There are 83 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 --
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H4829 -016 -0 | | | | | |
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2023 AARP Medicare Advantage Choice Plan 2 (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | 3,682 2023 Formulary |
|
2022 AARP Medicare Advantage SecureHorizons Focus (HMO)
| $0.00 |
$4,000 |
$0 | Yes, some additional gap coverage. |
H0543 -193 -0 | $0.00 | $12.00 | $47.00 | $47.00 | 3,654
2022 Formulary |
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2023 AARP Medicare Advantage SecureHorizons Focus (HMO-POS)
| $0.00 |
$3,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | 3,682 2023 Formulary |
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2022 Aetna Medicare Eagle Plan (HMO)
| $0.00 |
$4,200 |
No Rx Coverage |
H4982 -013 -0 | This plan does NOT include Prescription Drug coverage. | |
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2023 Aetna Medicare Eagle Plan (HMO)
| $0.00 |
$4,200 |
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 -369 -0 | | | | | |
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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 Elite Plan (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H5521 -293 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,672
2022 Formulary |
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2023 Aetna Medicare Elite Plan (PPO)
| $0.00 |
$5,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,597 2023 Formulary |
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2022 Aetna Medicare Plus Plan (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. |
H4982 -006 -0 | $0.00 | $0.00 | $42.00 | $42.00 | 3,698
2022 Formulary |
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2023 Aetna Medicare Plus Plan (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $42.00 | $42.00 | 3,622 2023 Formulary |
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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 --
|
H0523 -069 -0 | | | | | |
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2023 Aetna Medicare Select Plan (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $42.00 | $42.00 | 3,622 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 |
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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 |
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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 |
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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 AVA (HMO)
| $0.00 |
$1,999 |
$0 | Yes, some additional gap coverage. |
H3815 -026 -0 | $0.00 | $3.00 | $40.00 | $40.00 | 3,450
2022 Formulary |
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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 |
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-- This plan not offered in 2022 --
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H4961 -006 -0 | | | | | |
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2023 Alignment Health Balance (PPO)
| $0.00 |
$2,850 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $40.00 | $40.00 | 3,467 2023 Formulary |
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-- This plan not offered in 2022 --
|
H3815 -036 -0 | | | | | |
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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 |
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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 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 |
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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 |
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-- This plan not offered in 2022 --
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H3815 -010 -0 | | | | | |
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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 |
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2022 My Choice (HMO)
| $0.00 |
$3,000 |
$0 | Yes, some additional gap coverage. |
H3815 -007 -0 | $0.00 | $3.00 | $40.00 | $40.00 | 3,450
2022 Formulary |
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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 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 |
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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 Care On Site (HMO I-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands |
H0544 -050 -0 | $0.00 | $7.50 | $40.00 | $40.00 | 3,117
2022 Formulary |
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2023 Anthem MediBlue Care On Site (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 |
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2022 Anthem MediBlue Coordination Plus (HMO)
| $0.00 |
$7,550 |
$480 | Yes, some additional gap coverage. |
H0544 -110 -0 | $0.00 | $15.00 | $47.00 | $47.00 | 3,604
2022 Formulary |
