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 Choice (PPO)
| $0.00 |
$6,500 |
$225 | No additional gap coverage, only the Donut Hole Discount |
H1821 -002 -0 | $0.00 | $12.00 | $45.00 | $45.00 | 3,604
2021 Formulary |
|
new |
new |
|
2022 AARP Medicare Advantage Choice Plan 1 (PPO)
| $0.00 |
$6,500 |
$225 | Yes, some additional gap coverage. | $0.00 | $12.00 | $45.00 | $45.00 | 3,654 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H1821 -004 -0 | | | | | |
|
new |
new |
|
2022 AARP Medicare Advantage Patriot (PPO)
| $0.00 |
$5,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 AARP Medicare Advantage Plan 2 (HMO)
| $0.00 |
$6,700 |
$275 | No additional gap coverage, only the Donut Hole Discount |
H3805 -017 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
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|
|
|
2022 AARP Medicare Advantage Plan 2 (HMO)
| $0.00 |
$6,700 |
$275 | Yes, some additional gap coverage. | $0.00 | $12.00 | $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 Walgreens (HMO-POS)
| $0.00 |
$6,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3805 -032 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 AARP Medicare Advantage Walgreens (HMO-POS)
| $0.00 |
$6,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,654 2022 Formulary |
|
2021 Aetna Medicare Eagle Plan (PPO)
| $0.00 |
$7,550 |
No Rx Coverage |
H5521 -330 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Aetna Medicare Eagle Plan (PPO)
| $0.00 |
$5,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 Aetna Medicare Elite Plan (HMO)
| $0.00 |
$6,900 |
$0 | Yes, some additional gap coverage. |
H3748 -009 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
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|
|
|
2022 Aetna Medicare Elite Plan (HMO-POS)
| $0.00 |
$5,700 |
$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 Aetna Medicare Value Plan (HMO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H3931 -126 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Value Plan (HMO-POS)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 Aetna Medicare Value Plus Plan (HMO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H3748 -003 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Value Plus Plan (HMO-POS)
| $0.00 |
$6,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 Amerivantage Classic (HMO)
| $0.00 |
$5,900 |
$0 | Yes, some additional gap coverage. |
H1894 -001 -0 | $5.00 | $15.00 | $42.00 | $42.00 | 3,639
2021 Formulary |
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|
|
|
2022 Amerivantage Classic (HMO)
| $0.00 |
$5,900 |
$0 | Yes, some additional gap coverage. | $5.00 | $15.00 | $42.00 | $42.00 | 3,626 2022 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2021 --
|
H1894 -007 -0 | | | | | |
|
|
|
|
2022 Amerivantage Comfort (HMO I-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands | $0.00 | $7.50 | $40.00 | $40.00 | 3,117 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H1894 -008 -0 | | | | | |
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|
|
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2022 Amerivantage ESRD Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Few Generics | $5.00 | $15.00 | $42.00 | $42.00 | 3,603 2022 Formulary |
|
2021 Community Health Plan of WA MA No Rx Plan (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H5826 -006 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Community Health Plan of WA MA No Rx Plan (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 Community Health Plan of WA MA Plan 1 (HMO)
| $0.00 |
$6,700 |
$230 | No additional gap coverage, only the Donut Hole Discount |
H5826 -016 -0 | $0.00 | $10.00 | $42.00 | $42.00 | 3,396
2021 Formulary |
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|
|
|
2022 Community Health Plan of WA MA Plan 1 (HMO)
| $0.00 |
$6,700 |
$230 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $42.00 | $42.00 | 3,224 2022 Formulary |
|
2021 Humana Gold Plus H5619-057 (HMO)
| $0.00 |
$6,500 |
$100 | No additional gap coverage, only the Donut Hole Discount |
H5619 -057 -0 | $2.00 | $8.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
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|
|
|
2022 Humana Gold Plus H5619-057 (HMO)
| $0.00 |
$6,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H5216 -301 -4 | | | | | |
