There are 61 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 |
-- This plan not offered in 2021 --
|
H9295 -001 -0 | | | | | |
|
|
|
|
2022 Exemplar Health Freedom 1 (MSA)
| $0.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2021 --
|
H9295 -002 -0 | | | | | |
|
|
|
|
2022 Exemplar Health Freedom 2 (MSA)
| $0.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2021 --
|
H9295 -003 -0 | | | | | |
|
|
|
|
2022 Exemplar Health Freedom 3 (MSA)
| $0.00 |
n/a |
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 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 (HMO)
| $0.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H4527 -002 -0 | $3.00 | $14.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 AARP Medicare Advantage (HMO)
| $0.00 |
$5,500 |
$0 | Yes, some additional gap coverage. | $3.00 | $14.00 | $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 AARP Medicare Advantage Patriot (HMO-POS)
| $0.00 |
$5,500 |
No Rx Coverage |
H4527 -024 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 AARP Medicare Advantage Patriot (HMO-POS)
| $0.00 |
$5,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 AARP Medicare Advantage Walgreens (PPO)
| $0.00 |
$6,400 |
$345 | Yes, some additional gap coverage. |
H1278 -004 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 AARP Medicare Advantage Walgreens (PPO)
| $0.00 |
$6,400 |
$345 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,654 2022 Formulary |
|
2021 Aetna Medicare Choice Plan (PPO)
| $0.00 |
$7,550 |
$300 | Yes, some additional gap coverage. |
H3288 -046 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Choice Plan (PPO)
| $0.00 |
$7,550 |
$300 | 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 Premier Plan (HMO)
| $0.00 |
$5,900 |
$250 | Yes, some additional gap coverage. |
H4523 -001 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Premier Plan (HMO)
| $0.00 |
$5,900 |
$250 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H2593 -029 -0 | | | | | |
|
-- |
|
|
2022 Amerivantage Classic (HMO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $3.00 | $10.00 | $42.00 | $42.00 | 3,626 2022 Formulary |
|
2021 Amerivantage Classic Plus (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H8849 -008 -6 | $5.00 | $12.00 | $42.00 | $42.00 | 3,639
2021 Formulary |
|
new |
new |
|
2022 Amerivantage Classic Plus (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $5.00 | $12.00 | $42.00 | $42.00 | 3,626 2022 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2021 --
|
H9357 -002 -0 | | | | | |
new |
new |
new |
|
2022 Ascension Complete Seton 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 --
|
H9357 -001 -0 | | | | | |
new |
new |
new |
|
2022 Ascension Complete Seton 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 |
|
-- This plan not offered in 2021 --
|
H6678 -001 -0 | | | | | |
new |
new |
new |
|
2022 Ascension Complete Seton 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 |
|
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 --
|
H6678 -002 -0 | | | | | |
new |
new |
new |
|
2022 Ascension Complete Seton Secure (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $1.00 | $37.00 | $37.00 | 3,375 2022 Formulary |
|
2021 Blue Cross Medicare Advantage Choice Plus (PPO)
| $0.00 |
$7,550 |
$445 | Yes, some additional gap coverage. |
H1666 -004 -0 | $0.00 | $13.00 | $40.00 | $40.00 | 3,563
2021 Formulary |
|
|
|
|
2022 Blue Cross Medicare Advantage Choice Plus (PPO)
| $0.00 |
$7,550 |
$480 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,616 2022 Formulary |
|
2021 Blue Cross Medicare Advantage Value (HMO)
| $0.00 |
$6,700 |
$300 | Yes, some additional gap coverage. |
H9706 -003 -0 | $0.00 | $8.00 | $39.00 | $39.00 | 3,563
2021 Formulary |
|
new |
|
|
2022 Blue Cross Medicare Advantage Value (HMO)
| $0.00 |
$6,700 |
$100 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,616 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 --
|
H8142 -004 -0 | | | | | |
|
|
|
|
2022 BSW SeniorCare Advantage Select (HMO)
| $0.00 |
$5,900 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2021 --
|
H8142 -001 -0 | | | | | |
|
|
|
|
2022 BSW SeniorCare Advantage Select Rx (HMO)
