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 |
-- This plan not offered in 2022 --
|
H0543 -225 -0 | | | | | |
|
|
|
|
2023 AARP Medicare Advantage Freedom Plus (HMO-POS)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,682 2023 Formulary |
|
2022 AARP Medicare Advantage Patriot (HMO)
| $0.00 |
$4,900 |
No Rx Coverage |
H0543 -121 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2023 AARP Medicare Advantage Patriot (HMO-POS)
| $0.00 |
$4,900 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 AARP Medicare Advantage SecureHorizons Plan 4 (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H0543 -152 -0 | $5.00 | $11.00 | $47.00 | $47.00 | 3,654
2022 Formulary |
|
|
|
|
2023 AARP Medicare Advantage SecureHorizons Plan 4 (HMO-POS)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 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 Aetna Medicare Eagle Plan (HMO)
| $0.00 |
$4,200 |
No Rx Coverage |
H4982 -013 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2023 Aetna Medicare Eagle Plan (HMO)
| $0.00 |
$4,200 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2022 --
|
H5521 -369 -0 | | | | | |
|
|
|
|
2023 Aetna Medicare Eagle Plus Plan (PPO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 Aetna Medicare Plus Plan (HMO)
| $0.00 |
$2,000 |
$0 | Yes, some additional gap coverage. |
H4982 -004 -0 | $0.00 | $0.00 | $37.00 | $37.00 | 3,698
2022 Formulary |
|
|
|
|
2023 Aetna Medicare Plus Plan (HMO)
| $0.00 |
$2,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $37.00 | $37.00 | 3,622 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 Select Plan (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H0523 -052 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,672
2022 Formulary |
|
|
|
|
2023 Aetna Medicare Select Plan (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,597 2023 Formulary |
|
2022 Align Connect (HMO C-SNP)
| $0.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H3274 -003 -0 | $2.00 | $15.00 | $45.00 | $45.00 | 3,860
2022 Formulary |
|
new |
new |
|
2023 Align Connect (HMO C-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $45.00 | $45.00 | 3,833 2023 Formulary |
|
2022 Align Thrive (HMO I-SNP)
| $0.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H3274 -002 -0 | $2.00 | $15.00 | $45.00 | $45.00 | 3,860
2022 Formulary |
|
new |
new |
|
2023 Align Thrive (HMO I-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $45.00 | $45.00 | 3,833 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 --
|
H3815 -026 -0 | | | | | |
|
|
|
|
2023 Alignment Health AVA (HMO-POS)
| $0.00 |
$1,999 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $40.00 | $40.00 | 3,467 2023 Formulary |
|
2022 AVA (PPO)
| $22.50 |
$3,900 |
$0 | Yes, some additional gap coverage. |
H4961 -007 -0 | $0.00 | $5.00 | $40.00 | $40.00 | 3,450
2022 Formulary |
|
|
|
|
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 |
|
-- This plan not offered in 2022 --
|
H3815 -036 -0 | | | | | |
|
|
|
|
2023 Alignment Health CalPlus + Veterans (HMO)
| $0.00 |
$5,900 |
$505 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | 25% | 25% | 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 Harmony (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. |
H3815 -031 -0 | $0.00 | $3.00 | $40.00 | $40.00 | 3,450
2022 Formulary |
|
|
|
|
2023 Alignment Health Harmony (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $40.00 | $40.00 | 3,467 2023 Formulary |
|
2022 Heart & Diabetes (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics |
H3815 -010 -0 | $0.00 | $5.00 | $30.00 | $30.00 | 3,450
2022 Formulary |
|
|
|
|
2023 Alignment Health Heart & Diabetes (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $30.00 | $30.00 | 3,467 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H3815 -007 -0 | | | | | |
|
|
|
|
2023 Alignment Health My Choice CalPlus (HMO)