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2022 Humana Honor (PPO)
| $0.00 |
$5,000 |
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 H5216-247 (PPO)
| $0.00 |
$7,550 |
$400 | No additional gap coverage, only the Donut Hole Discount |
H5216 -247 -0 | $4.00 | $15.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
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|
|
|
2022 HumanaChoice H5216-247 (PPO)
| $0.00 |
$7,550 |
$400 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $15.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 Kaiser Permanente Medicare Advantage Key (HMO)
| $0.00 |
$6,600 |
$100 | Yes, some additional gap coverage. |
H5050 -022 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 4,700
2021 Formulary |
|
|
|
|
2022 Kaiser Permanente Medicare Advantage Key (HMO)
| $0.00 |
$6,600 |
$100 | Yes, some additional gap coverage. | $3.00 | $12.00 | $47.00 | $47.00 | 4,211 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H5823 -011 -0 | | | | | |
|
-- |
|
|
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 |
|
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 Premera Blue Cross Medicare Advantage (HMO)
| $0.00 |
$6,300 |
$180 | No additional gap coverage, only the Donut Hole Discount |
H7245 -001 -0 | $4.00 | $12.00 | $42.00 | $42.00 | 3,168
2021 Formulary |
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|
|
|
2022 Premera Blue Cross Medicare Advantage (HMO)
| $0.00 |
$6,500 |
$160 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $12.00 | $42.00 | $42.00 | 4,207 2022 Formulary |
|
2021 Premera Blue Cross Medicare Advantage Peak + Rx (HMO)
| $0.00 |
$6,700 |
$160 | No additional gap coverage, only the Donut Hole Discount |
H9302 -011 -0 | $3.00 | $12.00 | $42.00 | $42.00 | 3,168
2021 Formulary |
|
|
|
|
2022 Premera Blue Cross Medicare Advantage Peak + Rx (HMO)
| $0.00 |
$6,700 |
$160 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $42.00 | $42.00 | 4,207 2022 Formulary |
|
2021 Regence BlueAdvantage HMO (HMO)
| $0.00 |
$6,200 |
$250 | No additional gap coverage, only the Donut Hole Discount |
H1997 -009 -0 | $3.00 | $12.00 | $40.00 | $40.00 | 3,424
2021 Formulary |
|
|
|
|
2022 Regence BlueAdvantage HMO (HMO)
| $0.00 |
$6,500 |
$250 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $12.00 | $40.00 | $40.00 | 3,428 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 --
|
H5009 -010 -0 | | | | | |
|
|
|
|
2022 Regence MedAdvantage + Rx Core (PPO)
| $0.00 |
$7,200 |
$325 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $13.00 | $40.00 | $40.00 | 3,428 2022 Formulary |
|
2021 Regence Valiance (HMO)
| $0.00 |
$5,900 |
No Rx Coverage |
H1997 -008 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Regence Valiance (HMO)
| $0.00 |
$5,900 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 Regence Valiance (PPO)
| $0.00 |
$6,200 |
No Rx Coverage |
H5009 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Regence Valiance (PPO)
| $0.00 |
$6,200 |
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 WellCare Dividend (HMO)
| $0.00 |
$7,550 |
$200 | No additional gap coverage, only the Donut Hole Discount |
H1353 -006 -0 | $0.00 | $15.00 | $45.00 | $45.00 | 3,348
2021 Formulary |
|
new |
|
|
2022 Wellcare Giveback (HMO)
| $0.00 |
$7,550 |
$200 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $35.00 | $35.00 | 3,375 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H1353 -005 -0 | | | | | |
|
new |
|
|
2022 Wellcare No Premium (HMO)
| $0.00 |
$5,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $4.00 | $35.00 | $35.00 | 3,375 2022 Formulary |
|
2021 WellCare Premier (PPO)
| $0.00 |
$6,700 |
$250 | No additional gap coverage, only the Donut Hole Discount |
H5965 -002 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
new |
new |
|
2022 Wellcare No Premium Open (PPO)
| $0.00 |
$6,700 |
$250 | 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 WellCare Patriot (PPO)
| $0.00 |
$4,000 |
No Rx Coverage |
H5965 -003 -0 | This plan does NOT include Prescription Drug coverage. | |
|
new |
new |
|
2022 Wellcare Patriot Giveback Open (PPO)
| $0.00 |
$4,000 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 Humana Gold Plus SNP-DE H5619-136 (HMO D-SNP)
| $24.10 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5619 -136 -4 | $0.00 | $20.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
|
|
|
|
2022 Humana Gold Plus SNP-DE H5619-136 (HMO D-SNP)
