There are 110 Medicare Advantage plans meeting your criteria.
2022 / 2023 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 |
2022 Lasso Healthcare Growth (MSA)
| $0.00 |
n/a |
No Rx Coverage |
H1924 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
|
2023 Lasso Healthcare Growth (MSA)
| $0.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 Lasso Healthcare Growth Plus (MSA)
| $0.00 |
n/a |
No Rx Coverage |
H1924 -004 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
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2023 Lasso Healthcare Growth Plus (MSA)
| $0.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 AARP Medicare Advantage Patriot (PPO)
| $0.00 |
$5,000 |
No Rx Coverage |
H2228 -095 -0 | This plan does NOT include Prescription Drug coverage. | |
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2023 AARP Medicare Advantage Patriot (PPO)
| $0.00 |
$4,300 |
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 |
2022 AARP Medicare Advantage Plan 1 (HMO)
| $0.00 |
$3,900 |
$0 | Yes, some additional gap coverage. |
H0609 -026 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,654
2022 Formulary |
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|
|
|
2023 AARP Medicare Advantage Plan 1 (HMO-POS)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $45.00 | $45.00 | 3,682 2023 Formulary |
|
2022 AARP Medicare Advantage Plan 2 (HMO)
| $0.00 |
$3,000 |
$0 | Yes, some additional gap coverage. |
H0609 -027 -0 | $0.00 | $8.00 | $45.00 | $45.00 | 3,654
2022 Formulary |
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|
|
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2023 AARP Medicare Advantage Plan 2 (HMO-POS)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $45.00 | $45.00 | 3,682 2023 Formulary |
|
2022 AARP Medicare Advantage Plan 4 (HMO)
| $0.00 |
$3,900 |
$0 | Yes, some additional gap coverage. |
H0609 -046 -0 | $0.00 | $12.00 | $45.00 | $45.00 | 3,654
2022 Formulary |
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|
|
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2023 AARP Medicare Advantage Plan 4 (HMO-POS)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $12.00 | $45.00 | $45.00 | 3,682 2023 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 |
2022 AARP Medicare Advantage Walgreens Plan 1 (PPO)
| $0.00 |
$5,000 |
$150 | Yes, some additional gap coverage. |
H2228 -074 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,654
2022 Formulary |
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|
|
|
2023 AARP Medicare Advantage Walgreens Plan 1 (PPO)
| $0.00 |
$4,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,682 2023 Formulary |
|
2022 AARP Medicare Advantage Walgreens Plan 2 (PPO)
| $0.00 |
$5,900 |
$150 | Yes, some additional gap coverage. |
H2228 -077 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,654
2022 Formulary |
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|
|
2023 AARP Medicare Advantage Walgreens Plan 2 (PPO)
| $0.00 |
$5,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,682 2023 Formulary |
|
2022 Aetna Medicare Eagle Plan (PPO)
| $0.00 |
$5,500 |
No Rx Coverage |
H5521 -329 -0 | This plan does NOT include Prescription Drug coverage. | |
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2023 Aetna Medicare Eagle Plan (PPO)
| $0.00 |
$5,500 |
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 |
-- This plan not offered in 2022 --
|
H5521 -363 -0 | | | | | |
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|
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2023 Aetna Medicare Elite Plan (PPO)
| $0.00 |
$5,900 |
$0 | Yes, some additional gap coverage. | $2.00 | $5.00 | $47.00 | $47.00 | 3,597 2023 Formulary |
|
2022 Aetna Medicare Freedom Plan (PPO)
| $0.00 |
$5,500 |
$0 | Yes, some additional gap coverage. |
H5521 -100 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,672
2022 Formulary |
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|
|
2023 Aetna Medicare Freedom Plan (PPO)
| $0.00 |
$5,200 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,597 2023 Formulary |
|
2022 Aetna Medicare Platinum Plan (HMO-POS)
| $0.00 |
$6,200 |