| $0.00 |
$3,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $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 Platinum (HMO)
| $0.00 |
$998 |
$0 | Yes, some additional gap coverage. |
H3815 -016 -0 | $0.00 | $3.00 | $30.00 | $30.00 | 3,450
2022 Formulary |
|
|
|
|
2023 Alignment Health Platinum (HMO)
| $0.00 |
$998 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $30.00 | $30.00 | 3,467 2023 Formulary |
|
2022 Select (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H3815 -032 -0 | $0.00 | $3.00 | $40.00 | $40.00 | 3,450
2022 Formulary |
|
|
|
|
2023 Alignment Health Select (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $40.00 | $40.00 | 3,467 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H3815 -013 -0 | | | | | |
|
|
|
|
2023 Alignment Health smartHMO (HMO)
| $0.00 |
$2,499 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $30.00 | $30.00 | 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 the ONE + Rite Aid (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H3815 -034 -0 | $0.00 | $1.00 | $40.00 | $40.00 | 3,450
2022 Formulary |
|
|
|
|
2023 Alignment Health the ONE + Rite Aid (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $1.00 | $40.00 | $40.00 | 3,467 2023 Formulary |
|
2022 Anthem MediBlue Plus (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H0544 -065 -0 | $0.00 | $7.00 | $42.00 | $42.00 | 3,626
2022 Formulary |
|
|
|
|
2023 Anthem MediBlue Plus (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $7.00 | $42.00 | $42.00 | 3,603 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H4161 -003 -0 | | | | | |
new |
new |
new |
|
2023 Anthem MediBlue Prime (HMO)
| $0.00 |
$2,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 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 Anthem MediBlue Select (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. |
H0544 -091 -0 | $0.00 | $7.00 | $42.00 | $42.00 | 3,604
2022 Formulary |
|
|
|
|
2023 Anthem MediBlue Select (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $7.00 | $42.00 | $42.00 | 3,583 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H1993 -007 -0 | | | | | |
|
new |
|
|
2023 Astiva Health C-SNP Savings (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $4.00 | $28.00 | $28.00 | 3,387 2023 Formulary |
|
2022 Astiva Health Advantage (HMO)
| $0.00 |
$845 |
$0 | Yes, some additional gap coverage. |
H1993 -003 -0 | $0.00 | $0.00 | $32.00 | $32.00 | 3,315
2022 Formulary |
|
new |
|
|
2023 Astiva Health Classic Plan (HMO)
| $0.00 |
$650 |
$0 | Yes, some additional gap coverage. | $0.00 | $4.00 | $28.00 | $28.00 | 3,387 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 --
|
H1993 -001 -0 | | | | | |
|
new |
|
|
2023 Astiva Health Savings Plan (HMO)
| $0.00 |
$3,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $45.00 | $45.00 | 3,387 2023 Formulary |
|
2022 Blue Shield 65 Plus (HMO)
| $0.00 |
$3,399 |
$0 | Yes, some additional gap coverage. |
H0504 -028 -0 | $0.00 | $3.00 | $35.00 | $35.00 | 3,656
2022 Formulary |
|
|
|
|
2023 Blue Shield 65 Plus (HMO)
| $0.00 |
$3,399 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $35.00 | $35.00 | 3,677 2023 Formulary |
|
2022 Blue Shield AdvantageOptimum Plan 1 (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H5928 -010 -0 | $0.00 | $5.00 | $40.00 | $40.00 | 3,251
2022 Formulary |
|
|
|
|
2023 Blue Shield AdvantageOptimum Plan 1 (HMO)
| $0.00 |
$3,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $40.00 | $40.00 | 3,290 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 Brand New Day Bridges Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics |
H0838 -028 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,133
2022 Formulary |
|
|
|
|
2023 Brand New Day Bridges Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,467 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H0838 -050 -1 | | | | | |
