There are 68 Medicare Advantage plans meeting your criteria.
2022 / 2023 Medicare Advantage Plan Information
Click here to jump to the Chart Legend |
Plan Name |
Monthly Premium |
Part A&B Maximum Out-Of Pocket |
Part D Deduct- ible |
(Donut Hole) Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Formulary Drugs |
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2022 Lasso Healthcare Growth (MSA)
| $0.00 |
n/a |
No Rx Coverage |
H1924 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
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2023 Lasso Healthcare Growth (MSA)
| $0.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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2022 Lasso Healthcare Growth Plus (MSA)
| $0.00 |
n/a |
No Rx Coverage |
H1924 -004 -0 | This plan does NOT include Prescription Drug coverage. | |
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2023 Lasso Healthcare Growth Plus (MSA)
| $0.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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-- This plan not offered in 2022 --
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H8768 -033 -0 | | | | | |
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2023 AARP Medicare Advantage Choice Plan 4 (PPO)
| $0.00 |
$5,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | 3,682 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 --
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H8768 -021 -0 | | | | | |
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2023 AARP Medicare Advantage Patriot (PPO)
| $0.00 |
$4,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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-- This plan not offered in 2022 --
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H5253 -049 -0 | | | | | |
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2023 AARP Medicare Advantage Plan 7 (HMO-POS)
| $0.00 |
$4,500 |
$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 Premier (HMO-POS)
| $0.00 |
$4,900 |
$0 | Yes, some additional gap coverage. |
H0628 -001 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,698
2022 Formulary |
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2023 Aetna Medicare Premier (HMO-POS)
| $0.00 |
$4,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 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 |
2022 Aetna Medicare Value Plan (PPO)
| $0.00 |
$5,300 |
$150 | Yes, some additional gap coverage. |
H5521 -088 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,672
2022 Formulary |
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2023 Aetna Medicare Value Plan (PPO)
| $0.00 |
$5,300 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,597 2023 Formulary |
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2022 Anthem MediBlue Access Core (Regional PPO)
| $0.00 |
$4,900 |
No Rx Coverage |
R5941 -013 -0 | This plan does NOT include Prescription Drug coverage. | |
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2023 Anthem MediBlue Access Core (Regional PPO)
| $0.00 |
$4,900 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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2022 Anthem MediBlue Preferred (HMO)
| $0.00 |
$4,200 |
$0 | Yes, some additional gap coverage. |
H3655 -045 -1 | $4.00 | $10.00 | $42.00 | $42.00 | 3,626
2022 Formulary |
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2023 Anthem MediBlue Preferred (HMO)
| $0.00 |
$4,200 |
$0 | Yes, some additional gap coverage. | $4.00 | $10.00 | $42.00 | $42.00 | 3,603 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 Anthem MediBlue Service (PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
H4036 -022 -0 | This plan does NOT include Prescription Drug coverage. | |
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2023 Anthem MediBlue Service (PPO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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-- This plan not offered in 2022 --
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H2526 -001 -0 | | | | | |
new |
new |
new |
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2023 Devoted CHOICE Ohio (PPO)
| $0.00 |
$5,300 |
$150 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,364 2023 Formulary |
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-- This plan not offered in 2022 --
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H2697 -004 -0 | | | | | |
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2023 Devoted CORE Ohio (HMO)
| $0.00 |
