There are 73 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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H3418 -004 -0 | | | | | |
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-- |
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2023 AARP Medicare Advantage Choice (PPO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | 3,682 2023 Formulary |
|
2022 Aetna Medicare Credit Plan (PPO)
| $0.00 |
$7,550 |
$350 | Yes, some additional gap coverage. |
H5521 -313 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,672
2022 Formulary |
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2023 Aetna Medicare Credit Plan (PPO)
| $0.00 |
$7,550 |
$350 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,597 2023 Formulary |
|
2022 Aetna Medicare Eagle Plan (PPO)
| $0.00 |
$7,550 |
No Rx Coverage |
H5521 -323 -0 | This plan does NOT include Prescription Drug coverage. | |
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2023 Aetna Medicare Eagle Plan (PPO)
| $0.00 |
$7,000 |
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 Aetna Medicare Elite Plan (PPO)
| $0.00 |
$7,550 |
$250 | Yes, some additional gap coverage. |
H5521 -119 -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 |
$7,550 |
$195 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,597 2023 Formulary |
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-- This plan not offered in 2022 --
|
H5521 -382 -0 | | | | | |
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2023 Aetna Medicare Premier Plus Plan (PPO)
| $0.00 |
$7,550 |
$250 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,597 2023 Formulary |
|
2022 Aetna Medicare Value Plan (HMO-POS)
| $0.00 |
$7,550 |
$300 | Yes, some additional gap coverage. |
H3312 -062 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,672
2022 Formulary |
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2023 Aetna Medicare Value Plan (HMO-POS)
| $0.00 |
$7,550 |
$300 | 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 CDPHP $0 Medicare Rx (HMO)
| $0.00 |
$7,500 |
$300 | No additional gap coverage, only the Donut Hole Discount |
H3388 -014 -0 | $3.00 | $17.00 | $47.00 | $47.00 | 3,349
2022 Formulary |
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2023 CDPHP $0 Medicare Rx (HMO)
| $0.00 |
$7,000 |
$250 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $17.00 | $47.00 | $47.00 | 3,419 2023 Formulary |
|
2022 CDPHP Flex (PPO)
| $0.00 |
$5,500 |
No Rx Coverage |
H5042 -012 -0 | This plan does NOT include Prescription Drug coverage. | |
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2023 CDPHP Flex (PPO)
| $0.00 |
$6,100 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 CDPHP Vital Rx (PPO)
| $0.00 |
$7,500 |
$350 | No additional gap coverage, only the Donut Hole Discount |
H5042 -009 -0 | $3.00 | $17.00 | $47.00 | $47.00 | 3,349
2022 Formulary |
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2023 CDPHP Vital Rx (PPO)
| $0.00 |
$7,500 |
$300 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $17.00 | $47.00 | $47.00 | 3,419 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 --
|
H3330 -045 -0 | | | | | |
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2023 EmblemHealth VIP Rx Saver (HMO)
| $0.00 |
$7,550 |
$395 | Yes, some additional gap coverage. | $2.00 | $15.00 | $42.00 | $42.00 | 3,478 2023 Formulary |
|
2022 Highmark Blue Shield Freedom Basic (PPO)
| $0.00 |
$7,550 |
$350 | No additional gap coverage, only the Donut Hole Discount |
H5526 -022 -0 | $2.00 | $14.00 | $42.00 | $42.00 | 3,274
2022 Formulary |
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2023 Highmark Blue Shield Freedom Basic (PPO)
| $0.00 |
$8,300 |
$350 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $14.00 | $42.00 | $42.00 | 3,414 2023 Formulary |
|
2022 Highmark Blue Shield Freedom Nation (PPO)
| $0.00 |
$7,550 |
$325 | No additional gap coverage, only the Donut Hole Discount |
H5526 -021 -0 | $0.00 | $12.00 | $42.00 | $42.00 | 3,274
2022 Formulary |