$100 | Yes, some additional gap coverage. |
H3931 -129 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,672
2022 Formulary |
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2023 Aetna Medicare Platinum Plan (HMO-POS)
| $0.00 |
$6,200 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,597 2023 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 |
2022 Aetna Medicare Premier Plan (HMO-POS)
| $0.00 |
$4,700 |
$0 | Yes, some additional gap coverage. |
H4835 -002 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,672
2022 Formulary |
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2023 Aetna Medicare Premier Plan (HMO-POS)
| $0.00 |
$4,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,597 2023 Formulary |
|
2022 Aetna Medicare Prime Plan (HMO)
| $0.00 |
$7,550 |
$100 | Yes, some additional gap coverage. |
H3931 -092 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,672
2022 Formulary |
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|
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2023 Aetna Medicare Prime Plan (HMO-POS)
| $0.00 |
$3,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,597 2023 Formulary |
|
2022 Aetna Medicare Prime Plus Plan (HMO-POS)
| $0.00 |
$3,200 |
$0 | Yes, some additional gap coverage. |
H4835 -001 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,672
2022 Formulary |
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2023 Aetna Medicare Prime Plus Plan (HMO-POS)
| $0.00 |
$3,650 |
$0 | Yes, some additional gap coverage. | $2.00 | $5.00 | $47.00 | $47.00 | 3,597 2023 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 |
2022 AVA (PPO)
| $0.00 |
$3,900 |
$0 | Yes, some additional gap coverage. |
H9614 -001 -0 | $0.00 | $5.00 | $40.00 | $40.00 | 3,450
2022 Formulary |
|
new |
new |
|
2023 Alignment Health AVA (PPO)
| $0.00 |
$3,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $40.00 | $40.00 | 3,467 2023 Formulary |
|
2022 Alignment Health Plan Heart & Diabetes (HMO C-SNP)
| $0.00 |
n/a |
$0 | Few Generics |
H3443 -003 -0 | $0.00 | $0.00 | $40.00 | $40.00 | 3,450
2022 Formulary |
|
new |
new |
|
2023 Alignment Health Heart & Diabetes (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $40.00 | $40.00 | 3,467 2023 Formulary |
|
2022 Alignment Health Plan the ONE (HMO)
| $0.00 |
$2,499 |
$0 | Yes, some additional gap coverage. |
H3443 -001 -0 | $0.00 | $0.00 | $40.00 | $40.00 | 3,450
2022 Formulary |
|
new |
new |
|
2023 Alignment Health the ONE (HMO)
| $0.00 |
$2,499 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $40.00 | $40.00 | 3,467 2023 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 |
2022 Amerivantage Comfort (HMO I-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands |
H2593 -019 -0 | $0.00 | $7.50 | $40.00 | $40.00 | 3,117
2022 Formulary |
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-- |
|
|
2023 Amerivantage Comfort (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $40.00 | $40.00 | 3,157 2023 Formulary |
|
2022 Amerivantage Comfort Plus (HMO I-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands |
H1423 -008 -0 | $0.00 | $7.50 | $40.00 | $40.00 | 3,117
2022 Formulary |
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|
|
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2023 Amerivantage Comfort Plus (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $40.00 | $40.00 | 3,157 2023 Formulary |
|
2022 Amerivantage Plus (HMO)
| $0.00 |
$3,000 |
$0 | Yes, some additional gap coverage. |
H1423 -009 -0 | $0.00 | $7.50 | $40.00 | $40.00 | 3,604
2022 Formulary |
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|
|
|
2023 Amerivantage Plus (HMO)
| $0.00 |
$3,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $40.00 | $40.00 | 3,583 2023 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 |
2022 Banner Medicare Advantage Prime (HMO)
| $0.00 |
$2,775 |
$0 | Yes, some additional gap coverage. |
H5843 -001 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,490
2022 Formulary |
|
new |
|
|
2023 Banner Medicare Advantage Prime (HMO)
| $0.00 |
$2,775 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,467 2023 Formulary |
|
2022 Blue Medicare Advantage Classic (HMO)