$4,200 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $42.00 | $42.00 | 3,364 2023 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2022 --
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H2697 -006 -0 | | | | | |
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2023 Devoted GIVEBACK Ohio (HMO)
| $0.00 |
$5,900 |
$350 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,364 2023 Formulary |
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2022 Humana Honor (PPO)
| $0.00 |
$5,900 |
No Rx Coverage |
H5216 -218 -0 | This plan does NOT include Prescription Drug coverage. | |
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2023 Humana Honor (PPO)
| $0.00 |
$5,900 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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2022 HumanaChoice H5216-285 (PPO)
| $0.00 |
$5,300 |
$200 | No additional gap coverage, only the Donut Hole Discount |
H5216 -285 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,413
2022 Formulary |
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2023 HumanaChoice H5216-285 (PPO)
| $0.00 |
$5,300 |
$200 | 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 |
-- This plan not offered in 2022 --
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H5216 -309 -0 | | | | | |
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2023 HumanaChoice H5216-309 (PPO)
| $0.00 |
$6,500 |
$350 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,404 2023 Formulary |
|
2022 HumanaChoice H5525-042 (PPO)
| $0.00 |
$7,550 |
$250 | No additional gap coverage, only the Donut Hole Discount |
H5525 -042 -0 | $7.00 | $17.00 | $47.00 | $47.00 | 3,413
2022 Formulary |
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2023 HumanaChoice H5525-042 (PPO)
| $0.00 |
$7,550 |
$250 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $17.00 | $47.00 | $47.00 | 3,404 2023 Formulary |
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2022 HumanaChoice R5495-001 (Regional PPO)
| $0.00 |
$7,550 |
No Rx Coverage |
R5495 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
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2023 HumanaChoice R5495-001 (Regional PPO)
| $0.00 |
$6,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2022 MedMutual Advantage Classic (HMO)
| $0.00 |
$5,850 |
$95 | Yes, some additional gap coverage. |
H6723 -001 -2 | $0.00 | $5.00 | $42.00 | $42.00 | 3,490
2022 Formulary |
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2023 MedMutual Advantage Classic (HMO)
| $0.00 |
$5,850 |
$95 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 3,467 2023 Formulary |
|
2022 Molina Medicare Choice Care (HMO)
| $0.00 |
$7,550 |
$125 | No additional gap coverage, only the Donut Hole Discount |
H9955 -002 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,218
2022 Formulary |
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new |
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2023 Molina Medicare Choice Care (HMO)
| $0.00 |
$8,300 |
$125 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 3,221 2023 Formulary |
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-- This plan not offered in 2022 --
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H9955 -004 -0 | | | | | |
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new |
|
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2023 Molina Medicare Choice Care Select (HMO)
| $0.00 |
$8,300 |
$375 | No additional gap coverage, only the Donut Hole Discount | $15.00 | $20.00 | $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 SummaCare Medicare Amber (HMO)
| $0.00 |
$3,450 |
No Rx Coverage |
H3660 -052 -2 | This plan does NOT include Prescription Drug coverage. | |
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2023 SummaCare Medicare Amber (HMO)
| $0.00 |
$3,450 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 Wellcare Giveback (HMO)
| $0.00 |
$5,500 |
$480 | No additional gap coverage, only the Donut Hole Discount |
H0908 -005 -0 | $0.00 | $15.00 | $37.00 | $37.00 | 3,375
2022 Formulary |
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2023 Wellcare Giveback (HMO)
| $0.00 |
$7,500 |
$505 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $37.00 | $37.00 | 3,392 2023 Formulary |
|
2022 Wellcare Giveback Boost (HMO)
| $0.00 |
$7,550 |
$75 | Yes, some additional gap coverage. |
H0724 -007 -0 | $0.00 | $9.00 | $37.00 | $37.00 | 3,375
2022 Formulary |
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2023 Wellcare Giveback Boost (HMO)
| $0.00 |
$8,300 |
$150 | Yes, some additional gap coverage. | $0.00 | $9.00 | $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 No Premium (HMO)