| $0.00 |
$6,300 |
$300 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $20.00 | $47.00 | $47.00 | 3,416 2022 Formulary |
|
2021 Humana Gold Plus H0028-037 (HMO)
| $0.00 |
$6,700 |
$250 | No additional gap coverage, only the Donut Hole Discount |
H0028 -037 -0 | $3.00 | $8.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
|
|
|
|
2022 Humana Gold Plus H0028-037 (HMO)
| $0.00 |
$4,900 |
$0 | Yes, some additional gap coverage. | $2.00 | $5.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2021 Humana Honor (PPO)
| $0.00 |
$5,400 |
No Rx Coverage |
H5216 -128 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Humana Honor (PPO)
| $0.00 |
$5,400 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 HumanaChoice H0473-001 (PPO)
| $0.00 |
$6,700 |
$360 | No additional gap coverage, only the Donut Hole Discount |
H0473 -001 -0 | $3.00 | $10.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
|
|
|
2022 HumanaChoice H0473-001 (PPO)
| $0.00 |
$6,700 |
$200 | Yes, some additional gap coverage. | $3.00 | $10.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 HumanaChoice R4182-001 (Regional PPO)
| $0.00 |
$5,700 |
No Rx Coverage |
R4182 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 HumanaChoice R4182-001 (Regional PPO)
| $0.00 |
$5,700 |
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 UnitedHealthcare Chronic Complete (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H4527 -039 -0 | $0.00 | $14.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Chronic Complete (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics, Few Brands | $0.00 | $14.00 | $47.00 | $47.00 | 3,654 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H0174 -013 -1 | | | | | |
|
-- |
|
|
2022 Wellcare Giveback (HMO)
| $0.00 |
$6,700 |
$300 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $2.00 | $20.00 | $20.00 | 3,375 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H0174 -012 -1 | | | | | |
|
-- |
|
|
2022 Wellcare No Premium (HMO-POS)
| $0.00 |
$4,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $20.00 | $20.00 | 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 Rx Plus (PPO)
| $0.00 |
$6,000 |
$300 | No additional gap coverage, only the Donut Hole Discount |
H7323 -006 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,348
2021 Formulary |
|
new |
|
|
2022 Wellcare No Premium Rx Plus Open (PPO)
| $0.00 |
$6,000 |
$300 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $35.00 | $35.00 | 3,375 2022 Formulary |
|
2021 Allwell Medicare Simple (HMO)
| $0.00 |
$3,450 |
No Rx Coverage |
H5294 -014 -0 | This plan does NOT include Prescription Drug coverage. | |
|
-- |
|
|
2022 Wellcare Patriot No Premium (HMO)
| $0.00 |
$3,450 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 WellCare TexanPlus Classic (HMO)
| $0.00 |
$4,000 |
$200 | No additional gap coverage, only the Donut Hole Discount |
H0174 -002 -0 | $0.00 | $5.00 | $35.00 | $35.00 | 3,348
2021 Formulary |
|
-- |
|
|
2022 Wellcare TexanPlus No Premium (HMO)
| $0.00 |
$4,000 |
$200 | Yes, some additional gap coverage. | $0.00 | $0.00 | $25.00 | $25.00 | 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 Medicare Silver (Regional PPO C-SNP)
| $4.90 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
R6801 -008 -0 | | | | | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Medicare Silver (Regional PPO C-SNP)
| $3.70 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,663 2022 Formulary |
|
2021 Allwell Medicare Complement (HMO)
| $14.10 |
$3,450 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5294 -016 -0 | $2.00 | $19.00 | $47.00 | $47.00 | 3,352
2021 Formulary |
|
-- |
|
|
2022 Wellcare Complement Assist (HMO)
| $14.90 |
$3,450 |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,375 2022 Formulary |
|
2021 Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP)
| $23.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H9706 -002 -0 | | | | | 3,549
2021 Formulary |
|
new |
|
|
2022 Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP)
| $18.80 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,602 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 Choice II Plan (PPO)
| $19.00 |
