There are 69 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 AARP Medicare Advantage Patriot (HMO)
| $0.00 |
$3,200 |
No Rx Coverage |
H5253 -113 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 AARP Medicare Advantage Patriot (HMO)
| $0.00 |
$3,200 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 AARP Medicare Advantage Plan 1 (HMO)
| $0.00 |
$5,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5253 -083 -0 | $2.00 | $8.00 | $45.00 | $45.00 | 3,604
2021 Formulary |
|
|
|
|
2022 AARP Medicare Advantage Plan 1 (HMO)
| $0.00 |
$5,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $45.00 | $45.00 | 3,654 2022 Formulary |
|
2021 AARP Medicare Advantage Walgreens (PPO)
| $0.00 |
$5,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2577 -007 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 AARP Medicare Advantage Walgreens (PPO)
| $0.00 |
$5,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $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 |
-- This plan not offered in 2021 --
|
H5521 -355 -0 | | | | | |
|
|
|
|
2022 Aetna Medicare Eagle Plan (PPO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 Aetna Medicare Premier Plan (PPO)
| $0.00 |
$7,500 |
$0 | Yes, some additional gap coverage. |
H5521 -141 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Premier Plan (PPO)
| $0.00 |
$7,500 |
$0 | Yes, some additional gap coverage. | $2.00 | $5.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 Aetna Medicare Premier Plus Plan (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H5521 -321 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Premier Plus Plan (PPO)
| $0.00 |
$6,700 |
$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 Amerivantage Classic Plus (HMO-POS)
| $0.00 |
$4,900 |
$0 | Yes, some additional gap coverage. |
H5828 -005 -0 | $2.00 | $8.00 | $42.00 | $42.00 | 3,639
2021 Formulary |
|
new |
new |
|
2022 Amerivantage Classic Plus (HMO-POS)
| $0.00 |
$4,900 |
$0 | Yes, some additional gap coverage. | $2.00 | $8.00 | $42.00 | $42.00 | 3,626 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H8121 -002 -0 | | | | | |
new |
new |
new |
|
2022 Ascension Complete Saint Thomas Access (PPO)
| $0.00 |
$2,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $37.00 | $37.00 | 3,375 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H8121 -001 -0 | | | | | |
new |
new |
new |
|
2022 Ascension Complete Saint Thomas Access Plus (PPO)
| $0.00 |
$3,450 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $37.00 | $37.00 | 3,375 2022 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2021 Ascension Complete Saint Thomas Reward (HMO)
| $0.00 |
$7,550 |
$390 | No additional gap coverage, only the Donut Hole Discount |
H2853 -001 -0 | $2.00 | $20.00 | $47.00 | $47.00 | 3,370
2021 Formulary |
|
new |
new |
|
2022 Ascension Complete Saint Thomas Reward (HMO)
| $0.00 |
$2,900 |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $37.00 | $37.00 | 3,375 2022 Formulary |
|
2021 Ascension Complete Saint Thomas Secure (HMO)
| $0.00 |
$4,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2853 -002 -0 | $0.00 | $8.00 | $47.00 | $47.00 | 3,370
2021 Formulary |
|
new |
new |
|
2022 Ascension Complete Saint Thomas Secure (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $1.00 | $37.00 | $37.00 | 3,375 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H7006 -012 -0 | | | | | |
|
|
|
|
2022 ATRIO Choice Rx (PPO)
| $0.00 |
$5,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $20.00 | $45.00 | $45.00 | 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 |
-- This plan not offered in 2021 --
|
H7917 -039 -0 | | | | | |
|
|
|
|
2022 BlueAdvantage Freedom (PPO)
| $0.00 |
$4,900 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 BlueAdvantage Garnet (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H7917 -032 -0 | $1.00 | $10.00 | $42.00 | $42.00 | 3,611
2021 Formulary |
|
|
|
|
2022 BlueAdvantage Garnet (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $1.00 | $10.00 | $42.00 | $42.00 | 3,638 2022 Formulary |