| $0.00 |
$3,450 |
$75 | Yes, some additional gap coverage. |
H0908 -003 -0 | $0.00 | $9.00 | $37.00 | $37.00 | 3,375
2022 Formulary |
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|
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2023 Wellcare No Premium (HMO)
| $0.00 |
$4,700 |
$75 | Yes, some additional gap coverage. | $0.00 | $9.00 | $37.00 | $37.00 | 3,392 2023 Formulary |
|
2022 Wellcare No Premium Medicare (HMO)
| $0.00 |
$3,450 |
$75 | Yes, some additional gap coverage. |
H0724 -001 -0 | $0.00 | $9.00 | $37.00 | $37.00 | 3,375
2022 Formulary |
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|
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2023 Wellcare No Premium Medicare (HMO)
| $0.00 |
$6,500 |
$75 | Yes, some additional gap coverage. | $0.00 | $9.00 | $37.00 | $37.00 | 3,392 2023 Formulary |
|
2022 Wellcare No Premium Open (PPO)
| $0.00 |
$5,900 |
$160 | No additional gap coverage, only the Donut Hole Discount |
H7169 -001 -0 | $0.00 | $7.00 | $37.00 | $37.00 | 3,375
2022 Formulary |
|
new |
new |
|
2023 Wellcare No Premium Open (PPO)
| $0.00 |
$5,900 |
$160 | No additional gap coverage, only the Donut Hole Discount | $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 |
-- This plan not offered in 2022 --
|
H7169 -004 -0 | | | | | |
|
new |
new |
|
2023 Wellcare Patriot Giveback Open (PPO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 Anthem MediBlue Extra (HMO)
| $22.00 |
$7,550 |
$480 | Yes, some additional gap coverage. |
H3655 -041 -0 | $0.00 | $7.00 | $47.00 | $47.00 | 3,626
2022 Formulary |
|
|
|
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2023 Anthem MediBlue Extra (HMO)
| $10.40 |
$7,550 |
$505 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $20.00 | $47.00 | $47.00 | 3,603 2023 Formulary |
|
2022 Wellcare Assist (HMO)
| $16.80 |
$4,700 |
$480 | Yes, some additional gap coverage. |
H0908 -004 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,375
2022 Formulary |
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2023 Wellcare Assist (HMO)
| $10.80 |
$4,700 |
$505 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,392 2023 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2022 Wellcare Assist Complement (HMO)
| $17.60 |
$3,450 |
$480 | Yes, some additional gap coverage. |
H0724 -006 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,375
2022 Formulary |
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|
|
2023 Wellcare Assist Complement (HMO)
| $11.90 |
$6,000 |
$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 --
|
H5253 -050 -0 | | | | | |
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2023 AARP Medicare Advantage Plan 1 (HMO-POS)
| $19.00 |
$3,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,682 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H2697 -005 -0 | | | | | |
|
|
|
|
2023 Devoted PRIME Ohio (HMO)
| $19.00 |
$3,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $42.00 | $42.00 | 3,364 2023 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2022 --
|
H5253 -115 -0 | | | | | |
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|
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2023 AARP Medicare Advantage Flex Plan 8 (HMO-POS)
| $25.00 |
$4,200 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,682 2023 Formulary |
|
2022 Humana Value Plus H5525-041 (PPO)
| $21.30 |
$7,550 |
$260 | No additional gap coverage, only the Donut Hole Discount |
H5525 -041 -0 | $0.00 | $15.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
|
|
|
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2023 Humana Value Plus H5525-041 (PPO)
| $25.90 |
$7,550 |
$260 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $47.00 | $47.00 | 3,404 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H7169 -003 -0 | | | | | |
|
new |
new |
|
2023 Wellcare Dual Access Open (PPO D-SNP)
| $26.00 |
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 Wellcare Dual Access (HMO D-SNP)
| $32.00 |
n/a |
$480 | Some Generics |
H0908 -001 -0 | $0.00 | $9.00 | $40.00 | $40.00 | 3,375
2022 Formulary |
|
|
|
|
2023 Wellcare Dual Access (HMO D-SNP)
| $28.60 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,394 2023 Formulary |
|
2022 Anthem MediBlue Dual Advantage (HMO D-SNP)
| $33.50 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H3655 -033 -0 | $10.00 | $20.00 | $47.00 | $47.00 | 3,626
2022 Formulary |
|
|
|
|
2023 Anthem MediBlue Dual Advantage (HMO D-SNP)
