There are 57 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 NetworkPrime (MSA)
| $0.00 |
n/a |
No Rx Coverage |
H1181 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
2022 NetworkPrime (MSA)
| $0.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 Secure Saver (MSA)
| $0.00 |
n/a |
No Rx Coverage |
H4388 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
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2022 Secure Saver (MSA)
| $0.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 AARP Medicare Advantage Patriot Plan 2 (HMO-POS)
| $0.00 |
$4,900 |
No Rx Coverage |
H5253 -021 -0 | This plan does NOT include Prescription Drug coverage. | |
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2022 AARP Medicare Advantage Patriot Plan 2 (HMO-POS)
| $0.00 |
$4,900 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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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 AARP Medicare Advantage Value (HMO-POS)
| $0.00 |
$4,900 |
$275 | No additional gap coverage, only the Donut Hole Discount |
H5253 -033 -0 | $4.00 | $14.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
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|
|
|
2022 AARP Medicare Advantage Value (HMO-POS)
| $0.00 |
$4,900 |
$275 | Yes, some additional gap coverage. | $0.00 | $14.00 | $47.00 | $47.00 | 3,654 2022 Formulary |
|
2021 Aetna Medicare Eagle (PPO)
| $0.00 |
$5,900 |
No Rx Coverage |
H5521 -286 -0 | This plan does NOT include Prescription Drug coverage. | |
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2022 Aetna Medicare Eagle (PPO)
| $0.00 |
$5,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 Aetna Medicare Value (PPO)
| $0.00 |
$4,975 |
$200 | Yes, some additional gap coverage. |
H5521 -195 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
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2022 Aetna Medicare Value (PPO)
| $0.00 |
$4,975 |
$200 | 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 Anthem MediBlue Access Plus (PPO)
| $0.00 |
$4,500 |
$195 | Yes, some additional gap coverage. |
H4036 -020 -0 | $5.00 | $15.00 | $42.00 | $42.00 | 3,639
2021 Formulary |
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|
|
|
2022 Anthem MediBlue Access Plus (PPO)
| $0.00 |
$4,700 |
$225 | Yes, some additional gap coverage. | $5.00 | $15.00 | $42.00 | $42.00 | 3,626 2022 Formulary |
|
2021 Anthem MediBlue Plus (HMO)
| $0.00 |
$4,900 |
$175 | Yes, some additional gap coverage. |
H9525 -004 -0 | $2.00 | $9.00 | $42.00 | $42.00 | 3,639
2021 Formulary |
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2022 Anthem MediBlue Plus (HMO)
| $0.00 |
$4,400 |
$175 | Yes, some additional gap coverage. | $2.00 | $9.00 | $42.00 | $42.00 | 3,626 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H4036 -024 -0 | | | | | |
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2022 Anthem MediBlue Service (PPO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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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 Aurora Health Quartz Med Advantage Core D (w/Rx) (HMO)
| $0.00 |
$5,900 |
$150 | No additional gap coverage, only the Donut Hole Discount |
H5262 -012 -0 | $0.00 | $8.00 | $47.00 | $47.00 | 3,804
2021 Formulary |
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|
2022 Aurora Health Quartz Med Advantage Core D (w/Rx) (HMO)
| $0.00 |
$4,900 |
$150 | Yes, some additional gap coverage. | $0.00 | $8.00 | $47.00 | $47.00 | 3,829 2022 Formulary |
|
2021 Aurora Health Quartz Med Advantage Value (HMO)
| $0.00 |
$4,900 |
No Rx Coverage |
H5262 -013 -0 | This plan does NOT include Prescription Drug coverage. | |
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2022 Aurora Health Quartz Med Advantage Value (HMO)
| $0.00 |
$4,400 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2021 --
|
H5211 -012 -0 | | | | | |
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2022 Esteem Rx (HMO-POS)
| $0.00 |
$5,000 |
$250 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $16.00 | $47.00 | $47.00 | 3,709 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 H6622-034 (HMO)
| $0.00 |
$4,500 |
$300 | No additional gap coverage, only the Donut Hole Discount |
H6622 -034 -0 | $6.00 | $15.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
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2022 Humana Gold Plus H6622-034 (HMO)
| $0.00 |
$4,500 |
$300 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $10.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
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2021 Humana Honor (PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
H5216 -258 -0 | This plan does NOT include Prescription Drug coverage. | |