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2023 Highmark Blue Shield Freedom Nation (PPO)
| $0.00 |
$7,550 |
$175 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $12.00 | $42.00 | $42.00 | 3,414 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 --
|
H5526 -024 -0 | | | | | |
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2023 Highmark Blue Shield Freedom Valor (PPO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 Highmark Blue Shield Freedom Value (HMO)
| $0.00 |
$7,550 |
$295 | No additional gap coverage, only the Donut Hole Discount |
H3384 -063 -0 | $3.00 | $10.00 | $42.00 | $42.00 | 3,274
2022 Formulary |
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2023 Highmark Blue Shield Freedom Value (HMO)
| $0.00 |
$7,550 |
$295 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $10.00 | $42.00 | $42.00 | 3,414 2023 Formulary |
|
2022 Humana Gold Plus H3533-006 (HMO)
| $0.00 |
$7,200 |
$300 | No additional gap coverage, only the Donut Hole Discount |
H3533 -006 -0 | $2.00 | $9.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
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2023 Humana Gold Plus H3533-006 (HMO)
| $0.00 |
$6,500 |
$300 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 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 Honor (PPO)
| $0.00 |
$4,500 |
No Rx Coverage |
H5970 -016 -0 | This plan does NOT include Prescription Drug coverage. | |
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2023 Humana Honor (PPO)
| $0.00 |
$4,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 HumanaChoice H5970-015 (PPO)
| $0.00 |
$4,900 |
$250 | No additional gap coverage, only the Donut Hole Discount |
H5970 -015 -0 | $0.00 | $9.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
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|
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2023 HumanaChoice H5970-015 (PPO)
| $0.00 |
$4,900 |
$250 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,404 2023 Formulary |
|
2022 HumanaChoice H5970-018 (PPO)
| $0.00 |
$4,800 |
$310 | No additional gap coverage, only the Donut Hole Discount |
H5970 -018 -0 | $6.00 | $16.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
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2023 HumanaChoice H5970-018 (PPO)
| $0.00 |
$4,800 |
$310 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 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 MVP Medicare Preferred Gold without Part D (HMO-POS)
| $62.00 |
$7,550 |
No Rx Coverage |
H3305 -020 -0 | This plan does NOT include Prescription Drug coverage. | |
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2023 MVP Medicare Preferred Gold without Part D (HMO-POS)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 MVP Medicare WellSelect with Part D (PPO)
| $0.00 |
$7,550 |
$300 | No additional gap coverage, only the Donut Hole Discount |
H9615 -008 -0 | $0.00 | $12.00 | $47.00 | $47.00 | 3,546
2022 Formulary |
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2023 MVP Medicare WellSelect with Part D (PPO)
| $0.00 |
$7,550 |
$300 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $12.00 | $47.00 | $47.00 | 3,598 2023 Formulary |
|
2022 UnitedHealthcare Medicare Advantage Patriot (Regional PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
R5342 -002 -0 | This plan does NOT include Prescription Drug coverage. | |
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2023 UnitedHealthcare Medicare Advantage Patriot (Regional PPO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2022 Wellcare Advantage No Premium (PFFS)
| $0.00 |
n/a |
No Rx Coverage |
H2816 -038 -0 | This plan does NOT include Prescription Drug coverage. | |
|
-- |
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2023 Wellcare Advantage No Premium (PFFS)
| $0.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 Wellcare Giveback Open (PPO)
| $0.00 |
$7,550 |
$325 | Yes, some additional gap coverage. |
H2775 -111 -0 | $1.00 | $7.00 | $37.00 | $37.00 | 3,375