| $0.00 |
$4,250 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H0302 -006 -0 | $0.00 | $9.00 | $47.00 | $47.00 | 3,510
2022 Formulary |
|
|
|
|
2023 Blue Medicare Advantage Classic (HMO)
| $0.00 |
$2,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $9.00 | $47.00 | $47.00 | 3,506 2023 Formulary |
|
2022 BluePathway Plan 1 (HMO)
| $0.00 |
$2,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H6936 -006 -0 | $0.00 | $7.00 | $47.00 | $47.00 | 3,510
2022 Formulary |
|
|
|
|
2023 BluePathway Plan 1 (HMO)
| $0.00 |
$2,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $7.00 | $47.00 | $47.00 | 3,506 2023 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 |
2022 BluePathway Plan 2 (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H6936 -003 -0 | $0.00 | $7.00 | $47.00 | $47.00 | 3,510
2022 Formulary |
|
|
|
|
2023 BluePathway Plan 2 (HMO)
| $0.00 |
$2,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $7.00 | $47.00 | $47.00 | 3,506 2023 Formulary |
|
2022 Cigna Achieve Medicare (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics, Few Brands |
H0354 -027 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,459
2022 Formulary |
|
|
|
|
2023 Cigna Achieve Medicare (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,524 2023 Formulary |
|
2022 Cigna Alliance Medicare (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. |
H0354 -028 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,459
2022 Formulary |
|
|
|
|
2023 Cigna Alliance Medicare (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,524 2023 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 |
2022 Cigna Preferred Medicare (HMO)
| $0.00 |
$3,100 |
$0 | Yes, some additional gap coverage. |
H0354 -001 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,459
2022 Formulary |
|
|
|
|
2023 Cigna Preferred Medicare (HMO)
| $0.00 |
$2,300 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,524 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H0354 -029 -0 | | | | | |
|
|
|
|
2023 Cigna Preferred Savings Medicare (HMO)
| $0.00 |
$3,100 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,524 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H7849 -065 -0 | | | | | |
|
|
|
|
2023 Cigna True Choice Medicare (PPO)
| $0.00 |
$4,200 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,524 2023 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 2022 --
|
H7849 -066 -0 | | | | | |
|
|
|
|
2023 Cigna True Choice Savings Medicare (PPO)
| $0.00 |
$5,600 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,524 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H8173 -011 -0 | | | | | |
|
|
|
|
2023 Devoted BEWELL Arizona (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $45.00 | $45.00 | 3,364 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H6586 -001 -0 | | | | | |
new |
new |
new |
|
2023 Devoted CHOICE Arizona (PPO)
| $0.00 |
$4,900 |
$175 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,364 2023 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 |
2022 Devoted Health Core (HMO)
| $0.00 |
$3,200 |
$0 | Yes, some additional gap coverage. |
H8173 -001 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,349
2022 Formulary |
|
|
|
|
2023 Devoted CORE Arizona (HMO)
| $0.00 |
$3,200 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,364 2023 Formulary |
|
2022 Devoted Health Liberty (HMO)
| $0.00 |
$4,400 |
No Rx Coverage |
H8173 -005 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2023 Devoted LIBERTY Arizona (HMO)
| $0.00 |
$4,400 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2022 --
|
H4869 -003 -0 | | | | | |
new |
new |
new |
|
2023 Dialysis Plus (HMO-POS C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,288 2023 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 2022 --
|
H4869 -005 -0 | | | | | |
new |
new |
new |
|
2023 Honest Care (HMO)
| $0.00 |
$3,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,288 2023 Formulary |
|
2022 Humana Gold Plus H0028-027 (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H0028 -027 -0 | $2.00 | $5.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
|
|
|
|