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2022 Humana Honor (PPO)
| $0.00 |
$5,900 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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2021 HumanaChoice H5216-252 (PPO)
| $0.00 |
$4,900 |
$300 | No additional gap coverage, only the Donut Hole Discount |
H5216 -252 -0 | $6.00 | $15.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
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2022 HumanaChoice H5216-252 (PPO)
| $0.00 |
$4,900 |
$300 | 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 HumanaChoice H5216-253 (PPO)
| $0.00 |
$4,200 |
$275 | No additional gap coverage, only the Donut Hole Discount |
H5216 -253 -0 | $6.00 | $15.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
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2022 HumanaChoice H5216-253 (PPO)
| $0.00 |
$4,200 |
$275 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 HumanaChoice R5361-001 (Regional PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
R5361 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
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-- |
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2022 HumanaChoice R5361-001 (Regional PPO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2021 --
|
H2879 -003 -0 | | | | | |
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-- |
|
|
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 Network Health Medicare Go (PPO)
| $0.00 |
$4,900 |
$275 | No additional gap coverage, only the Donut Hole Discount |
H5215 -009 -0 | $2.00 | $8.00 | $42.00 | $42.00 | 5,998
2021 Formulary |
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|
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2022 Network Health Medicare Go (PPO)
| $0.00 |
$4,500 |
$195 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $42.00 | $42.00 | 5,943 2022 Formulary |
|
2021 Network Health Medicare Explore (HMO)
| $11.00 |
$4,100 |
$260 | No additional gap coverage, only the Donut Hole Discount |
H5644 -002 -0 | $2.00 | $8.00 | $42.00 | $42.00 | 4,600
2021 Formulary |
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-- |
|
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2022 Network Health Medicare Explore (HMO)
| $11.00 |
$4,100 |
$260 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $42.00 | $42.00 | 4,505 2022 Formulary |
|
2021 UnitedHealthcare Medicare Advantage Assist (PPO C-SNP)
| $14.00 |
n/a |
$300 | No additional gap coverage, only the Donut Hole Discount |
H0294 -002 -0 | $4.00 | $12.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
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2022 UnitedHealthcare Medicare Advantage Assist (PPO C-SNP)
| $14.00 |
n/a |
$300 | Some Generics | $4.00 | $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 Essence (HMO-POS)
| $16.00 |
$3,400 |
No Rx Coverage |
H5211 -003 -0 | This plan does NOT include Prescription Drug coverage. | |
|
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|
|
2022 Essence (HMO-POS)
| $18.00 |
$3,400 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 My Choice Wisconsin Partnership Plan (HMO D-SNP)
| $29.10 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5209 -002 -0 | | | | | 3,418
2021 Formulary |
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|
|
|
2022 My Choice Wisconsin Partnership Plan (HMO D-SNP)
| $19.20 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,350 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H6622 -076 -0 | | | | | |
|
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|
|
2022 Humana Together in Health I-SNP (HMO I-SNP)
| $24.40 |
n/a |
$410 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $6.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2021 --
|
H6622 -077 -0 | | | | | |
|
|
|
|
2022 Humana Together in Health IE-SNP (HMO I-SNP)
| $24.40 |
n/a |
$410 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $6.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 Humana Gold Plus H6622-002 (HMO)
| $38.00 |
$4,000 |
$200 | No additional gap coverage, only the Donut Hole Discount |
H6622 -002 -0 | $6.00 | $15.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
|
|
|
|
2022 Humana Gold Plus H6622-002 (HMO)
| $26.00 |
$4,000 |
$200 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $15.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 AARP Medicare Advantage (HMO-POS)
| $27.00 |
$4,500 |
$250 | No additional gap coverage, only the Donut Hole Discount |
H5253 -004 -0 | $2.00 | $12.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 AARP Medicare Advantage (HMO-POS)
| $27.00 |
$4,500 |
$250 | 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 Aetna Medicare Premier (PPO)
| $26.00 |
$4,600 |
$200 | Yes, some additional gap coverage. |
H5521 -150 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,659