|
2021 Cigna Fundamental Medicare (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H4513 -033 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Cigna Fundamental Medicare (HMO)
| $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 Cigna Preferred Medicare (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H4513 -049 -1 | $0.00 | $12.00 | $42.00 | $42.00 | 3,446
2021 Formulary |
|
|
|
|
2022 Cigna Preferred Medicare (HMO)
| $0.00 |
$5,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $42.00 | $42.00 | 3,459 2022 Formulary |
|
2021 Cigna True Choice Medicare (PPO)
| $0.00 |
$5,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H7849 -010 -0 | $0.00 | $4.00 | $40.00 | $40.00 | 3,446
2021 Formulary |
|
|
|
|
2022 Cigna True Choice Medicare (PPO)
| $0.00 |
$5,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $4.00 | $40.00 | $40.00 | 3,459 2022 Formulary |
|
2021 Clover Health Choice (PPO)
| $0.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5141 -033 -0 | $0.00 | $10.00 | $40.00 | $40.00 | 3,358
2021 Formulary |
|
|
|
|
2022 Clover Health Choice (PPO)
| $0.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $37.00 | $37.00 | 3,358 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 H4461-029 (HMO-POS)
| $0.00 |
$5,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H4461 -029 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
|
|
|
|
2022 Humana Gold Plus H4461-029 (HMO)
| $0.00 |
$5,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 Humana Honor (HMO-POS)
| $0.00 |
$5,900 |
No Rx Coverage |
H4461 -004 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Humana Honor (HMO)
| $0.00 |
$3,200 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 Humana Honor (PPO)
| $0.00 |
$3,400 |
No Rx Coverage |
H5216 -235 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Humana Honor (PPO)
| $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 |
-- This plan not offered in 2021 --
|
H5216 -274 -0 | | | | | |
|
|
|
|
2022 HumanaChoice H5216-274 (PPO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 HumanaChoice R7315-001 (Regional PPO)
| $0.00 |
$3,400 |
No Rx Coverage |
R7315 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
|
-- |
|
|
2022 HumanaChoice R7315-001 (Regional PPO)
| $0.00 |
$3,400 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2021 --
|
H1416 -073 -1 | | | | | |
|
-- |
|
|
2022 Wellcare Giveback (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $7.00 | $37.00 | $37.00 | 3,375 2022 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2021 WellCare Absolute (PPO)
| $0.00 |
$6,700 |
$90 | Yes, some additional gap coverage. |
H9428 -002 -0 | $0.00 | $15.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
new |
new |
|
2022 Wellcare Giveback Open (PPO)
| $0.00 |
$6,700 |
$90 | Yes, some additional gap coverage. | $0.00 | $10.00 | $37.00 | $37.00 | 3,375 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H1416 -075 -0 | | | | | |
|
-- |
|
|
2022 Wellcare No Premium (HMO-POS)
| $0.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $37.00 | $37.00 | 3,375 2022 Formulary |
|
2021 WellCare Premier (PPO)
| $0.00 |
$5,500 |
$75 | Yes, some additional gap coverage. |
H9428 -001 -0 | $0.00 | $15.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
new |
new |
|
2022 Wellcare No Premium Open (PPO)
| $0.00 |
$5,500 |
$75 | Yes, some additional gap coverage. | $0.00 | $10.00 | $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 Patriot (HMO-POS)
| $0.00 |
$4,500 |
No Rx Coverage |
H1416 -061 -0 | This plan does NOT include Prescription Drug coverage. | |
|
-- |
|
|
2022 Wellcare Patriot Giveback (HMO-POS)
| $0.00 |
$4,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 Amerivantage Classic (HMO)
| $0.00 |
$6,500 |
$0 | Yes, some additional gap coverage. |
H2593 -022 -0 | $2.00 | $8.00 | $42.00 | $42.00 | 3,639
2021 Formulary |
|
-- |
|
|
2022 Amerivantage Classic (HMO)
| $15.00 |
$6,500 |