2023 Humana Gold Plus H0028-027 (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $5.00 | $45.00 | $45.00 | 3,404 2023 Formulary |
|
2022 Humana Gold Plus H0028-028 (HMO)
| $0.00 |
$5,500 |
$225 | No additional gap coverage, only the Donut Hole Discount |
H0028 -028 -0 | $5.00 | $15.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
|
|
|
|
2023 Humana Gold Plus H0028-028 (HMO)
| $0.00 |
$5,500 |
$225 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $45.00 | $45.00 | 3,404 2023 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 |
2022 Humana Gold Plus H0028-052 (HMO)
| $0.00 |
$2,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H0028 -052 -0 | $2.00 | $5.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
|
|
|
|
2023 Humana Gold Plus H0028-052 (HMO)
| $0.00 |
$2,800 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,404 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H2463 -003 -0 | | | | | |
|
-- |
|
|
2023 Humana Gold Plus H2463-003 (HMO)
| $0.00 |
$3,600 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,404 2023 Formulary |
|
2022 Humana Honor (PPO)
| $0.00 |
$4,400 |
No Rx Coverage |
H5216 -213 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2023 Humana Honor (PPO)
| $0.00 |
$4,400 |
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 2022 --
|
H5216 -338 -0 | | | | | |
|
|
|
|
2023 Humana USAA Honor with Rx (PPO)
| $0.00 |
$6,100 |
$480 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,404 2023 Formulary |
|
2022 HumanaChoice H5216-137 (PPO)
| $0.00 |
$7,550 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5216 -137 -0 | $7.00 | $17.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
|
|
|
|
2023 HumanaChoice H5216-137 (PPO)
| $0.00 |
$7,350 |
$445 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $17.00 | $45.00 | $45.00 | 3,404 2023 Formulary |
|
2022 HumanaChoice H5216-265 (PPO)
| $0.00 |
$4,700 |
$250 | No additional gap coverage, only the Donut Hole Discount |
H5216 -265 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
|
|
|
|
2023 HumanaChoice H5216-265 (PPO)
| $0.00 |
$4,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,404 2023 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 |
2022 HumanaChoice R7220-001 (Regional PPO)
| $0.00 |
$6,000 |
No Rx Coverage |
R7220 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
|
-- |
|
|
2023 HumanaChoice R7220-001 (Regional PPO)
| $0.00 |
$6,000 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2022 --
|
H2793 -008 -0 | | | | | |
|
|
|
|
2023 Imperial Courage Plan (HMO)
| $0.00 |
$2,999 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 Imperial Insurance Company Traditional (HMO)
| $0.00 |
$2,999 |
$0 | Yes, some additional gap coverage. |
H2793 -003 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,315
2022 Formulary |
|
|
|
|
2023 Imperial Insurance Company Traditional (HMO)
| $0.00 |
$2,999 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,346 2023 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 |
2022 Imperial Insurance Traditional Plus (HMO)
| $0.00 |
$7,550 |
$480 | No additional gap coverage, only the Donut Hole Discount |
H2793 -007 -0 | | | | | 3,315
2022 Formulary |
|
|
|
|
2023 Imperial Insurance Traditional Plus (HMO)
| $0.00 |
$8,300 |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,346 2023 Formulary |
|
2022 Imperial Insurance Value (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands |
H2793 -005 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,364
2022 Formulary |
|
|
|
|
2023 Imperial Insurance Value (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,387 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H8845 -002 -0 | | | | | |
|
-- |
-- |
|
2023 Molina Medicare Choice Care (HMO)
| $0.00 |
$8,300 |
$125 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 3,221 2023 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 2022 --
|
H8845 -003 -0 | | | | | |
|
-- |
-- |
|
2023 Molina Medicare Choice Care Select (HMO)
| $0.00 |
$8,300 |
$350 | No additional gap coverage, only the Donut Hole Discount | $15.00 | $20.00 | $47.00 | $47.00 | 3,221 2023 Formulary |
|
2022 SCAN Balance (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands |
H1822 -002 -0 | $0.00 | $0.00 | $37.00 | $37.00 | 3,425
2022 Formulary |
|
new |
new |
|
2023 SCAN Balance (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $37.00 | $37.00 | 3,458 2023 Formulary |
|
2022 SCAN Classic (HMO)
| $0.00 |
$2,800 |
$0 | Yes, some additional gap coverage. |
H1822 -001 -0 | $0.00 | $0.00 | $37.00 | $37.00 | 3,425
2022 Formulary |
|
new |
new |
|
2023 SCAN Classic (HMO)
| $0.00 |
$2,800 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $37.00 | $37.00 | 3,458 2023 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 2022 --
|
H1822 -005 -0 | | | | | |
|
new |
new |
|
2023 SCAN Embrace (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $37.00 | $37.00 | 3,458 2023 Formulary |
|
2022 SCAN Heart First (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands |
H1822 -003 -0 | $0.00 | $0.00 | $37.00 | $37.00 | 3,425
2022 Formulary |
|
new |
new |
|
2023 SCAN Heart First (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $37.00 | $37.00 | 3,458 2023 Formulary |
|
2022 SCAN Venture (HMO)
| $0.00 |
$2,999 |
$0 | Yes, some additional gap coverage. |
H1822 -004 -0 | $0.00 | $0.00 | $40.00 | $40.00 | 3,425
2022 Formulary |
|
new |
new |
|
2023 SCAN Venture (HMO)
| $0.00 |
$2,999 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $40.00 | $40.00 | 3,458 2023 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 2022 --
|
H4869 -001 -0 | | | | | |
new |
new |
new |
|
2023 Super Plus (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,288 2023 Formulary |
|
2022 UnitedHealthcare Chronic Complete (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics |
H0609 -042 -0 | $0.00 | $8.00 | $45.00 | $45.00 | 3,654
2022 Formulary |
|
|
|
|
2023 UnitedHealthcare Chronic Complete (HMO-POS C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $45.00 | $45.00 | 3,682 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H0351 -060 -1 | | | | | |
|
-- |
|
|
2023 Wellcare Giveback (HMO)
| $0.00 |
$4,400 |
$350 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $42.00 | $42.00 | 3,392 2023 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 2022 --
|
H0351 -058 -1 | | | | | |
|
-- |
|
|
2023 Wellcare No Premium (HMO)
| $0.00 |
$3,450 |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $37.00 | $37.00 | 3,392 2023 Formulary |
|
2022 Wellcare No Premium Essentials (HMO)
| $0.00 |
$3,450 |
$0 | Yes, some additional gap coverage. |
H5590 -005 -0 | $0.00 | $15.00 | $37.00 | $37.00 | 3,375
2022 Formulary |
|
|
|
|
2023 Wellcare No Premium Essentials (HMO)
| $0.00 |
$6,000 |
$250 | Yes, some additional gap coverage. | $0.00 | $15.00 | $37.00 | $37.00 | 3,392 2023 Formulary |
|
2022 Wellcare No Premium Open (PPO)
| $0.00 |
$5,000 |
$200 | Yes, some additional gap coverage. |
H8553 -001 -0 | $0.00 | $5.00 | $37.00 | $37.00 | 3,375
2022 Formulary |
|
new |
|
|
2023 Wellcare No Premium Open (PPO)
| $0.00 |
$5,000 |
$200 | Yes, some additional gap coverage. | $0.00 | $5.00 | $37.00 | $37.00 | 3,392 2023 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 |
2022 Wellcare Patriot Giveback Open (PPO)
| $0.00 |
$4,400 |
No Rx Coverage |
H8553 -002 -0 | This plan does NOT include Prescription Drug coverage. | |
|
new |
|
|
2023 Wellcare Patriot Giveback Open (PPO)
| $0.00 |
$4,400 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 Wellcare Specialty No Premium (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands |
H0351 -038 -0 | $0.00 | $5.00 | $37.00 | $37.00 | 3,373
2022 Formulary |
|
-- |
|
|
2023 Wellcare Specialty No Premium (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $37.00 | $37.00 | 3,393 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H0351 -059 -1 | | | | | |
|
-- |
|
|
2023 Wellcare Assist (HMO)
| $12.20 |
$3,400 |
$505 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,392 2023 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 |
2022 HumanaChoice H5216-224 (PPO)
| $17.00 |
$4,500 |
$195 | No additional gap coverage, only the Donut Hole Discount |
H5216 -224 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
|
|
|
|
2023 HumanaChoice H5216-224 (PPO)
| $23.00 |
$3,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $45.00 | $45.00 | 3,404 2023 Formulary |