|
|
|
|
2023 Brand New Day Classic Care I Plan (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,467 2023 Formulary |
|
2022 Brand New Day Embrace Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics |
H0838 -039 -1 | $0.00 | $9.00 | $47.00 | $47.00 | 3,133
2022 Formulary |
|
|
|
|
2023 Brand New Day Embrace Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $9.00 | $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 Brand New Day Part B Savings Plan (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. |
H0838 -049 -0 | $0.00 | $12.00 | $47.00 | $47.00 | 3,133
2022 Formulary |
|
|
|
|
2023 Brand New Day Part B Savings Plan (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | 3,467 2023 Formulary |
|
2022 Brand New Day Select Care II Plan (HMO I-SNP)
| $0.00 |
n/a |
$0 | Some Generics |
H0838 -043 -0 | $0.00 | $12.00 | $47.00 | $47.00 | 3,133
2022 Formulary |
|
|
|
|
2023 Brand New Day Select Care II Plan (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | 3,467 2023 Formulary |
|
2022 Brand New Day Valor Care Plan (HMO)
| $0.00 |
$4,500 |
No Rx Coverage |
H0838 -048 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2023 Brand New Day Valor Care Plan (HMO)
| $0.00 |
$3,000 |
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 |
2022 Clever Care Fortune Medicare Advantage Plan (HMO)
| $0.00 |
$888 |
$0 | Yes, some additional gap coverage. |
H7607 -007 -3 | $0.00 | $0.00 | $35.00 | $35.00 | 3,510
2022 Formulary |
|
|
|
|
2023 Clever Care Fortune Medicare Advantage (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,506 2023 Formulary |
|
2022 Clever Care Longevity Medicare Advantage (HMO)
| $0.00 |
$1,700 |
$0 | Yes, some additional gap coverage. |
H7607 -002 -3 | $0.00 | $0.00 | $35.00 | $35.00 | 3,510
2022 Formulary |
|
|
|
|
2023 Clever Care Longevity Medicare Advantage (HMO)
| $0.00 |
$1,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,506 2023 Formulary |
|
2022 Clever Care Value Medicare Advantage Plan (HMO)
| $0.00 |
$3,000 |
$0 | Yes, some additional gap coverage. |
H7607 -008 -3 | $0.00 | $10.00 | $47.00 | $47.00 | 3,510
2022 Formulary |
|
|
|
|
2023 Clever Care Value Medicare Advantage (HMO)
| $0.00 |
$5,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $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 Humana Gold Plus H5619-016 (HMO)
| $0.00 |
$3,200 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5619 -016 -0 | $5.00 | $15.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
|
|
|
|
2023 Humana Gold Plus H5619-016 (HMO)
| $0.00 |
$3,200 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $47.00 | $47.00 | 3,404 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H5619 -150 -0 | | | | | |
|
|
|
|
2023 Humana Gold Plus H5619-150 (HMO)
| $0.00 |
$5,000 |
$100 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $47.00 | $47.00 | 3,404 2023 Formulary |
|
2022 Humana Honor (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H5619 -120 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2023 Humana Honor (HMO)
| $0.00 |
$3,500 |
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 |
-- This plan not offered in 2022 --
|
H5525 -057 -0 | | | | | |
|
|
|
|
2023 Humana USAA Honor with Rx (PPO)
| $0.00 |
$5,900 |
$350 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,404 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H5496 -016 -0 | | | | | |
|
-- |
|
|
2023 Imperial Courage Plan (HMO)
| $0.00 |
$2,999 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 Imperial Dynamic Plan (HMO)
| $0.00 |
$899 |
$0 | Yes, some additional gap coverage. |
H5496 -012 -0 | $0.00 | $3.00 | $30.00 | $30.00 | 3,315
2022 Formulary |
|
-- |
|
|
2023 Imperial Dynamic Plan (HMO)
| $0.00 |
$899 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $30.00 | $30.00 | 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 Senior Value (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands |
H5496 -005 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,364
2022 Formulary |
|
-- |
|
|
2023 Imperial Senior 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 |
|
2022 Imperial Strong (HMO)
| $0.00 |
$7,550 |
$480 | No additional gap coverage, only the Donut Hole Discount |
H5496 -014 -0 | | | | | 3,315
2022 Formulary |
|
-- |
|
|
2023 Imperial Strong (HMO)
| $0.00 |
$8,300 |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,346 2023 Formulary |
|
2022 Imperial Traditional (HMO)
| $0.00 |
$2,999 |
$0 | Yes, some additional gap coverage. |
H5496 -007 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,315
2022 Formulary |
|
-- |
|
|
2023 Imperial 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 Kaiser Permanente Senior Advantage San Diego (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H0524 -037 -0 | $0.00 | $7.00 | $47.00 | $47.00 | 4,211
2022 Formulary |
|
|
|
|
2023 Kaiser Permanente Senior Advantage San Diego (HMO)
| $0.00 |
$1,999 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $40.00 | $40.00 | 3,388 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H0524 -082 -0 | | | | | |
|
|
|
|
2023 Kaiser Permanente Senior Advantage San Diego Value (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $40.00 | $40.00 | 3,388 2023 Formulary |
|
2022 Molina Medicare Choice Care (HMO)
| $0.00 |
$7,550 |
$125 | No additional gap coverage, only the Donut Hole Discount |
H5810 -014 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,218
2022 Formulary |
|
-- |
|
|
2023 Molina Medicare Choice Care (HMO)
| $0.00 |
$8,300 |
$0 | 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 |
2022 Molina Medicare Choice Care Select (HMO)
| $0.00 |
$7,550 |
$480 | No additional gap coverage, only the Donut Hole Discount |
H5810 -015 -0 | $15.00 | $20.00 | $47.00 | $47.00 | 3,218
2022 Formulary |
|
-- |
|
|
2023 Molina Medicare Choice Care Select (HMO)
| $0.00 |
$8,300 |
$450 | No additional gap coverage, only the Donut Hole Discount | $15.00 | $20.00 | $47.00 | $47.00 | 3,221 2023 Formulary |
|
2022 SCAN Alta (HMO)
| $0.00 |
$900 |
$0 | Yes, some additional gap coverage. |
H5425 -082 -0 | $0.00 | $0.00 | $30.00 | $30.00 | 3,425
2022 Formulary |
|
|
|
|
2023 SCAN Alta (HMO)
| $0.00 |
$900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $25.00 | $25.00 | 3,458 2023 Formulary |
|
2022 Scripps Classic offered by SCAN Health Plan (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H5425 -005 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,425
2022 Formulary |
|
|
|
|
2023 Scripps Classic offered by SCAN Health Plan (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 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 |
2022 Sharp Direct Advantage Gold Card (HMO)
| $0.00 |
$2,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5386 -003 -0 | $2.00 | $8.00 | $40.00 | $40.00 | 3,188
2022 Formulary |
|
|
|
|
2023 Sharp Direct Advantage Gold Card (HMO)
| $0.00 |
$2,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $40.00 | $40.00 | 3,196 2023 Formulary |
|
2022 Sharp Direct Advantage VIP Plan (HMO)
| $0.00 |
$2,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5386 -005 -0 | $2.00 | $8.00 | $40.00 | $40.00 | 3,188
2022 Formulary |
|
|
|
|
2023 Sharp Direct Advantage VIP Plan (HMO)
| $0.00 |
$2,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $40.00 | $40.00 | 3,196 2023 Formulary |
|
2022 Sharp SecureHorizons Plan by UnitedHealthcare (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H0543 -145 -0 | $4.00 | $10.00 | $47.00 | $47.00 | 3,654
2022 Formulary |
|
|
|
|
2023 Sharp SecureHorizons Plan by UnitedHealthcare (HMO-POS)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $4.00 | $10.00 | $47.00 | $47.00 | 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 Sharp Walgreens by UnitedHealthcare (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. |