2022 Formulary |
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|
|
2023 Wellcare Giveback Open (PPO)
| $0.00 |
$7,550 |
$325 | Yes, some additional gap coverage. | $0.00 | $7.00 | $37.00 | $37.00 | 3,392 2023 Formulary |
|
2022 Wellcare No Premium Open (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H2775 -106 -0 | $0.00 | $7.00 | $37.00 | $37.00 | 3,375
2022 Formulary |
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|
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2023 Wellcare No Premium Open (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $7.00 | $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 Assist Open (PPO)
| $30.70 |
$6,700 |
$480 | No additional gap coverage, only the Donut Hole Discount |
H2775 -113 -0 | $0.00 | $15.00 | $45.00 | $45.00 | 3,375
2022 Formulary |
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|
|
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2023 Wellcare Assist Open (PPO)
| $8.70 |
$6,700 |
$505 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,392 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H5970 -001 -0 | | | | | |
|
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2023 HumanaChoice H5970-001 (PPO)
| $15.00 |
$4,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,404 2023 Formulary |
|
2022 UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO)
| $16.00 |
$7,200 |
$300 | Yes, some additional gap coverage. |
R5342 -001 -0 | $0.00 | $12.00 | $47.00 | $47.00 | n/a |
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2023 UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO)
| $16.00 |
$7,200 |
$200 | Yes, some additional gap coverage. | $0.00 | $12.00 | $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 Assure Plan (HMO D-SNP)
| $23.80 |
n/a |
$425 | No additional gap coverage, only the Donut Hole Discount |
H3312 -070 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,672
2022 Formulary |
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2023 Aetna Medicare Assure Plan (HMO D-SNP)
| $17.20 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,597 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H5521 -383 -0 | | | | | |
|
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|
|
2023 Aetna Medicare Discover Value Plan (PPO)
| $23.00 |
$7,550 |
$250 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,597 2023 Formulary |
|
2022 Wellcare Fidelis Dual Access (HMO D-SNP)
| $20.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H5599 -001 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,375
2022 Formulary |
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2023 Wellcare Fidelis Dual Access (HMO D-SNP)
| $24.70 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,394 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 H3533-013 (HMO)
| $26.00 |
$6,700 |
$275 | No additional gap coverage, only the Donut Hole Discount |
H3533 -013 -0 | $4.00 | $12.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
|
|
|
|
2023 Humana Gold Plus H3533-013 (HMO)
| $25.00 |
$6,000 |
$275 | Yes, some additional gap coverage. | $4.00 | $12.00 | $47.00 | $47.00 | 3,404 2023 Formulary |
|
2022 Wellcare Fidelis Dual Plus (HMO D-SNP)
| $23.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H5599 -008 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,375
2022 Formulary |
|
|
|
|
2023 Wellcare Fidelis Dual Plus (HMO D-SNP)
| $26.40 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,394 2023 Formulary |
|
2022 CDPHP Basic RX (HMO)
| $31.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3388 -013 -0 | $3.00 | $15.00 | $45.00 | $45.00 | 3,349
2022 Formulary |
|
|
|
|
2023 CDPHP Basic RX (HMO)
| $31.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $15.00 | $45.00 | $45.00 | 3,419 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 SNP-DE H5970-020 (PPO D-SNP)
| $19.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H5970 -020 -0 | $2.00 | $19.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