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2023 Anthem MediBlue Coordination Plus (HMO)
| $0.00 |
$7,550 |
$505 | Yes, some additional gap coverage. | $0.00 | $15.00 | $47.00 | $47.00 | 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 Diabetes Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands |
H0544 -102 -0 | $0.00 | $7.50 | $35.00 | $35.00 | 3,117
2022 Formulary |
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2023 Anthem MediBlue Diabetes Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $35.00 | $35.00 | 3,157 2023 Formulary |
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-- This plan not offered in 2022 --
|
H0544 -129 -0 | | | | | |
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2023 Anthem MediBlue Dual Advantage (HMO D-SNP)
| $0.00 |
n/a |
$380 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $20.00 | $47.00 | $47.00 | 3,583 2023 Formulary |
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-- This plan not offered in 2022 --
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H4161 -001 -0 | | | | | |
new |
new |
new |
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2023 Anthem MediBlue Full Dual Advantage (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | $15.00 | $20.00 | $47.00 | $47.00 | 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 Heart Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands |
H0544 -106 -0 | $0.00 | $7.50 | $40.00 | $40.00 | 3,117
2022 Formulary |
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2023 Anthem MediBlue Heart Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $40.00 | $40.00 | 3,157 2023 Formulary |
|
2022 Anthem MediBlue Lung Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands |
H0544 -101 -0 | $0.00 | $7.50 | $40.00 | $40.00 | 3,117
2022 Formulary |
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|
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2023 Anthem MediBlue Lung Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $40.00 | $40.00 | 3,157 2023 Formulary |
|
2022 Anthem MediBlue Plus (HMO)
| $0.00 |
$2,899 |
$0 | Yes, some additional gap coverage. |
H0544 -108 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,604
2022 Formulary |
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|
|
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2023 Anthem MediBlue Plus (HMO)
| $0.00 |
$2,899 |
$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 StartSmart Plus (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H0544 -121 -2 | $5.00 | $12.50 | $40.00 | $40.00 | 3,117
2022 Formulary |
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|
|
2023 Anthem MediBlue StartSmart Plus (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $12.50 | $40.00 | $40.00 | 3,157 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H0504 -047 -0 | | | | | |
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2023 Blue Shield Inspire (HMO)
| $0.00 |
$3,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $40.00 | $40.00 | 3,455 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H0838 -051 -1 | | | | | |
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2023 Brand New Day Classic Care II Plan (HMO)
| $0.00 |
$1,500 |
$50 | Yes, some additional gap coverage. | $0.00 | $12.00 | $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 Embrace Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics |
H0838 -039 -2 | $0.00 | $9.00 | $47.00 | $47.00 | 3,133
2022 Formulary |
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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 |
|
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 |
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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. | |
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|
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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 |
-- This plan not offered in 2022 --
|
H5649 -006 -0 | | | | | |
|
-- |
|
|
2023 Central Health Focus Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,467 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H5649 -020 -1 | | | | | |
|
-- |
|
|
2023 Central Health Premier Plan I (HMO)
| $0.00 |
$899 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,467 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H2986 -008 -0 | | | | | |
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|
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2023 Essence Advantage Select (HMO)
| $0.00 |
$4,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $45.00 | $45.00 | 3,508 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 --
|
H5496 -016 -0 | | | | | |
|
-- |
|
|
2023 Imperial Courage Plan (HMO)
| $0.00 |
$2,999 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2022 --
|
H5496 -012 -0 | | | | | |
|
-- |
|
|
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 |
|
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 |
|
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 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 |