H0543 -204 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,654
2022 Formulary |
|
|
|
|
2023 Sharp Walgreens by UnitedHealthcare (HMO-POS)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,682 2023 Formulary |
|
2022 UC San Diego Health Humana (HMO)
| $0.00 |
$2,800 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5619 -131 -0 | $0.00 | $3.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
|
|
|
|
2023 UC San Diego Health Humana (HMO)
| $0.00 |
$2,200 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $47.00 | $47.00 | 3,404 2023 Formulary |
|
2022 UnitedHealthcare Chronic Complete Focus (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics |
H0543 -214 -0 | $4.00 | $10.00 | $47.00 | $47.00 | 3,654
2022 Formulary |
|
|
|
|
2023 UnitedHealthcare Chronic Complete Focus (HMO-POS C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 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 Wellcare No Premium (HMO)
| $0.00 |
$3,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H0562 -012 -0 | $5.00 | $10.00 | $37.00 | $37.00 | 3,375
2022 Formulary |
|
|
|
|
2023 Wellcare No Premium (HMO)
| $0.00 |
$3,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $37.00 | $37.00 | 3,392 2023 Formulary |
|
2022 Wellcare Specialty No Premium (HMO C-SNP)
| $0.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H0562 -114 -0 | $0.00 | $10.00 | $37.00 | $37.00 | 3,373
2022 Formulary |
|
|
|
|
2023 Wellcare Specialty No Premium (HMO C-SNP)
| $0.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $37.00 | $37.00 | 3,393 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H4982 -016 -0 | | | | | |
|
|
|
|
2023 Aetna Medicare Preferred Plan (HMO D-SNP)
| $14.80 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 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 Anthem MediBlue Extra (HMO)
| $25.70 |
$900 |
$480 | Yes, some additional gap coverage. |
H0544 -081 -0 | $0.00 | $2.00 | $47.00 | $47.00 | 3,604
2022 Formulary |
|
|
|
|
2023 Anthem MediBlue Extra (HMO)
| $23.00 |
$800 |
$505 | Yes, some additional gap coverage. | $0.00 | $2.00 | $47.00 | $47.00 | 3,583 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H0562 -129 -0 | | | | | |
|
|
|
|
2023 Wellcare Dual Align 129 (HMO D-SNP)
| $23.10 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,394 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H5619 -148 -0 | | | | | |
|
|
|
|
2023 Humana Gold Plus H5619-148 (HMO)
| $24.00 |
$3,200 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $40.00 | $40.00 | 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 AARP Medicare Advantage SecureHorizons Value (HMO)
| $25.00 |
$5,300 |
$0 | Yes, some additional gap coverage. |
H0543 -013 -0 | $4.00 | $10.00 | $47.00 | $47.00 | 3,654
2022 Formulary |
|
|
|
|
2023 AARP Medicare Advantage SecureHorizons Value (HMO-POS)
| $25.00 |
$5,300 |
$0 | Yes, some additional gap coverage. | $4.00 | $10.00 | $47.00 | $47.00 | 3,682 2023 Formulary |
|
2022 Scripps Heart First offered by SCAN Health Plan (HMO C-SNP)
| $26.00 |
n/a |
$0 | Some Generics |
H5425 -055 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,425
2022 Formulary |
|
|
|
|
2023 Scripps Heart First offered by SCAN Health Plan (HMO C-SNP)
| $26.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 3,458 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H0524 -071 -0 | | | | | |
|
|
|
|
2023 Senior Advantage Medicare Medi-Cal San Diego (HMO D-SNP)
| $29.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,388 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 Anthem MediBlue ESRD Care (PPO C-SNP)
| $33.20 |
n/a |
$130 | Few Generics |
H8552 -028 -0 | $1.00 | $6.00 | $42.00 | $42.00 | 3,603
2022 Formulary |
|
-- |
|
|
