There are 120 Medicare Advantage plans meeting your criteria.
2022 / 2023 Medicare Advantage Plan Information
Click here to jump to the Chart Legend |
Plan Name |
Monthly Premium |
Part A&B Maximum Out-Of Pocket |
Part D Deduct- ible |
(Donut Hole) Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Formulary Drugs |
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2022 Lasso Healthcare Growth (MSA)
| $0.00 |
n/a |
No Rx Coverage |
H1924 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
|
2023 Lasso Healthcare Growth (MSA)
| $0.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 Lasso Healthcare Growth Plus (MSA)
| $0.00 |
n/a |
No Rx Coverage |
H1924 -004 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
|
|
2023 Lasso Healthcare Growth Plus (MSA)
| $0.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 AARP Medicare Advantage Walgreens (PPO)
| $0.00 |
$5,100 |
$225 | Yes, some additional gap coverage. |
H8768 -014 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,654
2022 Formulary |
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2023 AARP Medicare Advantage Choice (PPO)
| $0.00 |
$5,100 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $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 |
2022 AARP Medicare Advantage Patriot (PPO)
| $0.00 |
$4,500 |
No Rx Coverage |
H8768 -021 -0 | This plan does NOT include Prescription Drug coverage. | |
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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. | |
|
2022 AARP Medicare Advantage Plan 7 (HMO)
| $0.00 |
$4,500 |
$175 | Yes, some additional gap coverage. |
H5253 -049 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,654
2022 Formulary |
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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 |
|
2022 Aetna Medicare Eagle (HMO)
| $0.00 |
$5,900 |
No Rx Coverage |
H0628 -015 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
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2023 Aetna Medicare Eagle (HMO)
| $0.00 |
$5,900 |
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 Aetna Medicare Premier (HMO-POS)
| $0.00 |
$4,500 |
$0 | Yes, some additional gap coverage. |
H0628 -005 -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 |
$4,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,622 2023 Formulary |
|
2022 Aetna Medicare Value Plan (HMO-POS)
| $0.00 |
$7,550 |
$150 | Yes, some additional gap coverage. |
H3931 -107 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,672
2022 Formulary |
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2023 Aetna Medicare Value Plan (HMO-POS)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,622 2023 Formulary |
|
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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|
|
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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 |
|
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 Core (Regional PPO)
| $0.00 |
$4,900 |
No Rx Coverage |
R5941 -013 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2023 Anthem MediBlue Access Core (Regional PPO)
| $0.00 |
$4,900 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 Anthem MediBlue Preferred (HMO)
| $0.00 |
$3,800 |
$0 | Yes, some additional gap coverage. |
H3655 -045 -4 | $4.00 | $10.00 | $42.00 | $42.00 | 3,626
2022 Formulary |
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2023 Anthem MediBlue Preferred (HMO)
| $0.00 |
$3,800 |
$0 | Yes, some additional gap coverage. | $4.00 | $10.00 | $42.00 | $42.00 | 3,603 2023 Formulary |
|
2022 Anthem MediBlue Prime Select (HMO)
| $0.00 |
$3,450 |
$0 | Yes, some additional gap coverage. |
H3655 -038 -0 | $2.00 | $12.00 | $42.00 | $42.00 | 3,626
2022 Formulary |
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2023 Anthem MediBlue Prime Select (HMO)
| $0.00 |
$3,450 |
$0 | Yes, some additional gap coverage. | $2.00 | $12.00 | $42.00 | $42.00 | 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 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. | |
|
2022 CareSource MyCare Ohio (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics, All Brands |
H8452 -001 -0 | | | | | 3,490
2022 Formulary |
-- |
-- |
-- |
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2023 CareSource MyCare Ohio (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | | | | | 3,467 2023 Formulary |
|
2022 Cigna Preferred Medicare (HMO)
| $0.00 |
$4,500 |
$0 | Yes, some additional gap coverage. |