$7,550 |
$300 | Yes, some additional gap coverage. |
H3288 -048 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Choice II Plan (PPO)
| $19.00 |
$6,700 |
$300 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 WellCare Prime (PPO)
| $20.00 |
$6,700 |
$200 | No additional gap coverage, only the Donut Hole Discount |
H7323 -001 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,348
2021 Formulary |
|
new |
|
|
2022 Wellcare Low Premium Open (PPO)
| $20.00 |
$6,700 |
$200 | Yes, some additional gap coverage. | $0.00 | $1.00 | $35.00 | $35.00 | 3,375 2022 Formulary |
|
2021 WellCare Compass (HMO)
| $16.20 |
$3,450 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0174 -009 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
-- |
|
|
2022 Wellcare Assist (HMO)
| $20.60 |
$3,450 |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,375 2022 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2021 --
|
H2593 -032 -0 | | | | | |
|
-- |
|
|
2022 Amerivantage Dual Coordination (HMO D-SNP)
| $25.10 |
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 Coordination Plus (HMO D-SNP)
| $22.50 |
n/a |
$445 | Yes, some additional gap coverage. |
H8849 -010 -6 | $0.00 | $14.00 | $47.00 | $47.00 | 3,639
2021 Formulary |
|
new |
new |
|
2022 Amerivantage Dual Coordination Plus (HMO D-SNP)
| $25.10 |
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 Secure Plus (HMO D-SNP)
| $20.60 |
n/a |
$445 | Yes, some additional gap coverage. |
H8849 -011 -6 | $0.00 | $14.00 | $47.00 | $47.00 | 3,639
2021 Formulary |
|
new |
new |
|
2022 Amerivantage Dual Secure Plus (HMO D-SNP)
| $25.10 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $20.00 | $47.00 | $47.00 | 3,626 2022 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2021 --
|
H0028 -044 -0 | | | | | |
|
|
|
|
2022 Humana Gold Plus SNP-DE H0028-044 (HMO D-SNP)
| $25.10 |
n/a |
$460 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $20.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H5015 -001 -0 | | | | | |
|
new |
|
|
2022 Texas Independence Health Plan, Inc. (HMO I-SNP)
| $25.10 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,497 2022 Formulary |
|
2021 UnitedHealthcare Dual Complete (HMO D-SNP)
| $22.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H4514 -013 -2 | | | | | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Dual Complete (HMO D-SNP)
| $25.10 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654 2022 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2021 UnitedHealthcare Dual Complete Choice (Regional PPO D-SNP)
| $22.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
R6801 -011 -0 | | | | | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Dual Complete Choice (Regional PPO D-SNP)
| $25.10 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,663 2022 Formulary |
|
2021 WellCare Access (HMO D-SNP)
| $17.70 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0174 -004 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
-- |
|
|
2022 Wellcare Dual Access (HMO D-SNP)
| $25.10 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $45.00 | $45.00 | 3,375 2022 Formulary |
|
2021 Allwell Dual Medicare Harmony (HMO D-SNP)
| $20.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5294 -015 -0 | $1.00 | $10.00 | $47.00 | $47.00 | 3,352
2021 Formulary |
|
-- |
|
|
2022 Wellcare Dual Access Harmony (HMO D-SNP)
| $25.10 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $42.00 | $42.00 | 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 Imperial (PPO D-SNP)
| $22.50 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H7323 -005 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
new |
|
|
2022 Wellcare Dual Access Open (PPO D-SNP)
| $25.10 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $47.00 | $47.00 | 3,375 2022 Formulary |
|
2021 WellCare Liberty (HMO D-SNP)
| $20.30 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0174 -006 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
-- |
|
|
2022 Wellcare Dual Liberty (HMO D-SNP)
| $25.10 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,375 2022 Formulary |
|
2021 UnitedHealthcare Medicare Gold (Regional PPO C-SNP)
| $29.00 |