2023 Anthem MediBlue ESRD Care (PPO C-SNP)
| $29.30 |
n/a |
$130 | Yes, some additional gap coverage. | $1.00 | $6.00 | $42.00 | $42.00 | 3,579 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H0838 -051 -2 | | | | | |
|
|
|
|
2023 Brand New Day Classic Care II Plan (HMO)
| $36.70 |
$1,999 |
$50 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | 3,467 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H5425 -030 -0 | | | | | |
|
|
|
|
2023 SCAN Connections at Home (HMO D-SNP)
| $37.60 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 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 |
2022 Align Premier (HMO I-SNP)
| $26.70 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H3274 -001 -0 | | | | | 3,712
2022 Formulary |
|
new |
new |
|
2023 Align Premier (HMO I-SNP)
| $38.90 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,683 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H1993 -008 -0 | | | | | |
|
new |
|
|
2023 Astiva Health C-SNP Premium (HMO C-SNP)
| $38.90 |
n/a |
$505 | Yes, some additional gap coverage. | $0.00 | $4.00 | $28.00 | $28.00 | 3,387 2023 Formulary |
|
2022 Blue Shield TotalDual Plan (HMO D-SNP)
| $33.20 |
n/a |
$480 | Few Generics |
H5928 -005 -0 | $0.00 | 25% | 25% | 25% | 3,251
2022 Formulary |
|
|
|
|
2023 Blue Shield TotalDual Plan (HMO D-SNP)
| $38.90 |
n/a |
$505 | Yes, some additional gap coverage. | $0.00 | 25% | 25% | 25% | 3,290 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 Brand New Day Bridges Choice Plan (HMO C-SNP)
| $33.20 |
n/a |
$480 | Some Generics |
H0838 -029 -0 | $0.00 | 25% | 25% | 25% | 3,133
2022 Formulary |
|
|
|
|
2023 Brand New Day Bridges Choice Plan (HMO C-SNP)
| $38.90 |
n/a |
$505 | Yes, some additional gap coverage. | $0.00 | 25% | 25% | 25% | 3,467 2023 Formulary |
|
2022 Brand New Day Embrace Choice Plan (HMO C-SNP)
| $33.20 |
n/a |
$480 | Some Generics |
H0838 -040 -1 | $0.00 | 25% | 25% | 25% | 3,133
2022 Formulary |
|
|
|
|
2023 Brand New Day Embrace Choice Plan (HMO C-SNP)
| $38.90 |
n/a |
$505 | Yes, some additional gap coverage. | $0.00 | 25% | 25% | 25% | 3,467 2023 Formulary |
|
2022 Brand New Day Select Choice II Plan (HMO I-SNP)
| $33.20 |
n/a |
$480 | Some Generics |
H0838 -045 -0 | $0.00 | 25% | 25% | 25% | 3,133
2022 Formulary |
|
|
|
|
2023 Brand New Day Select Choice II Plan (HMO I-SNP)
| $38.90 |
n/a |
$505 | Yes, some additional gap coverage. | $0.00 | 25% | 25% | 25% | 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 |
-- This plan not offered in 2022 --
|
H4733 -001 -0 | | | | | |
new |
new |
new |
|
2023 CommuniCare Advantage (HMO SNP) (HMO D-SNP)
| $38.90 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,288 2023 Formulary |
|
2022 Molina Medicare Complete Care (HMO D-SNP)
| $33.20 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H5810 -001 -0 | $0.00 | $14.00 | $40.00 | $40.00 | 3,263
2022 Formulary |
|
-- |
|
|
2023 Molina Medicare Complete Care (HMO D-SNP)
| $38.90 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $14.00 | $40.00 | $40.00 | 3,270 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H5810 -016 -0 | | | | | |
|
-- |
|
|
2023 Molina Medicare Complete Care Plus (HMO D-SNP)
| $38.90 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $14.00 | $40.00 | $40.00 | 3,270 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 --
|
H5425 -010 -0 | | | | | |
|
|
|
|
2023 SCAN Connections (HMO D-SNP)
| $38.90 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,458 2023 Formulary |
|
2022 Sharp Direct Advantage Platinum Card (HMO)
| $58.00 |
$2,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5386 -004 -0 | $2.00 | $8.00 | $40.00 | $40.00 | 3,188
2022 Formulary |
|
|
|
|
2023 Sharp Direct Advantage Platinum Card (HMO)
| $58.00 |
$2,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $40.00 | $40.00 | 3,196 2023 Formulary |
|