| $21.70 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 Premera Blue Cross Medicare Advantage Alpine (HMO)
| $42.00 |
$6,500 |
No Rx Coverage |
H9302 -004 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Premera Blue Cross Medicare Advantage Alpine (HMO)
| $24.00 |
$6,500 |
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 Amerivantage Dual Coordination (HMO D-SNP)
| $22.90 |
n/a |
$445 | Yes, some additional gap coverage. |
H1894 -002 -0 | $0.00 | $6.00 | $47.00 | $47.00 | 3,639
2021 Formulary |
|
|
|
|
2022 Amerivantage Dual Coordination (HMO D-SNP)
| $24.50 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $20.00 | $47.00 | $47.00 | 3,626 2022 Formulary |
|
2021 Humana Value Plus H5619-134 (HMO)
| $25.00 |
$6,700 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5619 -134 -0 | $2.00 | $19.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
|
|
|
|
2022 Humana Value Plus H5619-134 (HMO)
| $26.00 |
$6,700 |
$440 | No additional gap coverage, only the Donut Hole Discount | $1.00 | $15.00 | 25% | 25% | 3,408 2022 Formulary |
|
2021 Kaiser Permanente Medicare Advantage Vital (HMO)
| $28.00 |
$5,800 |
$0 | Yes, some additional gap coverage. |
H5050 -013 -0 | $3.00 | $7.00 | $47.00 | $47.00 | 4,700
2021 Formulary |
|
|
|
|
2022 Kaiser Permanente Medicare Advantage Vital (HMO)
| $29.00 |
$5,800 |
$0 | Yes, some additional gap coverage. | $3.00 | $7.00 | $47.00 | $47.00 | 4,211 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 Regence MedAdvantage + Rx Primary (PPO)
| $38.00 |
$6,700 |
$300 | No additional gap coverage, only the Donut Hole Discount |
H5009 -009 -0 | $3.00 | $13.00 | $40.00 | $40.00 | 3,424
2021 Formulary |
|
|
|
|
2022 Regence MedAdvantage + Rx Primary (PPO)
| $29.00 |
$6,700 |
$300 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $13.00 | $40.00 | $40.00 | 3,428 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H1353 -007 -0 | | | | | |
|
new |
|
|
2022 Wellcare Assist (HMO)
| $29.10 |
$5,900 |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,375 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H5965 -004 -0 | | | | | |
|
new |
new |
|
2022 Wellcare Dual Access Open (PPO D-SNP)
| $33.20 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $8.00 | $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 Humana Gold Plus H5619-097 (HMO)
| $33.00 |
$5,500 |
$50 | No additional gap coverage, only the Donut Hole Discount |
H5619 -097 -0 | $2.00 | $8.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
|
|
|
|
2022 Humana Gold Plus H5619-097 (HMO)
| $34.00 |
$5,500 |
$50 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 Premera Blue Cross Medicare Advantage Sound + Rx (HMO)
| $40.00 |
$6,500 |
$160 | No additional gap coverage, only the Donut Hole Discount |
H9302 -007 -0 | $2.00 | $12.00 | $42.00 | $42.00 | 3,168
2021 Formulary |
|
|
|
|
2022 Premera Blue Cross Medicare Advantage Sound + Rx (HMO)
| $35.00 |
$6,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $12.00 | $42.00 | $42.00 | 4,207 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H1821 -005 -0 | | | | | |
|
new |
new |
|
2022 AARP Medicare Advantage Choice Plan 2 (PPO)
| $36.00 |
$6,000 |
$225 | Yes, some additional gap coverage. | $0.00 | $12.00 | $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 UnitedHealthcare Assisted Living Plan (PPO I-SNP)
| $36.00 |
n/a |
$200 | No additional gap coverage, only the Donut Hole Discount |
H0710 -030 -0 | $2.00 | $12.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
-- |
|
|
2022 UnitedHealthcare Assisted Living Plan (PPO I-SNP)
| $36.80 |
n/a |
$200 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $12.00 | $47.00 | $47.00 | 3,654 2022 Formulary |
|
2021 WellCare Liberty (HMO D-SNP)
| $27.90 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H1353 -004 -0 | $0.00 | $10.00 | $46.00 | $46.00 | 3,348
2021 Formulary |
|
new |
|
|
2022 Wellcare Dual Liberty (HMO D-SNP)
| $38.90 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $12.00 | $42.00 | $42.00 | 3,375 2022 Formulary |
|
2021 Kaiser Permanente Medicare Advantage Basic (HMO)
| $40.00 |
$4,200 |
No Rx Coverage |
H5050 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Kaiser Permanente Medicare Advantage Basic (HMO)
| $40.00 |
$4,200 |
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 Community Health Plan of WA Dual Plan (HMO D-SNP)
| $36.00 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5826 -014 -0 | | | | | 3,396