|
2022 Kaiser Permanente Sr Adv Basic Santa Clara (HMO)
| $15.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H0524 -062 -0 | $3.00 | $15.00 | $47.00 | $47.00 | 4,211
2022 Formulary |
|
|
|
|
2023 Kaiser Permanente Sr Adv Basic Santa Clara (HMO)
| $0.00 |
$6,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $12.00 | $45.00 | $45.00 | 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 SCAN Options (HMO)
| $0.00 |
$2,800 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5425 -073 -0 | $0.00 | $0.00 | $40.00 | $40.00 | 3,425
2022 Formulary |
|
|
|
|
2023 SCAN Options (HMO)
| $0.00 |
$2,800 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $40.00 | $40.00 | 3,458 2023 Formulary |
|
2022 Wellcare No Premium (HMO)
| $0.00 |
$3,450 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H0562 -120 -0 | $5.00 | $8.00 | $37.00 | $37.00 | 3,375
2022 Formulary |
|
|
|
|
2023 Wellcare No Premium (HMO)
| $0.00 |
$3,450 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $37.00 | $37.00 | 3,392 2023 Formulary |
|
2022 Anthem MediBlue Connect (HMO D-SNP)
| $22.00 |
n/a |
$480 | Many Generics, Some Brands |
H0544 -003 -0 | $0.00 | $0.00 | 20% | 20% | 3,117
2022 Formulary |
|
|
|
|
2023 Anthem MediBlue Connect (HMO D-SNP)
| $9.90 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $20.00 | $47.00 | $47.00 | 3,157 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 Assist (HMO)
| $27.90 |
$4,500 |
$480 | No additional gap coverage, only the Donut Hole Discount |
H0562 -127 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,375
2022 Formulary |
|
|
|
|
2023 Wellcare Assist (HMO)
| $10.30 |
$4,500 |
$505 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,392 2023 Formulary |
|
2022 UnitedHealthcare Medicare Advantage Assure (HMO)
| $29.70 |
$7,550 |
$480 | No additional gap coverage, only the Donut Hole Discount |
H0543 -183 -0 | | | | | 3,654
2022 Formulary |
|
|
|
|
2023 UnitedHealthcare Medicare Advantage Assure (HMO)
| $27.50 |
$8,300 |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,682 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H0524 -074 -0 | | | | | |
|
|
|
|
2023 Senior Advantage Medicare Medi-Cal Santa Clara (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 Essence Advantage Gold (HMO)
| $39.00 |
$5,500 |
$0 | Yes, some additional gap coverage. |
H2986 -002 -0 | $5.00 | $15.00 | $47.00 | $47.00 | 3,510
2022 Formulary |
|
|
|
|
2023 Essence Advantage Gold (HMO)
| $30.00 |
$5,500 |
$0 | Yes, some additional gap coverage. | $5.00 | $15.00 | $47.00 | $47.00 | 3,508 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H5649 -021 -2 | | | | | |
|
-- |
|
|
2023 Central Health Premier Plan II (HMO)
| $34.50 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,467 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H3274 -004 -0 | | | | | |
|
new |
new |
|
2023 Align Kidney Care (HMO C-SNP)
| $38.90 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $15.00 | $45.00 | $45.00 | 3,838 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 --
|
H0838 -050 -2 | | | | | |
|
|
|
|
2023 Brand New Day Classic Care I Plan (HMO)
| $38.90 |
$3,650 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,467 2023 Formulary |
|
2022 Brand New Day Embrace Choice Plan (HMO C-SNP)
| $33.20 |
n/a |
$480 | Some Generics |
H0838 -040 -2 | $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 |
|
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 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 |
|
-- This plan not offered in 2022 --
|
H4045 -001 -0 | | | | | |
new |
new |
new |
|
2023 DualConnect (HMO D-SNP)
| $38.90 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,288 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H4829 -004 -0 | | | | | |
|
|
|
|
2023 AARP Medicare Advantage Choice Plan 1 (PPO)
| $45.00 |
$5,900 |
$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 Sutter Advantage (HMO)
| $49.00 |
$4,900 |
$0 | Yes, some additional gap coverage. |
H3815 -020 -0 | $0.00 | $5.00 | $40.00 | $40.00 | 3,450
2022 Formulary |
|
|
|
|
2023 Alignment Health Sutter Advantage (HMO)
| $49.00 |
$4,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $40.00 | $40.00 | 3,467 2023 Formulary |
|
2022 SCAN Classic (HMO)
| $54.00 |
$3,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5425 -020 -0 | $0.00 | $0.00 | $42.00 | $42.00 | 3,425
2022 Formulary |
|
|
|
|
2023 SCAN Classic (HMO)
| $52.00 |
$3,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $42.00 | $42.00 | 3,458 2023 Formulary |
|
2022 Anthem MediBlue Value Plus (HMO)
| $54.00 |
$2,899 |
$0 | Yes, some additional gap coverage. |
H0544 -120 -2 | $0.00 | $9.50 | $40.00 | $40.00 | 3,117
2022 Formulary |
|
|
|
|
2023 Anthem MediBlue Value Plus (HMO)
| $54.00 |
$2,899 |
$0 | Yes, some additional gap coverage. | $0.00 | $9.50 | $40.00 | $40.00 | 3,157 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 Diabetes (HMO C-SNP)
| $55.00 |
n/a |
$0 | Many Generics, Some Brands |
H0544 -118 -2 | $0.00 | $7.50 | $35.00 | $35.00 | 3,117