|
2022 AARP Medicare Advantage Walgreens Plan 3 (PPO)
| $25.00 |
$4,000 |
$0 | Yes, some additional gap coverage. |
H2228 -097 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,654
2022 Formulary |
|
|
|
|
2023 AARP Medicare Advantage Walgreens Plan 3 (PPO)
| $25.00 |
$3,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,682 2023 Formulary |
|
2022 Banner Medicare Advantage Plus (PPO)
| $25.00 |
$4,500 |
$0 | Yes, some additional gap coverage. |
H7273 -001 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,490
2022 Formulary |
|
new |
new |
|
2023 Banner Medicare Advantage Plus (PPO)
| $25.00 |
$4,350 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,467 2023 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 |
2022 Wellcare Dual Liberty (HMO D-SNP)
| $40.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H5590 -008 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,375
2022 Formulary |
|
|
|
|
2023 Wellcare Dual Liberty (HMO D-SNP)
| $25.20 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,394 2023 Formulary |
|
2022 Devoted Health Select (HMO)
| $39.70 |
$3,200 |
$480 | No additional gap coverage, only the Donut Hole Discount |
H8173 -002 -0 | $0.00 | $0.00 | 25% | 25% | 3,349
2022 Formulary |
|
|
|
|
2023 Devoted SELECT Arizona (HMO)
| $28.40 |
$3,200 |
$150 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,364 2023 Formulary |
|
2022 AARP Medicare Advantage Plan 3 (HMO)
| $30.00 |
$2,500 |
$0 | Yes, some additional gap coverage. |
H0609 -044 -0 | $0.00 | $8.00 | $45.00 | $45.00 | 3,654
2022 Formulary |
|
|
|
|
2023 AARP Medicare Advantage Plan 3 (HMO-POS)
| $30.00 |
$2,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $45.00 | $45.00 | 3,682 2023 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 |
2022 Humana Value Plus H5216-197 (PPO)
| $29.60 |
$7,550 |
$450 | No additional gap coverage, only the Donut Hole Discount |
H5216 -197 -0 | $5.00 | $18.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
|
|
|
|
2023 Humana Value Plus H5216-197 (PPO)
| $36.30 |
$7,550 |
$450 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $16.00 | 23% | 23% | 3,404 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H8173 -014 -0 | | | | | |
|
|
|
|
2023 Devoted BEWELL PLUS Arizona (HMO C-SNP)
| $37.50 |
n/a |
$505 | Yes, some additional gap coverage. | 25% | 25% | 25% | 25% | 3,364 2023 Formulary |
|
2022 Humana Gold Plus H0028-023 (HMO)
| $50.00 |
$6,700 |
$225 | No additional gap coverage, only the Donut Hole Discount |
H0028 -023 -0 | $4.00 | $10.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
|
|
|
|
2023 Humana Gold Plus H0028-023 (HMO)
| $41.00 |
$6,700 |
$225 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $10.00 | $45.00 | $45.00 | 3,404 2023 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 |
2022 Banner Medicare Advantage Dual (HMO D-SNP)
| $26.30 |
n/a |
$480 | Few Generics |
H4931 -007 -0 | 25% | 25% | 25% | 25% | 3,490
2022 Formulary |
|
|
|
|
2023 Banner Medicare Advantage Dual (HMO D-SNP)
| $41.60 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,467 2023 Formulary |
|
2022 Banner Medicare Advantage Dual (HMO D-SNP)
| $37.30 |
n/a |
$480 | Few Generics |
H4931 -015 -0 | 25% | 25% | 25% | 25% | 3,490
2022 Formulary |
|
|
|
|
2023 Banner Medicare Advantage Dual (HMO D-SNP)
| $42.60 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,467 2023 Formulary |
|
2022 Health Choice Pathway (HMO D-SNP)
| $40.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H5587 -002 -0 | | | | | 3,251
2022 Formulary |
|
|
|
|
2023 BCBSAZ Health Choice Pathway (HMO D-SNP)
| $42.60 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,258 2023 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 2022 --
|
H4869 -004 -0 | | | | | |
new |
new |
new |
|
2023 Dialysis Complete (HMO-POS C-SNP)
| $42.60 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,288 2023 Formulary |
|
2022 Mercy Care Advantage (HMO D-SNP)
| $40.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H5580 -001 -0 | | | | | 3,251
2022 Formulary |
|
|
|
|
2023 Mercy Care Advantage (HMO D-SNP)
| $42.60 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,258 2023 Formulary |