2021 Formulary |
|
|
|
|
2022 Community Health Plan of WA Dual Plan (HMO D-SNP)
| $40.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,224 2022 Formulary |
|
2021 Community Health Plan of WA MA Plan 2 (HMO)
| $26.50 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5826 -010 -0 | $0.00 | $10.00 | $42.00 | $42.00 | 3,396
2021 Formulary |
|
|
|
|
2022 Community Health Plan of WA MA Plan 2 (HMO)
| $40.50 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $42.00 | $42.00 | 3,224 2022 Formulary |
|
2021 Molina Medicare Complete Care (HMO D-SNP)
| $36.00 |
n/a |
$250 | No additional gap coverage, only the Donut Hole Discount |
H5823 -006 -0 | $0.00 | $0.00 | $29.00 | $29.00 | 3,245
2021 Formulary |
|
-- |
|
|
2022 Molina Medicare Complete Care (HMO D-SNP)
| $40.50 |
n/a |
$250 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $29.00 | $29.00 | 3,263 2022 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2021 --
|
H5823 -010 -0 | | | | | |
|
-- |
|
|
2022 Molina Medicare Complete Care Select (HMO D-SNP)
| $40.50 |
n/a |
$250 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $29.00 | $29.00 | 3,263 2022 Formulary |
|
2021 UnitedHealthcare Dual Complete (HMO D-SNP)
| $36.00 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5008 -002 -0 | | | | | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Dual Complete (HMO D-SNP)
| $40.50 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H5008 -015 -0 | | | | | |
|
|
|
|
2022 UnitedHealthcare Dual Complete Select (HMO D-SNP)
| $40.50 |
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 UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)
| $30.70 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5008 -001 -0 | | | | | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)
| $40.50 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654 2022 Formulary |
|
2021 UnitedHealthcare Nursing Home Plan (PPO I-SNP)
| $36.00 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0710 -031 -0 | | | | | 3,604
2021 Formulary |
|
-- |
|
|
2022 UnitedHealthcare Nursing Home Plan (PPO I-SNP)
| $40.50 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654 2022 Formulary |
|
2021 WellCare Access (HMO D-SNP)
| $27.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H1353 -002 -0 | $0.00 | $7.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
new |
|
|
2022 Wellcare Dual Access (HMO D-SNP)
| $40.50 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $8.00 | $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 Aetna Medicare Platinum Plus Plan (HMO)
| $37.00 |
$7,000 |
$0 | Yes, some additional gap coverage. |
H3748 -004 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Platinum Plus Plan (HMO-POS)
| $43.00 |
$6,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 AARP Medicare Advantage Plan 3 (HMO)
| $45.00 |
$5,900 |
$225 | No additional gap coverage, only the Donut Hole Discount |
H3805 -015 -0 | $3.00 | $12.00 | $45.00 | $45.00 | 3,604
2021 Formulary |
|
|
|
|
2022 AARP Medicare Advantage Plan 3 (HMO)
| $45.00 |
$5,900 |
$225 | Yes, some additional gap coverage. | $0.00 | $12.00 | $45.00 | $45.00 | 3,654 2022 Formulary |
|
2021 Regence BlueAdvantage HMO Plus (HMO)
| $48.00 |
$5,900 |
$100 | No additional gap coverage, only the Donut Hole Discount |
H1997 -002 -0 | $3.00 | $12.00 | $40.00 | $40.00 | 3,424
2021 Formulary |
|
|
|
|
2022 Regence BlueAdvantage HMO Plus (HMO)
| $48.00 |
$5,900 |
$100 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $12.00 | $40.00 | $40.00 | 3,428 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 Plan (PPO)
| $63.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H5521 -127 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Choice Plan (PPO)
| $49.00 |
$6,200 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 Premera Blue Cross Medicare Advantage Classic (HMO)
| $55.00 |
$5,000 |
$180 | No additional gap coverage, only the Donut Hole Discount |
H7245 -002 -0 | $2.00 | $10.00 | $40.00 | $40.00 | 3,168
2021 Formulary |
|
|
|
|
2022 Premera Blue Cross Medicare Advantage Classic (HMO)
| $55.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $10.00 | $40.00 | $40.00 | 4,207 2022 Formulary |
|
2021 WellCare Prime (PPO)
| $65.00 |
$6,000 |
$100 | No additional gap coverage, only the Donut Hole Discount |
H5965 -001 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,348
2021 Formulary |
|