$0 | Yes, some additional gap coverage. | $2.00 | $8.00 | $42.00 | $42.00 | 3,626 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H7006 -013 -0 | | | | | |
|
|
|
|
2022 ATRIO Select Rx (PPO)
| $20.00 |
$4,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $20.00 | $45.00 | $45.00 | 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 Compass (HMO)
| $16.40 |
$4,900 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H1416 -042 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
-- |
|
|
2022 Wellcare Assist (HMO)
| $22.00 |
$4,900 |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,375 2022 Formulary |
|
2021 Amerivantage Balance Plus (HMO)
| $30.20 |
$6,700 |
$445 | Yes, some additional gap coverage. |
H5828 -008 -0 | $0.00 | $9.00 | $37.00 | $37.00 | 3,639
2021 Formulary |
|
new |
new |
|
2022 Amerivantage Balance Plus (HMO)
| $23.30 |
$4,900 |
$480 | Yes, some additional gap coverage. | $0.00 | $9.00 | $37.00 | $37.00 | 3,626 2022 Formulary |
|
2021 Cigna TotalCare (HMO D-SNP)
| $25.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H4513 -034 -0 | | | | | 3,446
2021 Formulary |
|
|
|
|
2022 Cigna TotalCare Plus (HMO D-SNP)
| $23.70 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,459 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 Plus Plan (HMO)
| $20.00 |
$6,700 |
$250 | Yes, some additional gap coverage. |
H3146 -012 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Value Plus Plan (HMO)
| $24.00 |
$6,700 |
$95 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 BlueCare Plus Choice (HMO D-SNP)
| $30.20 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3259 -002 -0 | | | | | 3,611
2021 Formulary |
|
|
|
|
2022 BlueCare Plus Choice (HMO D-SNP)
| $27.20 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,638 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H4461 -038 -0 | | | | | |
|
|
|
|
2022 Humana Gold Plus SNP-DE H4461-038 (HMO D-SNP)
| $27.80 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $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 SNP-DE H4461-022 (HMO D-SNP)
| $30.20 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H4461 -022 -0 | $1.00 | $7.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
|
|
|
|
2022 Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP)
| $27.90 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $10.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 HumanaChoice H5216-180 (PPO)
| $30.20 |
$6,700 |
$225 | No additional gap coverage, only the Donut Hole Discount |
H5216 -180 -0 | $8.00 | $15.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
|
|
|
|
2022 HumanaChoice H5216-180 (PPO)
| $29.30 |
$6,700 |
$480 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $15.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 WellCare Access (HMO D-SNP)
| $30.20 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H1416 -035 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
-- |
|
|
2022 Wellcare Dual Access (HMO D-SNP)
| $30.20 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $30.00 | $30.00 | 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 Amerivantage Balance (HMO)
| $25.50 |
$6,700 |
$445 | Yes, some additional gap coverage. |
H2593 -025 -0 | $0.00 | $9.00 | $37.00 | $37.00 | 3,639
2021 Formulary |
|
-- |
|
|
2022 Amerivantage Balance (HMO)
| $30.80 |
$6,700 |
$480 | Yes, some additional gap coverage. | $0.00 | $9.00 | $37.00 | $37.00 | 3,626 2022 Formulary |
|
2021 AARP Medicare Advantage Plan 2 (HMO)
| $43.00 |
$4,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5253 -084 -0 | $2.00 | $8.00 | $45.00 | $45.00 | 3,604
2021 Formulary |
|
|
|
|
2022 AARP Medicare Advantage Plan 2 (HMO)
| $31.00 |
$4,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $45.00 | $45.00 | 3,654 2022 Formulary |
|
2021 American Health Advantage of Tennessee (HMO I-SNP)
| $30.20 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H7779 -001 -0 | | | | | 3,568
2021 Formulary |
|
-- |
|
|
2022 American Health Advantage of Tennessee (HMO I-SNP)