n/a |
$295 | No additional gap coverage, only the Donut Hole Discount |
R6801 -009 -0 | $4.00 | $12.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Medicare Gold (Regional PPO C-SNP)
| $29.00 |
n/a |
$295 | Some Generics | $4.00 | $12.00 | $47.00 | $47.00 | tbd |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2021 UnitedHealthcare Medicare Advantage Choice (Regional PPO)
| $49.00 |
$7,550 |
$395 | No additional gap coverage, only the Donut Hole Discount |
R6801 -012 -0 | $4.00 | $12.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Medicare Advantage Choice (Regional PPO)
| $49.00 |
$7,550 |
$395 | Yes, some additional gap coverage. | $4.00 | $12.00 | $47.00 | $47.00 | tbd |
|
2021 HumanaChoice R4182-004 (Regional PPO)
| $55.00 |
$7,200 |
$175 | No additional gap coverage, only the Donut Hole Discount |
R4182 -004 -0 | $6.00 | $13.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
|
|
|
2022 HumanaChoice R4182-004 (Regional PPO)
| $54.00 |
$7,200 |
$175 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $13.00 | $47.00 | $47.00 | 3,421 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H8142 -005 -0 | | | | | |
|
|
|
|
2022 BSW SeniorCare Advantage Preferred (HMO)
| $83.00 |
$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 Blue Cross Medicare Advantage Choice Premier (PPO)
| $90.00 |
$7,550 |
$300 | Yes, some additional gap coverage. |
H1666 -001 -0 | $0.00 | $13.00 | $40.00 | $40.00 | 3,563
2021 Formulary |
|
|
|
|
2022 Blue Cross Medicare Advantage Choice Premier (PPO)
| $90.00 |
$5,900 |
$300 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,616 2022 Formulary |
|
2021 HumanaChoice R4182-003 (Regional PPO)
| $93.00 |
$7,200 |
$175 | No additional gap coverage, only the Donut Hole Discount |
R4182 -003 -0 | $7.00 | $12.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
|
|
|
2022 HumanaChoice R4182-003 (Regional PPO)
| $92.00 |
$7,200 |
$175 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $12.00 | $47.00 | $47.00 | 3,421 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H8142 -002 -0 | | | | | |
|
|
|
|
2022 BSW SeniorCare Advantage Preferred Rx (HMO)
| $145.00 |
$4,900 |
$100 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $15.00 | $45.00 | $45.00 | 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 |
-- This plan not offered in 2021 --
|
H8142 -006 -0 | | | | | |
|
|
|
|
2022 BSW SeniorCare Advantage Premium (HMO)
| $199.00 |
$4,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2021 --
|
H8142 -003 -0 | | | | | |
|
|
|
|
2022 BSW SeniorCare Advantage Premium Rx (HMO)
| $255.00 |
$4,800 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $12.00 | $45.00 | $45.00 | 3,416 2022 Formulary |
|
2021 Amerivantage Classic (HMO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H2593 -028 -6 | $5.00 | $12.00 | $42.00 | $42.00 | 3,639
2021 Formulary |
|
-- |
|
|
-- Members will be assigned to Amerivantage Classic (HMO) H2593-029 --
| | | | | |
|
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 Dual Coordination (HMO D-SNP)
| $22.50 |
n/a |
$445 | Yes, some additional gap coverage. |
H2593 -030 -6 | $0.00 | $14.00 | $47.00 | $47.00 | 3,639
2021 Formulary |
|
-- |
|
|
-- Members will be assigned to Amerivantage Dual Coordination (HMO D-SNP) H2593-032 --
| | | | | |
|
2021 Amerivantage Dual Secure (HMO D-SNP)
| $17.80 |
n/a |
$445 | Yes, some additional gap coverage. |
H2593 -036 -0 | $0.00 | $13.00 | $47.00 | $47.00 | 3,639
2021 Formulary |
|
-- |
|
|
-- Members will be assigned to Amerivantage Dual Coordination (HMO D-SNP) H2593-032 --
| | | | | |
|
2021 WellCare Dividend Prime (HMO)
| $0.00 |
$6,700 |
$300 | No additional gap coverage, only the Donut Hole Discount |
H0174 -007 -0 | $0.00 | $7.00 | $30.00 | $30.00 | 3,348
2021 Formulary |
|
-- |
|
|
-- Members will be assigned to Wellcare Giveback (HMO) H0174-013 --
| | | | | |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2021 WellCare Value (HMO-POS)
| $0.00 |
$4,500 |
$0 | Yes, some additional gap coverage. |
H0174 -005 -0 | $0.00 | $5.00 | $30.00 | $30.00 | 3,348
2021 Formulary |
|
-- |
|
|
-- Members will be assigned to Wellcare No Premium (HMO-POS) H0174-012 --
| | | | | |
|