2021 Formulary |
|
|
|
|
2022 Aetna Medicare Premier (PPO)
| $27.00 |
$4,300 |
$200 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,672 2022 Formulary |
|
2021 Anthem MediBlue Access (PPO)
| $27.00 |
$4,500 |
$95 | Yes, some additional gap coverage. |
H4036 -008 -0 | $5.00 | $15.00 | $42.00 | $42.00 | 3,639
2021 Formulary |
|
|
|
|
2022 Anthem MediBlue Access (PPO)
| $27.00 |
$4,500 |
$95 | Yes, some additional gap coverage. | $5.00 | $15.00 | $42.00 | $42.00 | 3,626 2022 Formulary |
|
2021 Aurora Health Quartz Med Advantage Value D (w/Rx) (HMO)
| $31.00 |
$4,900 |
$150 | No additional gap coverage, only the Donut Hole Discount |
H5262 -011 -0 | $0.00 | $8.00 | $47.00 | $47.00 | 3,804
2021 Formulary |
|
|
|
|
2022 Aurora Health Quartz Med Advantage Value D (w/Rx) (HMO)
| $30.00 |
$4,400 |
$150 | Yes, some additional gap coverage. | $0.00 | $8.00 | $47.00 | $47.00 | 3,829 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 My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
| $13.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5209 -004 -0 | | | | | 3,418
2021 Formulary |
|
|
|
|
2022 My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
| $30.50 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,350 2022 Formulary |
|
2021 Humana Value Plus H5216-173 (PPO)
| $33.00 |
$6,700 |
$230 | No additional gap coverage, only the Donut Hole Discount |
H5216 -173 -0 | $8.00 | $18.00 | $47.00 | $47.00 | 3,382
2021 Formulary |
|
|
|
|
2022 Humana Value Plus H5216-173 (PPO)
| $34.80 |
$6,700 |
$390 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $18.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 Network Health Medicare Anywhere (PPO)
| $35.00 |
$4,500 |
$250 | No additional gap coverage, only the Donut Hole Discount |
H5215 -010 -0 | $2.00 | $8.00 | $42.00 | $42.00 | 5,998
2021 Formulary |
|
|
|
|
2022 Network Health Medicare Anywhere (PPO)
| $35.00 |
$4,500 |
$250 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $42.00 | $42.00 | 5,943 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 Allwell Dual Medicare (HMO D-SNP)
| $30.20 |
n/a |
$225 | Yes, some additional gap coverage. |
H8189 -001 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,352
2021 Formulary |
|
|
|
|
2022 Wellcare Dual Access (HMO D-SNP)
| $35.70 |
n/a |
$480 | Some Generics | $0.00 | $0.00 | $47.00 | $47.00 | 3,375 2022 Formulary |
|
2021 UnitedHealthcare Dual Complete LP (HMO D-SNP)
| $38.10 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5253 -024 -0 | | | | | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Dual Complete LP (HMO D-SNP)
| $38.90 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H5211 -013 -0 | | | | | |
|
|
|
|
2022 Ascend Rx (HMO-POS)
| $40.00 |
$4,500 |
$330 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $9.00 | $47.00 | $47.00 | 3,709 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 Aurora Health Quartz Med Advantage Elite (HMO)
| $40.00 |
$3,900 |
No Rx Coverage |
H5262 -025 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Aurora Health Quartz Med Advantage Elite (HMO)
| $40.00 |
$3,900 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 Anthem MediBlue Dual Advantage (HMO D-SNP)
| $38.30 |
n/a |
$445 | Yes, some additional gap coverage. |
H9525 -003 -0 | $0.00 | $4.00 | $42.00 | $42.00 | 3,639
2021 Formulary |
|
|
|
|
2022 Anthem MediBlue Dual Advantage (HMO D-SNP)
| $40.50 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $40.00 | $40.00 | 3,626 2022 Formulary |
|
-- This plan not offered in 2021 --
|
H9525 -012 -0 | | | | | |
|
|
|
|
2022 Anthem MediBlue Dual Connect (HMO D-SNP)
| $41.90 |
n/a |
$480 | Some Generics | $0.00 | $4.00 | $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 |
2021 Community Care's Partnership Program (HMO D-SNP)
| $40.70 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H2034 -001 -0 | | | | | 3,023
2021 Formulary |
|
-- |
|
|
2022 Community Care's Partnership Program (HMO D-SNP)
| $42.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,094 2022 Formulary |
|
2021 iCare Medicare Plan (HMO D-SNP)
| $40.70 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H2237 -001 -0 | $15.00 | $45.00 | 25% | | 3,207
2021 Formulary |
|
|
|
|
2022 iCare Medicare Plan (HMO D-SNP)
| $42.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $10.00 | $20.00 | $20.00 | 2,827 2022 Formulary |
|
2021 Molina Medicare Complete Care (HMO D-SNP)
| $40.70 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H2879 -001 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,245
2021 Formulary |
|
-- |
|
|
2022 Molina Medicare Complete Care (HMO D-SNP)
| $42.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $47.00 | $47.00 | 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 |
2021 UnitedHealthcare Assisted Living Plan (HMO-POS I-SNP)