| $32.70 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,502 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 --
|
H5828 -009 -0 | | | | | |
|
new |
new |
|
2022 Amerivantage Comfort (HMO I-SNP)
| $32.70 |
n/a |
$0 | Many Generics, Some Brands | $0.00 | $7.50 | $40.00 | $40.00 | 3,117 2022 Formulary |
|
2021 Amerivantage Dual Coordination (HMO D-SNP)
| $30.20 |
n/a |
$445 | Yes, some additional gap coverage. |
H2593 -021 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,639
2021 Formulary |
|
-- |
|
|
2022 Amerivantage Dual Coordination (HMO D-SNP)
| $32.70 |
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 Amerivantage Dual Premier (HMO D-SNP)
| $30.20 |
n/a |
$445 | Yes, some additional gap coverage. |
H5828 -002 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,639
2021 Formulary |
|
new |
new |
|
2022 Amerivantage Dual Premier (HMO D-SNP)
| $32.70 |
n/a |
$400 | 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 Amerivantage Full Dual Coordination (HMO D-SNP)
| $30.20 |
n/a |
$445 | Yes, some additional gap coverage. |
H5828 -001 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,639
2021 Formulary |
|
new |
new |
|
2022 Amerivantage Full Dual Coordination (HMO D-SNP)
| $32.70 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $20.00 | $47.00 | $47.00 | 3,626 2022 Formulary |
|
2021 BlueCare Plus (HMO D-SNP)
| $30.20 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3259 -001 -0 | | | | | 3,611
2021 Formulary |
|
|
|
|
2022 BlueCare Plus (HMO D-SNP)
| $32.70 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,638 2022 Formulary |
|
2021 Clover Health Choice Value (PPO)
| $30.20 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5141 -034 -0 | $0.00 | $10.00 | $40.00 | $40.00 | 3,358
2021 Formulary |
|
|
|
|
2022 Clover Health Choice Value (PPO)
| $32.70 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $37.00 | $37.00 | 3,358 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)
| $30.20 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0251 -002 -0 | | | | | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Dual Complete (HMO D-SNP)
| $32.70 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654 2022 Formulary |
|
2021 UnitedHealthcare Dual Complete ONE (HMO D-SNP)
| $30.20 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0251 -004 -0 | | | | | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Dual Complete ONE (HMO D-SNP)
| $32.70 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654 2022 Formulary |
|
2021 UnitedHealthcare Dual Complete ONE Plus (HMO D-SNP)
| $30.20 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0251 -005 -0 | | | | | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Dual Complete ONE Plus (HMO D-SNP)
| $32.70 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654 2022 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2021 NHC Advantage (HMO I-SNP)
| $30.20 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H4172 -001 -0 | | | | | 3,764
2021 Formulary |
|
-- |
|
|
2022 NHC Advantage (HMO I-SNP)
| $32.80 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,712 2022 Formulary |
|
2021 UnitedHealthcare Nursing Home Plan (PPO I-SNP)
| $30.10 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0710 -004 -0 | | | | | 3,604
2021 Formulary |
|
-- |
|
|
2022 UnitedHealthcare Nursing Home Plan (PPO I-SNP)
| $32.80 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654 2022 Formulary |
|
2021 BlueAdvantage Emerald (PPO)
| $56.00 |
$5,900 |
$0 | Yes, some additional gap coverage. |
H7917 -035 -0 | $1.00 | $5.00 | $35.00 | $35.00 | 3,611
2021 Formulary |
|
|
|
|
2022 BlueAdvantage Emerald (PPO)
| $56.00 |
$5,900 |
$0 | Yes, some additional gap coverage. | $1.00 | $5.00 | $35.00 | $35.00 | 3,638 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 Cigna Premier Medicare (HMO-POS)
| $55.00 |
$6,700 |
$200 | Yes, some additional gap coverage. |
H4513 -036 -0 | $3.00 | $12.00 | $42.00 | $42.00 | 3,446
2021 Formulary |
|
|
|
|