H0672 -006 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,459
2022 Formulary |
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2023 Cigna Preferred Medicare (HMO)
| $0.00 |
$3,850 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $42.00 | $42.00 | 3,524 2023 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2022 --
|
H0672 -016 -0 | | | | | |
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|
|
2023 Cigna Preferred Savings Medicare (HMO)
| $0.00 |
$5,600 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $42.00 | $42.00 | 3,524 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H7849 -090 -0 | | | | | |
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2023 Cigna True Choice Courage Medicare (PPO)
| $0.00 |
$4,100 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 Cigna True Choice Medicare (PPO)
| $0.00 |
$5,500 |
$0 | Yes, some additional gap coverage. |
H7849 -015 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,459
2022 Formulary |
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|
|
2023 Cigna True Choice Medicare (PPO)
| $0.00 |
$4,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $42.00 | $42.00 | 3,524 2023 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2022 --
|
H2526 -001 -0 | | | | | |
new |
new |
new |
|
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 |
|
2022 Devoted Health Core (HMO)
| $0.00 |
$4,200 |
$0 | Yes, some additional gap coverage. |
H2697 -001 -0 | $0.00 | $0.00 | $42.00 | $42.00 | 3,349
2022 Formulary |
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|
|
2023 Devoted CORE Ohio (HMO)
| $0.00 |
$3,800 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $42.00 | $42.00 | 3,364 2023 Formulary |
|
2022 Devoted Health Saver (HMO)
| $0.00 |
$5,900 |
$200 | No additional gap coverage, only the Donut Hole Discount |
H2697 -003 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,349
2022 Formulary |
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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 |
|
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 Cleveland Clinic Preferred (HMO)
| $0.00 |
$3,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H6622 -023 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
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|
|
|
2023 Humana Cleveland Clinic Preferred (HMO-POS)
| $0.00 |
$3,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,404 2023 Formulary |
|
2022 Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
| $16.00 |
n/a |
$200 | No additional gap coverage, only the Donut Hole Discount |
H6622 -017 -0 | $7.00 | $17.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
|
|
|
|
2023 Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
| $0.00 |
n/a |
$200 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $17.00 | $47.00 | $47.00 | 3,404 2023 Formulary |
|
2022 Humana Gold Plus H6622-014 (HMO)
| $0.00 |
$4,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H6622 -014 -0 | $0.00 | $8.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
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|
|
|
2023 Humana Gold Plus H6622-014 (HMO-POS)
| $0.00 |
$4,000 |
$0 | 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 |
$5,900 |
No Rx Coverage |
H5216 -218 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2023 Humana Honor (PPO)
| $0.00 |
$5,900 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
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 |
|
|
|
|
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 |
|
-- This plan not offered in 2022 --
|
H5216 -309 -0 | | | | | |
|
|
|
|
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 |
|
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 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 |
|
2022 HumanaChoice R5495-001 (Regional PPO)
| $0.00 |
$7,550 |
No Rx Coverage |
R5495 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2023 HumanaChoice R5495-001 (Regional PPO)
| $0.00 |
$6,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 MedMutual Advantage Access (PPO)
| $0.00 |
$5,400 |
$0 | Yes, some additional gap coverage. |
H4497 -005 -1 | $4.00 | $8.00 | $42.00 | $42.00 | 3,224
2022 Formulary |
|
|
|
|
2023 MedMutual Advantage Access (PPO)
| $0.00 |
$6,050 |
$0 | Yes, some additional gap coverage. | $4.00 | $8.00 | $42.00 | $42.00 | 3,178 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 Classic (HMO)
| $0.00 |
$4,800 |
$95 | Yes, some additional gap coverage. |
H6723 -001 -1 | $0.00 | $5.00 | $42.00 | $42.00 | 3,490
2022 Formulary |
|
|
|