|
2022 Mercy Care Advantage (HMO D-SNP)
| $40.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H5580 -004 -0 | | | | | 3,251
2022 Formulary |
|
|
|
|
2023 Mercy Care Advantage (HMO D-SNP)
| $42.60 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,258 2023 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 |
2022 Mercy Care Advantage (HMO D-SNP)
| $40.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H5580 -005 -0 | | | | | 3,251
2022 Formulary |
|
|
|
|
2023 Mercy Care Advantage (HMO D-SNP)
| $42.60 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,258 2023 Formulary |
|
2022 Molina Medicare Complete Care (HMO D-SNP)
| $40.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H8845 -001 -0 | | | | | 3,263
2022 Formulary |
|
-- |
-- |
|
2023 Molina Medicare Complete Care (HMO D-SNP)
| $42.60 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,270 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H4869 -002 -0 | | | | | |
new |
new |
new |
|
2023 Super Complete (HMO C-SNP)
| $42.60 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | 25% | 25% | 25% | 25% | 3,288 2023 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 |
2022 UnitedHealthcare Dual Complete LP (HMO D-SNP)
| $40.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H0321 -002 -0 | | | | | 3,654
2022 Formulary |
|
|
|
|
2023 UnitedHealthcare Dual Complete LP (HMO-POS D-SNP)
| $42.60 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,682 2023 Formulary |
|
2022 UnitedHealthcare Dual Complete ONE (HMO D-SNP)
| $40.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H0321 -004 -0 | | | | | 3,654
2022 Formulary |
|
|
|
|
2023 UnitedHealthcare Dual Complete ONE (HMO-POS D-SNP)
| $42.60 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,682 2023 Formulary |
|
2022 UnitedHealthcare Nursing Home Plan (PPO I-SNP)
| $40.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H0710 -005 -0 | | | | | 3,654
2022 Formulary |
|
-- |
|
|
2023 UnitedHealthcare Nursing Home Plan (PPO I-SNP)
| $42.60 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,682 2023 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 |
2022 Blue Medicare Advantage Plus (HMO)
| $48.00 |
$4,250 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H0302 -001 -0 | $0.00 | $9.00 | $47.00 | $47.00 | 3,510
2022 Formulary |
|
|
|
|
2023 Blue Medicare Advantage Plus (HMO)
| $51.00 |
$2,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $9.00 | $47.00 | $47.00 | 3,506 2023 Formulary |
|
2022 HumanaChoice R7220-002 (Regional PPO)
| $60.00 |
$6,700 |
$440 | No additional gap coverage, only the Donut Hole Discount |
R7220 -002 -0 | $4.00 | $15.00 | 24% | 24% | 3,421
2022 Formulary |
|
-- |
|
|
2023 HumanaChoice R7220-002 (Regional PPO)
| $56.00 |
$6,700 |
$505 | No additional gap coverage, only the Donut Hole Discount | $12.00 | $15.00 | 21% | 21% | 3,409 2023 Formulary |
|
2022 BlueJourney (PPO)
| $59.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5140 -001 -0 | $0.00 | $9.00 | $47.00 | $47.00 | 3,510
2022 Formulary |
|
|
|
|
2023 BlueJourney (PPO)
| $68.00 |
$3,600 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $9.00 | $47.00 | $47.00 | 3,506 2023 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 |
2022 Aetna Medicare Platinum Plan (PPO)
| $85.00 |
$6,500 |
$0 | Yes, some additional gap coverage. |
H5521 -184 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,672
2022 Formulary |
|
|
|
|
2023 Aetna Medicare Platinum Plan (PPO)
| $83.00 |
$6,500 |
$175 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,597 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H5216 -335 -0 | | | | | |
|
|
|
|
2023 HumanaChoice H5216-335 (PPO)
| $96.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $2.00 | $45.00 | $45.00 | 3,404 2023 Formulary |
|
2022 HumanaChoice H5216-034 (PPO)
| $119.00 |
$7,550 |
$225 | No additional gap coverage, only the Donut Hole Discount |
H5216 -034 -0 | $5.00 | $15.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
|
|
|
|
2023 HumanaChoice H5216-034 (PPO)
| $118.00 |
$7,550 |
$225 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $45.00 | $45.00 | 3,404 2023 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 |