2022 Cigna Premier Medicare (HMO-POS)
| $57.00 |
$6,700 |
$200 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $42.00 | $42.00 | 3,459 2022 Formulary |
|
2021 HumanaChoice H5216-097 (PPO)
| $71.00 |
$6,700 |
$150 | No additional gap coverage, only the Donut Hole Discount |
H5216 -097 -0 | $5.00 | $15.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
|
|
|
2022 HumanaChoice H5216-097 (PPO)
| $68.00 |
$6,700 |
$150 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $47.00 | $47.00 | 3,413 2022 Formulary |
|
2021 HumanaChoice R7315-002 (Regional PPO)
| $71.00 |
$6,700 |
$400 | No additional gap coverage, only the Donut Hole Discount |
R7315 -002 -0 | $7.00 | $17.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
-- |
|
|
2022 HumanaChoice R7315-002 (Regional PPO)
| $84.00 |
$6,700 |
$380 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $12.00 | 25% | 25% | 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 BlueAdvantage Ruby (PPO)
| $107.00 |
$4,800 |
$0 | Yes, some additional gap coverage. |
H7917 -013 -0 | $1.00 | $5.00 | $28.00 | $28.00 | 3,611
2021 Formulary |
|
|
|
|
2022 BlueAdvantage Ruby (PPO)
| $107.00 |
$4,800 |
$0 | Yes, some additional gap coverage. | $1.00 | $5.00 | $28.00 | $28.00 | 3,638 2022 Formulary |
|
2021 BlueAdvantage Diamond (PPO)
| $201.00 |
$3,700 |
$0 | Yes, some additional gap coverage. |
H7917 -009 -0 | $1.00 | $5.00 | $28.00 | $28.00 | 3,611
2021 Formulary |
|
|
|
|
2022 BlueAdvantage Diamond (PPO)
| $201.00 |
$3,700 |
$0 | Yes, some additional gap coverage. | $1.00 | $5.00 | $28.00 | $28.00 | 3,638 2022 Formulary |
|
2021 Cigna Alliance Medicare (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H4513 -042 -0 | $3.00 | $12.00 | $42.00 | $42.00 | 3,446
2021 Formulary |
|
|
|
|
-- Members will be assigned to Cigna Preferred Medicare (HMO) H4513-049 --
| | | | | |
|
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 Cigna Preferred Plus Medicare (HMO)
| $79.00 |
$4,800 |
$0 | Yes, some additional gap coverage. |
H4513 -043 -0 | $3.00 | $12.00 | $42.00 | $42.00 | 3,446
2021 Formulary |
|
|
|
|
-- Members will be assigned to Cigna Preferred Medicare (HMO) H4513-049 --
| | | | | |
|
2021 WellCare Dividend (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H1416 -039 -0 | $0.00 | $12.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
-- |
|
|
-- Members will be assigned to Wellcare Giveback (HMO) H1416-073 --
| | | | | |
|
2021 WellCare Value (HMO-POS)
| $0.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H1416 -069 -1 | $0.00 | $10.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
-- |
|
|
-- Members will be assigned to Wellcare No Premium (HMO-POS) H1416-075 --
| | | | | |
|
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 Choice (PPO)
| $0.00 |
$5,900 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H1393 -001 -0 | $0.00 | 25% | 25% | 25% | 3,364
2021 Formulary |
|
|
|
|
-- This plan not offered in 2022 --
|
| | | | |
|
2021 Bright Advantage Choice Plus (PPO)
| $59.00 |
$4,900 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H1393 -002 -0 | $0.00 | 25% | 25% | 25% | 3,364
2021 Formulary |
|
|
|
|
-- This plan not offered in 2022 --
|
| | | | |
|
2021 Bright Advantage (HMO)
| $0.00 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H2011 -001 -0 | $0.00 | 25% | 25% | 25% | 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 Plus (HMO)
| $38.00 |
$4,900 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H2011 -002 -0 | $0.00 | 25% | 25% | 25% | 3,364
2021 Formulary |
|
|
|
|
-- This plan not offered in 2022 --
|
| | | | |
|
2021 BlueEssential (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H2120 -002 -0 | $1.00 | $10.00 | $42.00 | $42.00 | 3,611
2021 Formulary |
|
|
|
|
-- This plan not offered in 2022 --
|
| | | | |
|
2021 NHC Advantage Gold (HMO I-SNP)
| $176.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H4172 -002 -0 | $4.00 | $15.00 | $45.00 | $45.00 | 3,941
2021 Formulary |
|
-- |
|
|
-- This plan not offered in 2022 --
|
| | | | |
|