new |
new |
|
2022 Wellcare Premium Enhanced Open (PPO)
| $65.00 |
$6,000 |
$100 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $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 Community Health Plan of WA MA Plan 3 (HMO)
| $68.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5826 -008 -0 | $0.00 | $10.00 | $42.00 | $42.00 | 3,396
2021 Formulary |
|
|
|
|
2022 Community Health Plan of WA MA Plan 3 (HMO)
| $68.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $42.00 | $42.00 | 3,224 2022 Formulary |
|
2021 Regence MedAdvantage + Rx Classic (PPO)
| $78.00 |
$6,200 |
$250 | No additional gap coverage, only the Donut Hole Discount |
H5009 -008 -0 | $3.00 | $13.00 | $40.00 | $40.00 | 3,424
2021 Formulary |
|
|
|
|
2022 Regence MedAdvantage + Rx Classic (PPO)
| $78.00 |
$6,200 |
$250 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $13.00 | $40.00 | $40.00 | 3,428 2022 Formulary |
|
2021 AARP Medicare Advantage Plan 1 (HMO)
| $88.00 |
$4,200 |
$185 | No additional gap coverage, only the Donut Hole Discount |
H3805 -037 -0 | $3.00 | $12.00 | $45.00 | $45.00 | 3,604
2021 Formulary |
|
|
|
|
2022 AARP Medicare Advantage Plan 1 (HMO)
| $88.00 |
$4,200 |
$185 | Yes, some additional gap coverage. | $0.00 | $12.00 | $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 Aetna Medicare Select Plan (PPO)
| $99.00 |
$7,000 |
$0 | Yes, some additional gap coverage. |
H5521 -128 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Select Plan (PPO)
| $99.00 |
$5,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 Kaiser Permanente Medicare Advantage Essential (HMO)
| $99.00 |
$4,800 |
$0 | Yes, some additional gap coverage. |
H5050 -009 -0 | $3.00 | $7.00 | $45.00 | $45.00 | 4,700
2021 Formulary |
|
|
|
|
2022 Kaiser Permanente Medicare Advantage Essential (HMO)
| $99.00 |
$4,800 |
$0 | Yes, some additional gap coverage. | $3.00 | $7.00 | $45.00 | $45.00 | 4,211 2022 Formulary |
|
2021 HumanaChoice H5216-047 (PPO)
| $102.00 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount |
H5216 -047 -0 | $4.00 | $15.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
|
|
|
2022 HumanaChoice H5216-047 (PPO)
| $100.00 |
$6,700 |
$320 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $15.00 | $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 Premera Blue Cross Medicare Advantage Charter + Rx (HMO)
| $151.00 |
$4,900 |
$160 | No additional gap coverage, only the Donut Hole Discount |
H9302 -003 -0 | $2.00 | $12.00 | $42.00 | $42.00 | 3,168
2021 Formulary |
|
|
|
|
2022 Premera Blue Cross Medicare Advantage Charter + Rx (HMO)
| $110.00 |
$4,900 |
$160 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $12.00 | $42.00 | $42.00 | 4,207 2022 Formulary |
|
2021 Regence MedAdvantage + Rx Enhanced (PPO)
| $157.00 |
$5,400 |
$250 | No additional gap coverage, only the Donut Hole Discount |
H5009 -002 -0 | $3.00 | $8.00 | $40.00 | $40.00 | 3,424
2021 Formulary |
|
|
|
|
2022 Regence MedAdvantage + Rx Enhanced (PPO)
| $158.00 |
$5,400 |
$250 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $8.00 | $40.00 | $40.00 | 3,428 2022 Formulary |
|
2021 Premera Blue Cross Medicare Advantage Classic Plus (HMO)
| $191.00 |
$5,000 |
$180 | No additional gap coverage, only the Donut Hole Discount |
H7245 -003 -0 | $4.00 | $12.00 | $42.00 | $42.00 | 3,168
2021 Formulary |
|
|
|
|
2022 Premera Blue Cross Medicare Advantage Classic Plus (HMO)
| $170.00 |
$5,000 |
$180 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $12.00 | $42.00 | $42.00 | 4,207 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 Kaiser Permanente Medicare Advantage Optimal (HMO)
| $295.00 |
$3,450 |
$0 | Yes, some additional gap coverage. |
H5050 -004 -0 | $3.00 | $7.00 | $45.00 | $45.00 | 4,700
2021 Formulary |
|
|
|
|
2022 Kaiser Permanente Medicare Advantage Optimal (HMO)
| $296.00 |
$3,450 |
$0 | Yes, some additional gap coverage. | $3.00 | $7.00 | $45.00 | $45.00 | 4,211 2022 Formulary |
|
2021 Humana Honor (PPO)
| $0.00 |
$5,000 |
No Rx Coverage |
H5216 -046 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
-- Members will be assigned to Humana Honor (PPO) H5216-301 --
| | | | | |
|
2021 WellCare Value (HMO)
| $0.00 |
$5,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H1353 -001 -0 | $0.00 | $9.00 | $45.00 | $45.00 | 3,348
2021 Formulary |
|
new |
|
|
-- Members will be assigned to Wellcare No Premium (HMO) H1353-005 --
| | | | | |
|