2022 AARP Medicare Advantage SecureHorizons Premier (HMO)
| $69.00 |
$4,300 |
$0 | Yes, some additional gap coverage. |
H0543 -060 -0 | $4.00 | $10.00 | $47.00 | $47.00 | 3,654
2022 Formulary |
|
|
|
|
2023 AARP Medicare Advantage SecureHorizons Premier (HMO-POS)
| $67.00 |
$4,300 |
$0 | Yes, some additional gap coverage. | $4.00 | $10.00 | $47.00 | $47.00 | 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 |
-- This plan not offered in 2022 --
|
H4937 -002 -0 | | | | | |
|
|
|
|
2023 Blue Shield Select (PPO)
| $67.00 |
$4,200 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $40.00 | $40.00 | 3,455 2023 Formulary |
|
2022 Scripps Signature offered by SCAN Health Plan (HMO)
| $74.00 |
$2,500 |
$0 | Yes, some additional gap coverage. |
H5425 -004 -0 | $0.00 | $3.00 | $37.00 | $37.00 | 3,425
2022 Formulary |
|
|
|
|
2023 Scripps Signature offered by SCAN Health Plan (HMO)
| $74.00 |
$2,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $37.00 | $37.00 | 3,458 2023 Formulary |
|
2022 Aetna Medicare Choice Plan (PPO)
| $90.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H5521 -053 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,672
2022 Formulary |
|
|
|
|
2023 Aetna Medicare Choice Plan (PPO)
| $87.00 |
$5,500 |
$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 UnitedHealthcare Medicare Advantage Assure (HMO)
| $24.00 |
$7,550 |
$480 | No additional gap coverage, only the Donut Hole Discount |
H0543 -172 -0 | | | | | 3,654
2022 Formulary |
|
|
|
|
-- Members will be assigned to AARP Medicare Advantage SecureHorizons Value (HMO-POS) H0543-013 --
| | | | | |
|
2022 AVA (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. |
H3815 -027 -0 | $0.00 | $3.00 | $40.00 | $40.00 | 3,450
2022 Formulary |
|
|
|
|
-- Members will be assigned to Alignment Health AVA (HMO-POS) H3815-026 --
| | | | | |
|
2022 Anthem MediBlue Coordination Plus (HMO)
| $3.70 |
$7,550 |
$480 | Yes, some additional gap coverage. |
H0544 -070 -0 | $0.00 | $9.00 | $47.00 | $47.00 | 3,604
2022 Formulary |
|
|
|
|
-- Members will be assigned to Anthem MediBlue Plus (HMO) H0544-065 --
| | | | | |
|
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 Shield Coordinated Choice Plan (HMO)
| $33.20 |
$6,700 |
$480 | Yes, some additional gap coverage. |
H5928 -037 -0 | $0.00 | 25% | 25% | 25% | 3,251
2022 Formulary |
|
|
|
|
-- Members will be assigned to Blue Shield 65 Plus Choice Plan (HMO) H0504-040 --
| | | | | |
|
2022 Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics, All Brands |
H0148 -001 -0 | | | | | 3,251
2022 Formulary |
|
|
|
|
-- Members will be assigned to Blue Shield TotalDual Plan (HMO D-SNP) H5928-005 --
| | | | | |
|
2022 Brand New Day Classic Care I Plan (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. |
H0838 -025 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,133
2022 Formulary |
|
|
|
|
-- Members will be assigned to Brand New Day Classic Care I Plan (HMO) H0838-050 --
| | | | | |
|
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 Brand New Day Classic Care II Plan (HMO)
| $0.00 |
$999 |
$50 | Yes, some additional gap coverage. |
H0838 -037 -0 | $0.00 | $12.00 | $47.00 | $47.00 | 3,133
2022 Formulary |
|
|
|
|
-- Members will be assigned to Brand New Day Classic Care II Plan (HMO) H0838-051 --
| | | | | |
|
2022 CommuniCare Advantage Cal MediConnect Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics, All Brands |
H5172 -002 -0 | | | | | 3,133
2022 Formulary |
|
|
|
|
-- Members will be assigned to CommuniCare Advantage (HMO SNP) (HMO D-SNP) H4733-001 --
| | | | | |
|
2022 Humana Value Plus H5619-037 (HMO)
| $22.60 |
$7,550 |
$480 | No additional gap coverage, only the Donut Hole Discount |
H5619 -037 -0 | $0.00 | $19.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
|
|
|
|
-- Members will be assigned to Humana Gold Plus H5619-016 (HMO) H5619-016 --