2022 BluePathway Plan 3 (HMO)
| $32.00 |
$2,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H6936 -004 -0 | $0.00 | $7.00 | $47.00 | $47.00 | 3,510
2022 Formulary |
|
|
|
|
-- Members will be assigned to BluePathway Plan 2 (HMO) H6936-003 --
| | | | | |
|
2022 Devoted Health Advance (HMO C-SNP)
| $0.00 |
n/a |
$0 | Few Generics |
H8173 -004 -0 | $0.00 | $0.00 | $45.00 | $45.00 | 3,349
2022 Formulary |
|
|
|
|
-- Members will be assigned to Devoted BEWELL Arizona (HMO C-SNP) H8173-011 --
| | | | | |
|
2022 Devoted Health Essence (HMO C-SNP)
| $0.00 |
n/a |
$0 | Few Generics |
H8173 -006 -0 | $0.00 | $0.00 | $45.00 | $45.00 | 3,349
2022 Formulary |
|
|
|
|
-- Members will be assigned to Devoted BEWELL Arizona (HMO C-SNP) H8173-011 --
| | | | | |
|
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 |
2022 Devoted Health Flex (HMO)
| $45.00 |
$4,200 |
$0 | Yes, some additional gap coverage. |
H8173 -003 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,349
2022 Formulary |
|
|
|
|
-- Members will be assigned to Devoted CORE Arizona (HMO) H8173-001 --
| | | | | |
|
2022 Wellcare No Premium Rx Plus Open (PPO)
| $0.00 |
$6,000 |
$300 | Yes, some additional gap coverage. |
H8553 -003 -0 | $0.00 | $5.00 | $37.00 | $37.00 | 3,375
2022 Formulary |
|
|
|
|
-- Members will be assigned to Wellcare No Premium Open (PPO) H8553-001 --
| | | | | |
|
2022 Wellcare No Premium (HMO)
| $0.00 |
$3,000 |
$0 | Yes, some additional gap coverage. |
H0351 -052 -0 | $0.00 | $8.00 | $37.00 | $37.00 | 3,375
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|
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 |
2022 Wellcare Assist (HMO)
| $35.00 |
$3,400 |
$480 | No additional gap coverage, only the Donut Hole Discount |
H0351 -055 -0 | $0.00 | $15.00 | $45.00 | $45.00 | 3,375
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|
2022 Wellcare Giveback (HMO)
| $0.00 |
$3,450 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H0351 -056 -0 | $0.00 | $15.00 | $37.00 | $37.00 | 3,375
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|
2022 Bright Advantage Classic Care Plan (HMO)
| $0.00 |
$2,800 |
$0 | Yes, some additional gap coverage. |
H4853 -001 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,133
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|
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 |
2022 Bright Advantage Classic Choice Plan (HMO)
| $39.20 |
$3,200 |
$480 | Yes, some additional gap coverage. |
H4853 -002 -0 | $0.00 | 25% | 25% | 25% | 3,133
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|
2022 Bright Advantage Embrace Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics |
H4853 -016 -0 | $0.00 | $9.00 | $47.00 | $47.00 | 3,133
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|
2022 Bright Advantage Embrace Choice Plan (HMO C-SNP)
| $40.00 |
n/a |
$480 | Some Generics |
H4853 -017 -0 | $0.00 | 25% | 25% | 25% | 3,133
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|
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 |
2022 Bright Advantage Harmony Choice Plan (HMO C-SNP)
| $40.00 |
n/a |
$480 | Some Generics |
H4853 -018 -0 | $0.00 | 25% | 25% | 25% | 3,133
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|
2022 Bright Advantage Embrace Assist Plan (HMO C-SNP)
| $40.00 |
n/a |
$480 | Some Generics |
H4853 -020 -0 | $0.00 | 25% | 25% | 25% | 3,133
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|
2022 Global Classic (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H9078 -001 -0 | $5.00 | $15.00 | $42.00 | $42.00 | 3,188
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|
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 |
2022 Global Special Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics, Few Brands |
H9078 -007 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,188
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|
2022 Global Special Care Savings (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics, Few Brands |
H9078 -008 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,188
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|