|
2023 MedMutual Advantage Classic (HMO)
| $0.00 |
$4,800 |
$95 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 3,467 2023 Formulary |
|
2022 MedMutual Advantage Signature (HMO)
| $0.00 |
$3,900 |
$0 | Yes, some additional gap coverage. |
H6723 -006 -3 | $4.00 | $8.00 | $42.00 | $42.00 | 3,224
2022 Formulary |
|
|
|
|
2023 MedMutual Advantage Signature (HMO)
| $0.00 |
$3,500 |
$0 | Yes, some additional gap coverage. | $4.00 | $8.00 | $42.00 | $42.00 | 3,178 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 |
|
new |
|
|
2023 Molina Medicare Choice Care (HMO)
| $0.00 |
$8,300 |
$125 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 3,221 2023 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2022 --
|
H9955 -004 -0 | | | | | |
|
new |
|
|
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 |
|
-- This plan not offered in 2022 --
|
H3653 -026 -0 | | | | | |
|
|
|
|
2023 PARAMOUNT ELITE NE OHIO STANDARD (HMO)
| $0.00 |
$3,600 |
$0 | Yes, some additional gap coverage. | $2.00 | $8.00 | $45.00 | $45.00 | 3,196 2023 Formulary |
|
2022 Paramount Elite Enhanced Medical Only (HMO)
| $20.00 |
$3,400 |
No Rx Coverage |
H3653 -018 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2023 Paramount Elite Prevail (HMO)
| $0.00 |
$5,900 |
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 PrimeTime Health Plan Aultimate (HMO-POS)
| $0.00 |
$4,500 |
$200 | No additional gap coverage, only the Donut Hole Discount |
H3664 -021 -0 | $0.00 | $15.00 | $42.00 | $42.00 | 3,861
2022 Formulary |
|
|
|
|
2023 PrimeTime Health Plan Aultimate (HMO-POS)
| $0.00 |
$4,300 |
$150 | Yes, some additional gap coverage. | $0.00 | $15.00 | $42.00 | $42.00 | 3,864 2023 Formulary |
|
2022 PrimeTime Health Plan Basic - MA Only (HMO-POS)
| $0.00 |
$3,400 |
No Rx Coverage |
H3664 -014 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2023 PrimeTime Health Plan Basic - MA Only (HMO-POS)
| $0.00 |
$3,400 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 SummaCare Medicare Amber (HMO)
| $0.00 |
$3,450 |
No Rx Coverage |
H3660 -052 -1 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2023 SummaCare Medicare Amber (HMO)
| $0.00 |
$3,450 |
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 SummaCare Medicare Topaz (HMO)
| $0.00 |
$3,900 |
$150 | Yes, some additional gap coverage. |
H3660 -050 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,510
2022 Formulary |
|
|
|
|
2023 SummaCare Medicare Topaz (HMO)
| $0.00 |
$3,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $9.00 | $46.00 | $46.00 | 3,518 2023 Formulary |
|
2022 The Health Plan SecureCare - Option I, MA Only (HMO)
| $0.00 |
$3,900 |
No Rx Coverage |
H3672 -014 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2023 The Health Plan SecureCare - Option I, MA Only (HMO)
| $0.00 |
$3,900 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 The Health Plan SecureCare - Option II (HMO)
| $0.00 |
$3,900 |
$100 | No additional gap coverage, only the Donut Hole Discount |
H3672 -013 -0 | $3.00 | $10.00 | $47.00 | $47.00 | 3,224
2022 Formulary |
|
|
|
|
2023 The Health Plan SecureCare - Option II (HMO)
| $0.00 |
$3,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $47.00 | $47.00 | 3,178 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 Connected for MyCareOhio (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | All Generics, All Brands |
H2531 -001 -0 | | | | | 3,528
2022 Formulary |
-- |
-- |
-- |
|
2023 UnitedHealthcare Connected for MyCareOhio (Medicare-Medicaid Plan)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | | | | | 3,538 2023 Formulary |
|
2022 Wellcare Dividend Giveback (HMO)
| $0.00 |
$3,450 |
$480 | No additional gap coverage, only the Donut Hole Discount |
H5475 -032 -0 | $0.00 | $15.00 | $37.00 | $37.00 | 3,375
2022 Formulary |
|
-- |
|
|
2023 Wellcare Dividend 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 (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 |
|
|
|
|
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 |
|
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 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 |
|
|
|
|
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 |
|
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 |
|
|
|
|
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 Essential (HMO-POS)
| $0.00 |
$3,450 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5475 -022 -0 | $0.00 | $5.00 | $37.00 | $37.00 | 3,375
2022 Formulary |
|
-- |
|
|
2023 Wellcare No Premium Essential (HMO-POS)
| $0.00 |