| | | | | |
|
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 Molina Dual Options (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics, All Brands |
H8677 -001 -0 | | | | | 3,260
2022 Formulary |
|
|
|
|
-- Members will be assigned to Molina Medicare Complete Care Plus (HMO D-SNP) H5810-016 --
| | | | | |
|
2022 Kaiser Permanente Sr Adv Medicare Medi-Cal (HMO D-SNP)
| $31.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H0524 -030 -0 | | | | | 4,211
2022 Formulary |
|
|
|
|
-- Members will be assigned to Senior Advantage Medicare Medi-Cal Los Angeles (HMO D-SNP) H0524-070 --
| | | | | |
|
2022 Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics, All Brands |
H3237 -002 -0 | | | | | 3,382
2022 Formulary |
|
|
|
|
-- Members will be assigned to Wellcare Dual Align 129 (HMO D-SNP) H0562-129 --
| | | | | |
|
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)
| $33.20 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H0562 -121 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,375
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|
2022 Wellcare Plus Sapphire I (HMO)
| $33.20 |
$3,450 |
$480 | No additional gap coverage, only the Donut Hole Discount |
H0562 -122 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,375
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|
2022 Brand New Day Harmony Choice Plan (HMO C-SNP)
| $33.20 |
n/a |
$480 | Some Generics |
H0838 -020 -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 Brand New Day Harmony Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$100 | Some Generics |
H0838 -032 -0 | $0.00 | $0.00 | $45.00 | $45.00 | 3,133
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|
2022 Brand New Day Classic Choice Plan (HMO)
| $32.20 |
$7,550 |
$480 | Yes, some additional gap coverage. |
H0838 -033 -0 | $0.00 | 25% | 25% | 25% | 3,133
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|
2022 Astiva Health Value (HMO)
| $33.20 |
$7,550 |
$480 | Yes, some additional gap coverage. |
H1993 -004 -0 | $0.00 | $0.00 | 25% | 25% | 3,315
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 Connected Care (HMO)
| $0.00 |
$3,000 |
$0 | Yes, some additional gap coverage. |
H2241 -017 -0 | $5.00 | $10.00 | $45.00 | $45.00 | n/a |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|
2022 Wellcare Plus Sapphire II (HMO)
| $33.20 |
$3,450 |
$480 | No additional gap coverage, only the Donut Hole Discount |
H3561 -002 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,375
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|
2022 CalPlus (HMO)
| $0.00 |
$4,900 |
$480 | No additional gap coverage, only the Donut Hole Discount |
H3815 -009 -0 | $0.00 | $20.00 | 25% | 25% | 3,450
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 Aetna Medicare Plus Plan 2 (HMO)
| $19.30 |
$7,550 |
$220 | No additional gap coverage, only the Donut Hole Discount |
H4982 -015 -0 | $0.00 | $0.00 | 25% | 25% | 3,672
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|
2022 Scripps Plus offered by SCAN Health Plan (HMO)
| $33.20 |
$7,550 |
$480 | No additional gap coverage, only the Donut Hole Discount |
H5425 -040 -0 | $0.00 | 25% | 25% | 25% | 3,425
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|
2022 Imperial Traditional Plus (HMO)
| $33.20 |
$2,999 |
$480 | Yes, some additional gap coverage. |
H5496 -009 -0 | 0% | 25% | 25% | 25% | 3,315
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 Blue Shield AdvantageOptimum Plan 2 (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H5928 -053 -0 | $0.00 | $10.00 | $40.00 | $40.00 | 3,251
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|
2022 Clever Care Balance Medicare Advantage (HMO)
| $33.20 |
$5,999 |
$480 | Yes, some additional gap coverage. |
H7607 -003 -3 | $0.00 | 25% | 25% | 25% | 3,510
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|