|
|
|
|
2023 HumanaChoice SNP-DE H5970-020 (PPO D-SNP)
| $32.30 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,404 2023 Formulary |
|
2022 Humana Gold Plus SNP-DE H3533-002 (HMO D-SNP)
| $30.10 |
n/a |
$460 | No additional gap coverage, only the Donut Hole Discount |
H3533 -002 -0 | $4.00 | $15.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
|
|
|
|
2023 Humana Gold Plus SNP-DE H3533-002 (HMO D-SNP)
| $32.50 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,404 2023 Formulary |
|
2022 UnitedHealthcare Dual Complete Plan 2 (HMO D-SNP)
| $37.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H3387 -015 -1 | | | | | 3,654
2022 Formulary |
|
|
|
|
2023 UnitedHealthcare Dual Complete Plan 2 (HMO-POS D-SNP)
| $34.10 |
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 Aetna Medicare Premier Plan (PPO)
| $50.00 |
$7,550 |
$250 | Yes, some additional gap coverage. |
H5521 -110 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,672
2022 Formulary |
|
|
|
|
2023 Aetna Medicare Premier Plan (PPO)
| $37.00 |
$7,550 |
$195 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,597 2023 Formulary |
|
2022 EmblemHealth VIP Dual (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H3330 -042 -3 | | | | | 3,453
2022 Formulary |
|
|
|
|
2023 EmblemHealth VIP Dual (HMO D-SNP)
| $38.90 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $47.00 | $47.00 | 3,478 2023 Formulary |
|
2022 Empire MediBlue Dual Advantage (HMO D-SNP)
| $36.90 |
n/a |
$480 | Some Generics |
H8432 -039 -1 | $0.00 | $5.00 | $47.00 | $47.00 | 3,626
2022 Formulary |
|
|
|
|
2023 Empire MediBlue Dual Advantage (HMO D-SNP)
| $38.90 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $20.00 | $47.00 | $47.00 | 3,603 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 Hamaspik Medicare Select (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H0034 -001 -0 | | | | | 3,240
2022 Formulary |
|
-- |
|
|
2023 Hamaspik Medicare Select (HMO D-SNP)
| $38.90 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,265 2023 Formulary |
|
2022 MVP DualAccess (HMO D-SNP)
| $42.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H3305 -033 -0 | | | | | 3,546
2022 Formulary |
|
|
|
|
2023 MVP DualAccess (HMO D-SNP)
| $38.90 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,598 2023 Formulary |
|
2022 MVP DualAccess Complete (HMO D-SNP)
| $42.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H3305 -034 -0 | | | | | 3,546
2022 Formulary |
|
|
|
|
2023 MVP DualAccess Complete (HMO D-SNP)
| $38.90 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,598 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 MVP DualAccess Plus (HMO D-SNP)
| $42.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H3305 -035 -0 | | | | | 3,546
2022 Formulary |
|
|
|
|
2023 MVP DualAccess Plus (HMO D-SNP)
| $38.90 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,598 2023 Formulary |
|
2022 Nascentia Dual Advantage (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H9066 -003 -0 | | | | | 3,315
2022 Formulary |
|
-- |
-- |
|
2023 Nascentia Dual Advantage (HMO D-SNP)
| $38.90 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,346 2023 Formulary |
|
2022 Nascentia Medicaid Advantage Plus (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H9066 -001 -0 | | | | | 3,315
2022 Formulary |
|
-- |
-- |
|
2023 Nascentia Medicaid Advantage Plus (HMO D-SNP)
| $38.90 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 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 Nascentia Skilled Nursing Facility (HMO I-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H9066 -002 -0 | | | | | 3,315
2022 Formulary |
|
-- |
-- |
|
2023 Nascentia Skilled Nursing Facility (HMO I-SNP)
| $38.90 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,346 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H0271 -060 -1 | | | | | |
|
|
|
|
2023 UnitedHealthcare Dual Complete Choice (PPO D-SNP)
| $38.90 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,682 2023 Formulary |