$4,200 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $37.00 | $37.00 | 3,393 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 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 |
|
|
|
|
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 |
|
-- 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. | |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2022 Anthem MediBlue Extra (HMO)
| $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 |
|
|
|
|
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 |
|
|
|
|
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 |
|
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 |
|
|
|
|
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 |
|
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 H5216-106 (PPO)
| $15.00 |
$3,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5216 -106 -0 | $0.00 | $8.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
|
|
|
|
2023 HumanaChoice H5216-106 (PPO)
| $14.00 |
$3,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,404 2023 Formulary |
|
2022 Aetna Medicare Assure 1 (HMO D-SNP)
| $23.20 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H0628 -013 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,672
2022 Formulary |
|
|
|
|
2023 Aetna Medicare Assure 1 (HMO D-SNP)
| $14.20 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,597 2023 Formulary |
|
2022 AARP Medicare Advantage Plan 1 (HMO)
| $19.00 |
$4,200 |
$0 | Yes, some additional gap coverage. |
H5253 -050 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,654
2022 Formulary |
|
|
|
|
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 |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2022 Devoted Health Prime (HMO)
| $31.00 |
$4,100 |
$0 | Yes, some additional gap coverage. |
H2697 -002 -0 | $0.00 | $0.00 | $42.00 | $42.00 | 3,349
2022 Formulary |
|
|
|
|
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 |
|
-- This plan not offered in 2022 --
|
H3660 -056 -1 | | | | | |
|
|
|
|
2023 SummaCare Medicare Jade with Bene-FlexTM (HMO)
| $19.00 |
$3,850 |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $44.00 | $44.00 | 3,518 2023 Formulary |
|
2022 MedMutual Advantage Secure (HMO)
| $22.00 |
$3,500 |
$95 | Yes, some additional gap coverage. |
H6723 -005 -1 | $0.00 | $5.00 | $42.00 | $42.00 | 3,490
2022 Formulary |
|
|
|
|
2023 MedMutual Advantage Secure (HMO)
| $22.00 |
$3,500 |
$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 |
-- This plan not offered in 2022 --
|
H0672 -011 -0 | | | | | |
|
|
|
|
2023 Cigna Preferred Plus Medicare (HMO)
| $23.00 |
$3,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $42.00 | $42.00 | 3,524 2023 Formulary |
|
2022 AARP Medicare Advantage Plan 8 (HMO)
| $25.00 |
$3,900 |
$0 | Yes, some additional gap coverage. |
H5253 -115 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,654
2022 Formulary |
|
|
|
|
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 Anthem MediBlue Preferred Plus (HMO)
| $19.00 |
$3,650 |
$0 | Yes, some additional gap coverage. |
H3655 -042 -0 | $4.00 | $10.00 | $42.00 | $42.00 | 3,626
2022 Formulary |
|
|
|
|
2023 Anthem MediBlue Preferred Plus (HMO)
| $25.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $4.00 | $10.00 | $42.00 | $42.00 | 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 |
-- This plan not offered in 2022 --
|
H5525 -041 -0 | | | | | |
|
|
|
|
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 |
|
-- This plan not offered in 2022 --
|
H3653 -027 -0 | | | | | |
|
|
|
|
2023 PARAMOUNT ELITE NE OHIO PRIME (HMO)
| $28.00 |
$4,000 |
$0 | Yes, some additional gap coverage. | $2.00 | $8.00 | $45.00 | $45.00 | 3,196 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 --
|
H0672 -012 -0 | | | | | |
|
|
|
|
2023 Cigna TotalCare (HMO D-SNP)
| $28.50 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,524 2023 Formulary |
|
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 Wellcare Dual Access Extra (HMO-POS D-SNP)
| $29.60 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H5475 -021 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,375
2022 Formulary |
|
-- |
|
|
2023 Wellcare Dual Access Extra (HMO-POS D-SNP)
| $28.60 |
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 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 |
|
2022 SummaCare Medicare Garnet (HMO)
| $29.00 |
$3,800 |
$0 | Yes, some additional gap coverage. |
H3660 -053 -1 | $0.00 | $8.00 | $44.00 | $44.00 | 3,510
2022 Formulary |
|
|
|
|
2023 SummaCare Medicare Garnet (HMO)
| $29.00 |