| $40.70 |
n/a |
$200 | No additional gap coverage, only the Donut Hole Discount |
H5253 -064 -0 | $2.00 | $12.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Assisted Living Plan (HMO-POS I-SNP)
| $42.30 |
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 UnitedHealthcare Dual Complete LP1 (HMO D-SNP)
| $37.10 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H3794 -002 -0 | | | | | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Dual Complete LP1 (HMO D-SNP)
| $42.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,654 2022 Formulary |
|
2021 UnitedHealthcare Nursing Home Plan 1 (HMO-POS I-SNP)
| $38.10 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5253 -007 -0 | | | | | 3,604
2021 Formulary |
|
|
|
|
2022 UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)
| $42.30 |
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 AARP Medicare Advantage Open Plan 1 (PPO)
| $47.00 |
$5,900 |
$325 | No additional gap coverage, only the Donut Hole Discount |
H0294 -004 -0 | $4.00 | $12.00 | $47.00 | $47.00 | 3,604
2021 Formulary |
|
|
|
|
2022 AARP Medicare Advantage Open Plan 1 (PPO)
| $47.00 |
$5,900 |
$325 | Yes, some additional gap coverage. | $3.00 | $14.00 | $47.00 | $47.00 | 3,654 2022 Formulary |
|
2021 Aurora Health Quartz Med Advantage Elite D (w/Rx) (HMO)
| $70.90 |
$3,900 |
$150 | No additional gap coverage, only the Donut Hole Discount |
H5262 -024 -0 | $0.00 | $8.00 | $47.00 | $47.00 | 3,804
2021 Formulary |
|
|
|
|
2022 Aurora Health Quartz Med Advantage Elite D (w/Rx) (HMO)
| $71.00 |
$3,900 |
$150 | Yes, some additional gap coverage. | $0.00 | $8.00 | $47.00 | $47.00 | 3,829 2022 Formulary |
|
2021 Humana Gold Choice H8145-006 (PFFS)
| $81.00 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H8145 -006 -0 | $6.00 | $15.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
|
|
|
2022 Humana Gold Choice H8145-006 (PFFS)
| $78.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $15.00 | $47.00 | $47.00 | 3,413 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 H5216-001 (PPO)
| $78.00 |
$3,900 |
$200 | No additional gap coverage, only the Donut Hole Discount |
H5216 -001 -0 | $6.00 | $15.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
|
|
|
2022 HumanaChoice H5216-001 (PPO)
| $78.00 |
$3,900 |
$200 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $15.00 | $47.00 | $47.00 | 3,408 2022 Formulary |
|
2021 Essence Rx (HMO-POS)
| $85.00 |
$3,400 |
$330 | No additional gap coverage, only the Donut Hole Discount |
H5211 -002 -0 | $4.00 | $12.00 | $47.00 | $47.00 | 3,646
2021 Formulary |
|
|
|
|
2022 Essence Rx (HMO-POS)
| $88.00 |
$3,400 |
$330 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $9.00 | $47.00 | $47.00 | 3,709 2022 Formulary |
|
2021 HumanaChoice R5361-002 (Regional PPO)
| $120.00 |
$6,700 |
$420 | No additional gap coverage, only the Donut Hole Discount |
R5361 -002 -0 | $3.00 | $9.00 | $47.00 | $47.00 | 3,386
2021 Formulary |
|
-- |
|
|
2022 HumanaChoice R5361-002 (Regional PPO)
| $120.00 |
$6,700 |
$480 | No additional gap coverage, only the Donut Hole Discount | $8.00 | $12.00 | $47.00 | $47.00 | 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 Spirit (HMO-POS)
| $150.00 |
$1,200 |
No Rx Coverage |
H5211 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2022 Spirit (HMO-POS)
| $150.00 |
$1,200 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2021 Spirit Rx (HMO-POS)
| $226.00 |
$1,200 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5211 -004 -0 | $9.00 | $20.00 | $47.00 | $47.00 | 3,646
2021 Formulary |
|
|
|
|
2022 Spirit Rx (HMO-POS)
| $229.00 |
$1,200 |
$0 | No additional gap coverage, only the Donut Hole Discount | $9.00 | $20.00 | $47.00 | $47.00 | 3,709 2022 Formulary |
|
2021 Assurance Rx (HMO-POS)
| $0.00 |
$6,500 |
$330 | No additional gap coverage, only the Donut Hole Discount |
H5211 -007 -0 | $7.00 | $20.00 | $47.00 | $47.00 | 3,646
2021 Formulary |
|
|
|
|
-- Members will be assigned to Esteem Rx (HMO-POS) H5211-012 --
| | | | | |
|
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 H6622-040 (HMO)
| $0.00 |
$6,700 |
$315 | No additional gap coverage, only the Donut Hole Discount |
H6622 -040 -0 | $6.00 | $15.00 | $47.00 | $47.00 | 3,172
2021 Formulary |
|
|
|
|
-- Members will be assigned to Humana Gold Plus (HMO) H6622-034 --
| | | | | |
|
2021 UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)
| $38.80 |
n/a |
$445 | No additional gap coverage, only the Donut Hole Discount |
H0710 -043 -0 | | | | | 3,604
2021 Formulary |
|
-- |
|
|
-- This plan not offered in 2022 --
|
| | | | |
|
2021 Anthem MediBlue Access Core (PPO)
| $0.00 |
$5,500 |
No Rx Coverage |
H4036 -016 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
-- This plan not offered in 2022 --
|
| | | | |
|