|
2022 UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H3387 -014 -1 | | | | | 3,654
2022 Formulary |
|
|
|
|
2023 UnitedHealthcare Dual Complete Plan 1 (HMO-POS D-SNP)
| $38.90 |
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 Wellcare Dual Access Open (PPO D-SNP)
| $37.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H2775 -112 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,375
2022 Formulary |
|
|
|
|
2023 Wellcare Dual Access Open (PPO D-SNP)
| $38.90 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,394 2023 Formulary |
|
2022 CDPHP Flex Rx (PPO)
| $42.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5042 -011 -0 | $2.00 | $14.00 | $44.00 | $44.00 | 3,349
2022 Formulary |
|
|
|
|
2023 CDPHP Flex Rx (PPO)
| $39.40 |
$6,100 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $14.00 | $44.00 | $44.00 | 3,419 2023 Formulary |
|
2022 CDPHP Choice (HMO)
| $39.90 |
$5,000 |
No Rx Coverage |
H3388 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2023 CDPHP Choice (HMO)
| $39.90 |
$6,100 |
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 MVP Medicare Secure with Part D (HMO-POS)
| $40.00 |
$7,550 |
$150 | No additional gap coverage, only the Donut Hole Discount |
H3305 -032 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,546
2022 Formulary |
|
|
|
|
2023 MVP Medicare Secure with Part D (HMO-POS)
| $40.00 |
$7,550 |
$150 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,598 2023 Formulary |
|
2022 UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO)
| $46.00 |
$6,900 |
$250 | Yes, some additional gap coverage. |
R5342 -005 -0 | $0.00 | $14.00 | $47.00 | $47.00 | n/a |
|
|
|
|
2023 UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO)
| $44.00 |
$6,900 |
$100 | Yes, some additional gap coverage. | $0.00 | $14.00 | $47.00 | $47.00 | 3,682 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H9615 -018 -0 | | | | | |
|
|
|
|
2023 MVP Medicare Patriot Plan with Part D (PPO)
| $45.00 |
$7,550 |
$250 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $45.00 | $45.00 | 3,598 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 Empire MediBlue Plus (HMO)
| $54.00 |
$5,000 |
$325 | No additional gap coverage, only the Donut Hole Discount |
H8432 -038 -1 | $0.00 | $10.00 | $37.00 | $37.00 | 2,921
2022 Formulary |
|
|
|
|
2023 Empire MediBlue Plus (HMO)
| $54.00 |
$5,000 |
$325 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $37.00 | $37.00 | 2,912 2023 Formulary |
|
2022 Highmark Blue Shield Freedom Plus (HMO)
| $57.00 |
$6,700 |
$275 | No additional gap coverage, only the Donut Hole Discount |
H3384 -059 -0 | $2.00 | $8.00 | $42.00 | $42.00 | 3,274
2022 Formulary |
|
|
|
|
2023 Highmark Blue Shield Freedom Plus (HMO)
| $55.00 |
$6,700 |
$275 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $8.00 | $42.00 | $42.00 | 3,414 2023 Formulary |
|
2022 CDPHP Value Rx (HMO)
| $60.80 |
$5,800 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3388 -004 -0 | $2.00 | $13.00 | $42.00 | $42.00 | 3,349
2022 Formulary |
|
|
|
|
2023 CDPHP Value Rx (HMO)
| $58.30 |
$6,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $13.00 | $42.00 | $42.00 | 3,419 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 Advantage Premium Enhanced (PFFS)
| $62.00 |
n/a |
No Rx Coverage |
H2816 -037 -0 | This plan does NOT include Prescription Drug coverage. | |
|
-- |
|
|
2023 Wellcare Advantage Premium Enhanced (PFFS)
| $60.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 UnitedHealthcare Medicare Advantage Choice Plan 4 (Regional PPO)
| $84.00 |
$6,700 |
$150 | Yes, some additional gap coverage. |
R5342 -006 -0 | $0.00 | $12.00 | $47.00 | $47.00 | n/a |
|
|
|
|
2023 UnitedHealthcare Medicare Advantage Choice Plan 4 (Regional PPO)
| $82.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | 3,682 2023 Formulary |
|
2022 MVP Medicare Secure Plus with Part D (HMO-POS)
| $90.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H3305 -022 -0 | $0.00 | $15.00 | $45.00 | $45.00 | 3,546