$3,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $44.00 | $44.00 | 3,518 2023 Formulary |
|
2022 UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
| $29.80 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H2406 -001 -0 | | | | | 3,654
2022 Formulary |
|
|
|
|
2023 UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
| $29.00 |
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 |
-- 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 CommuniCare Advantage ISNP (HMO I-SNP)
| $33.50 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H3727 -002 -3 | | | | | 3,497
2022 Formulary |
|
new |
|
|
2023 CommuniCare Advantage ISNP (HMO I-SNP)
| $34.20 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,445 2023 Formulary |
|
2022 CareSource Dual Advantage (HMO D-SNP)
| $33.50 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H6396 -014 -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 |
|
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 -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 |
|
2022 Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP)
| $27.60 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H6622 -015 -0 | $2.00 | $18.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
|
|
|
|
2023 Humana Gold Plus SNP-DE H6622-015 (HMO 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 |
|
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 --
|
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 |
|
2022 Perennial Advantage Concierge (HMO C-SNP)
| $31.30 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H8797 -002 -0 | $2.00 | $15.00 | $45.00 | $45.00 | 3,860
2022 Formulary |
|
new |
|
|
2023 Perennial Advantage Concierge (HMO C-SNP)
| $34.70 |
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 Perennial Advantage Strive (HMO I-SNP)
| $28.20 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H8797 -001 -0 | | | | | 3,712
2022 Formulary |
|
new |
|
|
2023 Perennial Advantage Strive (HMO I-SNP)
| $34.70 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,683 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 Assisted Living Plan (PPO I-SNP)
| $33.50 |
n/a |
$200 | No additional gap coverage, only the Donut Hole Discount |
H0710 -057 -0 | $2.00 | $12.00 | $47.00 | $47.00 | 3,654
2022 Formulary |
|
-- |
|
|
2023 UnitedHealthcare Assisted Living Plan (PPO I-SNP)
| $34.70 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $12.00 | $47.00 | $47.00 | 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 |
|
2022 UnitedHealthcare Dual Complete LP (HMO D-SNP)
| $33.50 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H5253 -059 -0 | | | | | 3,654
2022 Formulary |
|
|
|
|
2023 UnitedHealthcare Dual Complete LP (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 |
-- This plan not offered in 2022 --
|
H5253 -122 -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 |
|
2022 UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)
| $33.50 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H0710 -027 -0 | | | | | 3,654
2022 Formulary |
|
-- |
|
|
2023 UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)
| $34.70 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,682 2023 Formulary |
|
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 |
|
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 Plus (HMO)
| $55.00 |
$4,100 |
$0 | Yes, some additional gap coverage. |
H3655 -034 -0 | $2.00 | $10.00 | $37.00 | $37.00 | 3,626
2022 Formulary |
|
|
|
|
2023 Anthem MediBlue Plus (HMO)
| $37.00 |
$4,100 |
$0 | Yes, some additional gap coverage. | $2.00 | $10.00 | $37.00 | $37.00 | 3,603 2023 Formulary |
|
2022 PrimeTime Health Plan Classic (HMO-POS)
| $39.00 |
$4,200 |
$150 | No additional gap coverage, only the Donut Hole Discount |
H3664 -020 -0 | $0.00 | $8.00 | $42.00 | $42.00 | 3,861
2022 Formulary |
|
|
|
|
2023 PrimeTime Health Plan Classic (HMO-POS)
| $39.00 |
$4,100 |
$125 | Yes, some additional gap coverage. | $0.00 | $8.00 | $42.00 | $42.00 | 3,864 2023 Formulary |
|
2022 MedMutual Advantage Choice (HMO)
| $40.00 |
$4,300 |
$55 | Yes, some additional gap coverage. |
H6723 -002 -1 | $0.00 | $5.00 | $42.00 | $42.00 | 3,490
2022 Formulary |
|
|
|
|
2023 MedMutual Advantage Choice (HMO)
| $40.00 |
$4,300 |
$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 The Health Plan SecureCare SNP (HMO D-SNP)
| $40.40 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H3672 -019 -0 | | | | | 3,224
2022 Formulary |
|
|
|
|
2023 The Health Plan SecureCare SNP (HMO D-SNP)