2022 Formulary |
|
|
|
|
2023 Anthem MediBlue Diabetes (HMO C-SNP)
| $55.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $35.00 | $35.00 | 3,157 2023 Formulary |
|
2022 Anthem MediBlue Heart (HMO C-SNP)
| $55.00 |
n/a |
$0 | Many Generics, Some Brands |
H0544 -119 -2 | $0.00 | $7.50 | $40.00 | $40.00 | 3,117
2022 Formulary |
|
|
|
|
2023 Anthem MediBlue Heart (HMO C-SNP)
| $55.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $40.00 | $40.00 | 3,157 2023 Formulary |
|
2022 Anthem MediBlue Lung (HMO C-SNP)
| $55.00 |
n/a |
$0 | Many Generics, Some Brands |
H0544 -117 -1 | $0.00 | $7.50 | $40.00 | $40.00 | 3,117
2022 Formulary |
|
|
|
|
2023 Anthem MediBlue Lung (HMO C-SNP)
| $55.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $40.00 | $40.00 | 3,157 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 Sr Adv Enhanced Santa Clara (HMO)
| $75.00 |
$4,900 |
$0 | Yes, some additional gap coverage. |
H0524 -039 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 4,211
2022 Formulary |
|
|
|
|
2023 Kaiser Permanente Sr Adv Enhanced Santa Clara (HMO)
| $65.00 |
$3,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,388 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H0543 -230 -0 | | | | | |
|
|
|
|
2023 AARP Medicare Advantage Focus (HMO-POS)
| $77.00 |
$5,900 |
$200 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | 3,682 2023 Formulary |
|
2022 Essence Advantage Platinum (HMO)
| $89.00 |
$4,500 |
$0 | Yes, some additional gap coverage. |
H2986 -001 -0 | $5.00 | $15.00 | $47.00 | $47.00 | 3,510
2022 Formulary |
|
|
|
|
2023 Essence Advantage Platinum (HMO)
| $79.00 |
$4,500 |
$0 | Yes, some additional gap coverage. | $5.00 | $15.00 | $47.00 | $47.00 | 3,508 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 (HMO)
| $101.00 |
$5,900 |
$355 | Yes, some additional gap coverage. |
H0543 -029 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,654
2022 Formulary |
|
|
|
|
2023 AARP Medicare Advantage SecureHorizons (HMO-POS)
| $119.00 |
$6,700 |
$355 | Yes, some additional gap coverage. | $3.00 | $12.00 | $47.00 | $47.00 | 3,682 2023 Formulary |
|
2022 AARP Medicare Advantage Choice (PPO)
| $45.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H4829 -007 -0 | $0.00 | $12.00 | $47.00 | $47.00 | 3,654
2022 Formulary |
|
|
|
|
-- Members will be assigned to AARP Medicare Advantage Choice Plan 1 (PPO) H4829-004 --
| | | | | |
|
2022 Anthem MediBlue Dual Advantage (HMO D-SNP)
| $0.00 |
n/a |
$480 | Few Generics |
H0544 -130 -0 | $0.00 | $15.00 | $47.00 | $47.00 | 3,604
2022 Formulary |
|
|
|
|
-- Members will be assigned to Anthem MediBlue Dual Advantage (HMO D-SNP) H0544-129 --
| | | | | |
|
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 Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics, All Brands |
H6229 -006 -0 | | | | | 3,135
2022 Formulary |
|
|
|
|
-- Members will be assigned to Anthem MediBlue Full Dual Advantage (HMO D-SNP) H4161-001 --
| | | | | |
|
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 Inspire (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H0504 -046 -0 | $0.00 | $10.00 | $40.00 | $40.00 | 3,426
2022 Formulary |
|
|
|
|
-- Members will be assigned to Blue Shield Inspire (HMO) H0504-047 --
| | | | | |
|
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 Santa Clara Family Health Plan (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics, All Brands |
H7890 -001 -0 | | | | | 3,133
2022 Formulary |
|
|
|
|
-- Members will be assigned to DualConnect (HMO D-SNP) H4045-001 --
| | | | | |
|
2022 SCAN Plus (HMO)
| $33.20 |
$7,550 |
$480 | No additional gap coverage, only the Donut Hole Discount |
H5425 -072 -0 | $0.00 | 25% | 25% | 25% | 3,425
2022 Formulary |
|
|
|
|
-- Members will be assigned to SCAN Options (HMO) H5425-073 --
| | | | | |
|
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 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 Anthem MediBlue Connect Plus (HMO)
| $21.50 |
$7,550 |
$480 | Yes, some additional gap coverage. |
H0544 -128 -0 | 25% | 25% | 25% | 25% | 3,117
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 --
|
| | | | |
|
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 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 --
|
| | | | |
|
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 --
|
| | | | |
|
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 Choice (HMO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H1426 -002 -0 | $0.00 | $7.00 | $45.00 | $45.00 | n/a |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|
2022 Plus (HMO)
| $33.10 |
$7,550 |
$480 | No additional gap coverage, only the Donut Hole Discount |
H1426 -003 -0 | $0.00 | 25% | 25% | 25% | n/a |
|
|
|
|
-- 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 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 --
|
| | | | |
|
2022 Blue Shield AdvantageOptimum Plan (HMO)
| $0.00 |
$3,400 |
$200 | Yes, some additional gap coverage. |
H5928 -050 -0 | $0.00 | $5.00 | $40.00 | $40.00 | 3,251
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|