2022 Formulary |
|
|
|
|
2023 MVP Medicare Secure Plus with Part D (HMO-POS)
| $90.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $15.00 | $45.00 | $45.00 | 3,598 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 Empire MediBlue Access (PPO)
| $91.00 |
$6,200 |
$310 | Yes, some additional gap coverage. |
H3342 -023 -1 | $3.00 | $10.00 | $38.00 | $38.00 | 3,626
2022 Formulary |
|
-- |
|
|
2023 Empire MediBlue Access (PPO)
| $91.00 |
$6,200 |
$310 | Yes, some additional gap coverage. | $3.00 | $10.00 | $38.00 | $38.00 | 3,603 2023 Formulary |
|
2022 Wellcare Premium Ultra Open (PPO)
| $121.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2775 -105 -0 | $0.00 | $5.00 | $35.00 | $35.00 | 3,375
2022 Formulary |
|
|
|
|
2023 Wellcare Premium Ultra Open (PPO)
| $115.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $35.00 | $35.00 | 3,392 2023 Formulary |
|
2022 Highmark Blue Shield Senior Blue 652 (HMO)
| $124.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3384 -013 -0 | $2.00 | $10.00 | $42.00 | $42.00 | 3,274
2022 Formulary |
|
|
|
|
2023 Highmark Blue Shield Senior Blue 652 (HMO)
| $122.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $10.00 | $42.00 | $42.00 | 3,414 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 MVP Medicare WellSelect Plus with Part D (PPO)
| $125.00 |
$6,500 |
$0 | Yes, some additional gap coverage. |
H9615 -007 -0 | $0.00 | $10.00 | $35.00 | $35.00 | 3,546
2022 Formulary |
|
|
|
|
2023 MVP Medicare WellSelect Plus with Part D (PPO)
| $125.00 |
$6,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $35.00 | $35.00 | 3,598 2023 Formulary |
|
2022 CDPHP Choice Rx (HMO)
| $131.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3388 -002 -0 | $0.00 | $11.00 | $40.00 | $40.00 | 3,349
2022 Formulary |
|
|
|
|
2023 CDPHP Choice Rx (HMO)
| $128.50 |
$6,100 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $11.00 | $40.00 | $40.00 | 3,419 2023 Formulary |
|
2022 MVP Medicare Preferred Gold with Part D (HMO-POS)
| $140.00 |
$5,800 |
$0 | Yes, some additional gap coverage. |
H3305 -021 -0 | $0.00 | $10.00 | $35.00 | $35.00 | 3,546
2022 Formulary |
|
|
|
|
2023 MVP Medicare Preferred Gold with Part D (HMO-POS)
| $140.00 |
$5,800 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $35.00 | $35.00 | 3,598 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 Highmark Blue Shield Forever Blue 770 (PPO)
| $201.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5526 -018 -0 | $2.00 | $10.00 | $42.00 | $42.00 | 3,274
2022 Formulary |
|
|
|
|
2023 Highmark Blue Shield Forever Blue 770 (PPO)
| $199.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $10.00 | $42.00 | $42.00 | 3,414 2023 Formulary |
|
2022 EmblemHealth VIP Rx Saver (HMO)
| $0.00 |
$7,550 |
$395 | No additional gap coverage, only the Donut Hole Discount |
H3330 -039 -2 | $2.00 | $15.00 | $42.00 | $42.00 | 3,453
2022 Formulary |
|
|
|
|
-- Members will be assigned to EmblemHealth VIP Rx Saver (HMO) H3330-045 --
| | | | | |
|
2022 HumanaChoice H5970-019 (PPO)
| $24.00 |
$4,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5970 -019 -0 | $0.00 | $8.00 | $47.00 | $47.00 | 3,413
2022 Formulary |
|
|
|
|
-- Members will be assigned to HumanaChoice H5970-001 (PPO) H5970-001 --
| | | | | |
|
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 No Premium Open (PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
H2775 -108 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|
2022 Highmark Blue Shield Freedom (HMO)
| $0.00 |
$5,000 |
No Rx Coverage |
H3384 -066 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|
2022 MVP SmartFund (MSA)
| $0.00 |
n/a |
No Rx Coverage |
H5613 -002 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
-- 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 EmblemHealth VIP Solutions (HMO D-SNP)
| $42.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H5991 -002 -0 | | | | | 3,453
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|