| $28.90 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $20.00 | $47.00 | $47.00 | 3,603 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H8768 -007 -0 | | | | | |
|
|
|
|
2023 AARP Medicare Advantage Choice Flex (PPO)
| $30.00 |
$4,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $45.00 | $45.00 | 3,682 2023 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2022 --
|
H2697 -011 -0 | | | | | |
|
|
|
|
2023 Devoted DUAL Ohio - 2 (HMO D-SNP)
| $33.70 |
n/a |
$505 | Yes, some additional gap coverage. | 25% | 25% | 25% | 25% | 3,364 2023 Formulary |
|
2022 CareSource Dual Advantage (HMO D-SNP)
| $33.50 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H6396 -005 -0 | 25% | 25% | 25% | 25% | 3,490
2022 Formulary |
|
|
|
|
2023 CareSource Dual Advantage (HMO D-SNP)
| $34.70 |
n/a |
$505 | Yes, some additional gap coverage. | $0.00 | 25% | 25% | 25% | 3,467 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H2697 -010 -0 | | | | | |
|
|
|
|
2023 Devoted DUAL Ohio - 1 (HMO D-SNP)
| $34.70 |
n/a |
$505 | Yes, some additional gap coverage. | 25% | 25% | 25% | 25% | 3,364 2023 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2022 HumanaChoice SNP-DE H5525-046 (PPO D-SNP)
| $27.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H5525 -046 -0 | $1.00 | $13.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
|
|
|
|
2023 HumanaChoice SNP-DE H5525-046 (PPO D-SNP)
| $34.70 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,404 2023 Formulary |
|
2022 Molina Medicare Complete Care (HMO D-SNP)
| $33.50 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H9955 -001 -0 | $0.00 | $4.00 | $44.00 | $44.00 | 3,263
2022 Formulary |
|
new |
|
|
2023 Molina Medicare Complete Care (HMO D-SNP)
| $34.70 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $4.00 | $44.00 | $44.00 | 3,270 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H9955 -003 -0 | | | | | |
|
new |
|
|
2023 Molina Medicare Complete Care Select (HMO D-SNP)
| $34.70 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $29.00 | $29.00 | 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 |
2022 UnitedHealthcare Dual Complete (HMO-POS D-SNP)
| $33.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H5322 -028 -0 | | | | | 3,654
2022 Formulary |
|
|
|
|
2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP)
| $34.70 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,682 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H0271 -055 -0 | | | | | |
|
|
|
|
2023 UnitedHealthcare Dual Complete Choice (PPO D-SNP)
| $34.70 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,682 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H5322 -034 -0 | | | | | |
|
|
|
|
2023 UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)
| $34.70 |
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 Valor Health Plan (HMO I-SNP)
| $33.50 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H1119 -001 -0 | | | | | 3,497
2022 Formulary |
|
-- |
|
|
2023 Valor Health Plan (HMO I-SNP)
| $34.70 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,445 2023 Formulary |
|
2022 Anthem MediBlue Access (PPO)
| $56.00 |
$5,500 |
$0 | Yes, some additional gap coverage. |
H4036 -025 -0 | $4.00 | $15.00 | $42.00 | $42.00 | 3,626
2022 Formulary |
|
|
|
|
2023 Anthem MediBlue Access (PPO)
| $56.00 |
$5,500 |
$0 | Yes, some additional gap coverage. | $4.00 | $15.00 | $42.00 | $42.00 | 3,603 2023 Formulary |
|
2022 SummaCare Medicare Sapphire (HMO-POS)
| $76.00 |
$3,600 |
$0 | Yes, some additional gap coverage. |
H3660 -029 -0 | $0.00 | $8.00 | $44.00 | $44.00 | 3,510
2022 Formulary |
|
|
|
|
2023 SummaCare Medicare Sapphire (HMO-POS)
| $76.00 |
$3,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $44.00 | $44.00 | 3,518 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 Access Basic (Regional PPO)
| $83.00 |
$6,000 |
$200 | Yes, some additional gap coverage. |
R5941 -014 -0 | $6.00 | $15.00 | $42.00 | $42.00 | 3,635
2022 Formulary |
|
|
|
|
2023 Anthem MediBlue Access Basic (Regional PPO)
| $78.00 |
$6,050 |
$50 | Yes, some additional gap coverage. | $6.00 | $15.00 | $42.00 | $42.00 | 3,603 2023 Formulary |
|
2022 HumanaChoice H5216-050 (PPO)
| $80.00 |
$5,300 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5216 -050 -0 | $7.00 | $17.00 | $47.00 | $47.00 | 3,413
2022 Formulary |
|
|
|
|
2023 HumanaChoice H5216-050 (PPO)
| $79.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $47.00 | $47.00 | 3,404 2023 Formulary |
|
2022 Humana Gold Choice H8145-032 (PFFS)
| $83.00 |
n/a |
$225 | No additional gap coverage, only the Donut Hole Discount |
H8145 -032 -0 | $7.00 | $17.00 | $47.00 | $47.00 | 3,413
