueJourney Value (HMO)
| $60.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $40.00 | $40.00 | 3,532 2022 Formulary |
|
2021 Aetna Medicare Silver (HMO)
| $69.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H3931 -070 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Silver (HMO)
| $65.00 |
$7,550 |
$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 |
2021 Freedom Blue PPO Basic (PPO)
| $66.00 |
$5,900 |
No Rx Coverage |
H3916 -012 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Freedom Blue PPO Basic (PPO)
| $65.00 |
$5,900 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 Freedom Blue PPO ValueRx (PPO)
| $70.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3916 -018 -0 | $0.00 | $13.00 | $45.00 | $45.00 | 3,586
2021 Formulary |
|
|
|
|
2022 Freedom Blue PPO ValueRx (PPO)
| $69.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $13.00 | $45.00 | $45.00 | 3,533 2022 Formulary |
|
2021 HumanaChoice R0923-002 (Regional PPO)
| $63.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
R0923 -002 -0 | $6.00 | $20.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
|
|
|
2022 HumanaChoice R0923-002 (Regional PPO)
| $72.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $20.00 | $47.00 | $47.00 | 3,416 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 UPMC for Life HMO Rx (HMO)
| $81.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H3907 -029 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,574
2021 Formulary |
|
|
|
|
2022 UPMC for Life HMO Rx (HMO)
| $81.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,703 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H3924 -059 -21 | | | | | |
|
|
|
|
2022 Geisinger Gold Preferred Advantage Rx (PPO)
| $111.00 |
$4,000 |
$0 | Yes, some additional gap coverage. | $3.00 | $20.00 | $47.00 | $47.00 | 3,877 2022 Formulary |
|
2021 BlueJourney Premier (HMO)
| $106.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H3962 -001 -0 | $0.00 | $0.00 | $40.00 | $40.00 | 3,471
2021 Formulary |
|
|
|
|
2022 BlueJourney Premier (HMO)
| $116.00 |
$4,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $40.00 | $40.00 | 3,532 2022 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2021 HumanaChoice H5216-120 (PPO)
| $127.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5216 -120 -0 | $5.00 | $15.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
|
|
|
2022 HumanaChoice H5216-120 (PPO)
| $128.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $47.00 | $47.00 | 3,413 2022 Formulary |
|
2021 UPMC for Life PPO Rx Enhanced (PPO)
| $136.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5533 -005 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,574
2021 Formulary |
|
|
|
|
2022 UPMC for Life PPO Rx Enhanced (PPO)
| $136.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,703 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H3954 -157 -21 | | | | | |
|
|
|
|
2022 Geisinger Gold Classic Advantage Rx (HMO)
| $161.00 |
$3,450 |
$0 | Yes, some additional gap coverage. | $3.00 | $20.00 | $47.00 | $47.00 | 3,877 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 Gold Plan (PPO)
| $169.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H5521 -122 -0 | $2.00 | $5.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Gold Plan (PPO)
| $170.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $2.00 | $5.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 BlueJourney Prime (PPO)
| $171.00 |
$4,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3923 -017 -0 | $0.00 | $5.00 | $40.00 | $40.00 | 3,471
2021 Formulary |
|
|
|
|
2022 BlueJourney Prime (PPO)
| $172.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $40.00 | $40.00 | 3,532 2022 Formulary |
|
2021 Freedom Blue PPO Standard (PPO)
| $175.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3916 -015 -0 | $0.00 | $13.00 | $45.00 | $45.00 | 4,161
2021 Formulary |
|
|
|
|
2022 Freedom Blue PPO Standard (PPO)
| $174.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $13.00 | $45.00 | $45.00 | 4,151 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 Freedom Blue PPO Deluxe (PPO)
| $289.00 |
$4,500 |
$0 | Yes, some additional gap coverage. |
H3916 -005 -0 | $0.00 | $13.00 | $45.00 | $45.00 | 4,161
2021 Formulary |
|
|
|
|
2022 Freedom Blue PPO Deluxe (PPO)
| $288.00 |
$4,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $13.00 | $45.00 | $45.00 | 4,151 2022 Formulary |
|
2021 UPMC for Life HMO Rx Enhanced (HMO)
| $302.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3907 -006 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,574
2021 Formulary |
|
|
|
|
2022 UPMC for Life HMO Rx Enhanced (HMO)
| $302.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,703 2022 Formulary |
|
2021 Geisinger Gold Classic Essential Rx (HMO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H3954 -159 -14 | $3.00 | $20.00 | $47.00 | $47.00 | 3,838
2021 Formulary |
|
|
|
|
-- Members will be assigned to Geisinger Gold Classic Essential Rx (HMO) H3954-161 --
| | | | | |
|
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 Geisinger Gold Preferred Complete Rx (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H3924 -060 -14 | $3.00 | $20.00 | $47.00 | $47.00 | 3,838
2021 Formulary |
|
|
|
|
-- Members will be assigned to Geisinger Gold Preferred Complete Rx (PPO) H3924-065 --
| | | | | |
|
2021 HumanaChoice H5525-038 (PPO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5525 -038 -0 | $7.00 | $17.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
|
|
|
-- Members will be assigned to HumanaChoice H5525-051 (PPO) H5525-051 --
| | | | | |
|
2021 Geisinger Gold Preferred Advantage Rx (PPO)
| $115.00 |
$4,000 |
$0 | Yes, some additional gap coverage. |
H3924 -059 -14 | $3.00 | $20.00 | $47.00 | $47.00 | 3,838
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 Geisinger Gold Classic Advantage (HMO)
| $74.00 |
$3,450 |
No Rx Coverage |
H3954 -156 -14 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
-- This plan not offered in 2022 --
|
| | | | |
|
2021 Geisinger Gold Classic Advantage Rx (HMO)
| $166.00 |
$3,450 |
$0 | Yes, some additional gap coverage. |
H3954 -157 -14 | $3.00 | $20.00 | $47.00 | $47.00 | 3,838
2021 Formulary |
|
|
|
|
-- This plan not offered in 2022 --
|
| | | | |
|