2022 Formulary |
|
|
|
|
2023 Humana Gold Choice H8145-032 (PFFS)
| $82.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,409 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 R5495-002 (Regional PPO)
| $114.00 |
$6,700 |
$480 | No additional gap coverage, only the Donut Hole Discount |
R5495 -002 -0 | $16.00 | $20.00 | 17% | 17% | 3,421
2022 Formulary |
|
|
|
|
2023 HumanaChoice R5495-002 (Regional PPO)
| $84.00 |
$6,700 |
$505 | No additional gap coverage, only the Donut Hole Discount | $18.00 | $20.00 | 18% | 18% | 3,409 2023 Formulary |
|
2022 MedMutual Advantage Choice (HMO)
| $100.00 |
$4,800 |
$55 | Yes, some additional gap coverage. |
H6723 -002 -2 | $0.00 | $5.00 | $42.00 | $42.00 | 3,490
2022 Formulary |
|
|
|
|
2023 MedMutual Advantage Choice (HMO)
| $100.00 |
$4,800 |
$55 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 3,467 2023 Formulary |
|
2022 MedMutual Advantage Select (PPO)
| $100.00 |
$6,900 |
$95 | Yes, some additional gap coverage. |
H4497 -001 -2 | $0.00 | $5.00 | $42.00 | $42.00 | 3,490
2022 Formulary |
|
|
|
|
2023 MedMutual Advantage Select (PPO)
| $100.00 |
$6,900 |
$95 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 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 MedMutual Advantage Plus (HMO)
| $134.00 |
$3,450 |
$55 | Yes, some additional gap coverage. |
H6723 -003 -2 | $0.00 | $5.00 | $42.00 | $42.00 | 3,490
2022 Formulary |
|
|
|
|
2023 MedMutual Advantage Plus (HMO)
| $134.00 |
$3,450 |
$55 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 3,467 2023 Formulary |
|
2022 Aetna Medicare Premier Plus 2 (Regional PPO)
| $179.00 |
$5,100 |
$260 | No additional gap coverage, only the Donut Hole Discount |
R6694 -005 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,680
2022 Formulary |
|
|
|
|
2023 Aetna Medicare Premier Plus 2 (Regional PPO)
| $137.00 |
$5,100 |
$505 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | 18% | 18% | 3,597 2023 Formulary |
|
2022 HumanaChoice H5525-030 (PPO)
| $151.00 |
$3,400 |
$100 | No additional gap coverage, only the Donut Hole Discount |
H5525 -030 -0 | $1.00 | $4.00 | $47.00 | $47.00 | 3,413
2022 Formulary |
|
|
|
|
2023 HumanaChoice H5525-030 (PPO)
| $150.00 |
$3,400 |
$100 | No additional gap coverage, only the Donut Hole Discount | $1.00 | $4.00 | $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 MedMutual Advantage Preferred (PPO)
| $150.00 |
$6,400 |
$55 | Yes, some additional gap coverage. |
H4497 -002 -2 | $0.00 | $5.00 | $42.00 | $42.00 | 3,490
2022 Formulary |
|
|
|
|
2023 MedMutual Advantage Preferred (PPO)
| $150.00 |
$6,400 |
$55 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 3,467 2023 Formulary |
|
2022 Aetna Medicare Premier Plus 1 (Regional PPO)
| $217.00 |
$4,900 |
$0 | Yes, some additional gap coverage. |
R6694 -003 -0 | $0.00 | $0.00 | $42.00 | $42.00 | 3,706
2022 Formulary |
|
|
|
|
2023 Aetna Medicare Premier Plus 1 (Regional PPO)
| $198.00 |
$4,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $42.00 | $42.00 | 3,622 2023 Formulary |
|
2022 MedMutual Advantage Premium (PPO)
| $200.00 |
$3,450 |
$55 | Yes, some additional gap coverage. |
H4497 -003 -2 | $0.00 | $5.00 | $42.00 | $42.00 | 3,490
2022 Formulary |
|
|
|
|
2023 MedMutual Advantage Premium (PPO)
| $200.00 |
$3,450 |
$55 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 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 HumanaChoice H5216-109 (PPO)
| $19.00 |
$5,700 |
$150 | No additional gap coverage, only the Donut Hole Discount |
H5216 -109 -0 | $0.00 | $8.00 | $47.00 | $47.00 | 3,413
2022 Formulary |
|
|
|
|
-- Members will be assigned to HumanaChoice H5216-285 (PPO) H5216-285 --
| | | | | |
|
2022 UnitedHealthcare Dual Complete LP1 (HMO D-SNP)
| $33.50 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H8125 -002 -0 | | | | | 3,654
2022 Formulary |
|
|
|
|
-- Members will be assigned to UnitedHealthcare Dual Complete (HMO-POS D-SNP) H5322-028 --
| | | | | |
|
2022 Wellcare Patriot No Premium (HMO)
| $0.00 |
$3,450 |
No Rx Coverage |
H0724 -005 -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 CareSource Advantage (HMO)
| $30.00 |
$7,550 |
$100 | No additional gap coverage, only the Donut Hole Discount |
H6396 -001 -0 | $4.00 | $10.00 | $45.00 | $45.00 | 3,490
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|
2022 CareSource Advantage Zero Premium (HMO)
| $0.00 |
$7,550 |
$175 | No additional gap coverage, only the Donut Hole Discount |
H6396 -004 -0 | $5.00 | $15.00 | $45.00 | $45.00 | 3,490
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|