| $40.80 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,178 2023 Formulary |
|
2022 SummaCare Medicare Ruby (HMO)
| $43.00 |
$3,700 |
$0 | Yes, some additional gap coverage. |
H3660 -044 -0 | $0.00 | $8.00 | $44.00 | $44.00 | 3,510
2022 Formulary |
|
|
|
|
2023 SummaCare Medicare Ruby (HMO)
| $43.00 |
$3,600 |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $44.00 | $44.00 | 3,518 2023 Formulary |
|
2022 MedMutual Advantage Select (PPO)
| $44.00 |
$5,900 |
$95 | Yes, some additional gap coverage. |
H4497 -001 -1 | $0.00 | $5.00 | $42.00 | $42.00 | 3,490
2022 Formulary |
|
|
|
|
2023 MedMutual Advantage Select (PPO)
| $44.00 |
$6,200 |
$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 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 The Health Plan SecureChoice - Option II (PPO)
| $100.00 |
$6,700 |
$100 | No additional gap coverage, only the Donut Hole Discount |
H8604 -010 -0 | $3.00 | $10.00 | $47.00 | $47.00 | 3,224
2022 Formulary |
|
|
|
|
2023 The Health Plan SecureChoice - Option II (PPO)
| $58.00 |
$6,700 |
$100 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $10.00 | $47.00 | $47.00 | 3,178 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H3653 -025 -0 | | | | | |
|
|
|
|
2023 PARAMOUNT ELITE NE OHIO ENHANCED (HMO)
| $68.00 |
$3,800 |
$0 | Yes, some additional gap coverage. | $2.00 | $8.00 | $45.00 | $45.00 | 3,196 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 H5216-024 (PPO)
| $76.00 |
$6,700 |
$100 | No additional gap coverage, only the Donut Hole Discount |
H5216 -024 -0 | $7.00 | $17.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
|
|
|
|
2023 HumanaChoice H5216-024 (PPO)
| $75.00 |
$6,700 |
$100 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,404 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 |
|
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 |
|
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)
| $80.00 |
$5,700 |
$55 | Yes, some additional gap coverage. |
H4497 -002 -1 | $0.00 | $5.00 | $42.00 | $42.00 | 3,490
2022 Formulary |
|
|
|
|
2023 MedMutual Advantage Preferred (PPO)
| $80.00 |
$6,050 |
$55 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 3,467 2023 Formulary |
|
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 Anthem MediBlue Access Plus (PPO)
| $89.00 |
$4,300 |
$40 | Yes, some additional gap coverage. |
H4036 -017 -0 | $4.00 | $15.00 | $42.00 | $42.00 | 3,626
2022 Formulary |
|
|
|
|
2023 Anthem MediBlue Access Plus (PPO)
| $87.00 |
$4,300 |
$40 | Yes, some additional gap coverage. | $4.00 | $15.00 | $42.00 | $42.00 | 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 PrimeTime Health Plan Plus (HMO-POS)
| $89.00 |
$3,900 |
$100 | No additional gap coverage, only the Donut Hole Discount |
H3664 -017 -0 | $0.00 | $8.00 | $42.00 | $42.00 | 3,861
2022 Formulary |
|
|
|
|
2023 PrimeTime Health Plan Plus (HMO-POS)
| $89.00 |
$3,900 |
$75 | Yes, some additional gap coverage. | $0.00 | $8.00 | $42.00 | $42.00 | 3,864 2023 Formulary |
|
2022 Humana Gold Plus H6622-019 (HMO)
| $91.00 |
$3,900 |
$125 | No additional gap coverage, only the Donut Hole Discount |
H6622 -019 -0 | $1.00 | $4.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
|
|
|
|
2023 Humana Gold Plus H6622-019 (HMO)
| $90.00 |
$3,900 |
$125 | No additional gap coverage, only the Donut Hole Discount | $1.00 | $4.00 | $47.00 | $47.00 | 3,404 2023 Formulary |
|
2022 MedMutual Advantage Plus (HMO)
| $97.00 |
$3,450 |
$55 | Yes, some additional gap coverage. |
H6723 -003 -1 | $0.00 | $5.00 | $42.00 | $42.00 | 3,490
2022 Formulary |
|
|
|
|
2023 MedMutual Advantage Plus (HMO)
| $97.00 |
$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 Aetna Medicare Premier 2 (PPO)
| $118.00 |
$4,800 |
$0 | Yes, some additional gap coverage. |
H5521 -020 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,672
2022 Formulary |
|
|
|
|
2023 Aetna Medicare Premier 2 (PPO)
| $101.00 |
$4,800 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $42.00 | $42.00 | 3,622 2023 Formulary |
|
2022 AARP Medicare Advantage Plan 3 (HMO)
| $111.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H5253 -051 -0 | $0.00 | $8.00 | $45.00 | $45.00 | 3,654
2022 Formulary |
|
|
|
|
2023 AARP Medicare Advantage Plan 3 (HMO-POS)
| $109.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $45.00 | $45.00 | 3,682 2023 Formulary |
|
2022 Aetna Medicare Premier 1 (PPO)
| $149.00 |
$5,500 |
$150 | Yes, some additional gap coverage. |
H5521 -134 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,672
2022 Formulary |
|
|
|
|
2023 Aetna Medicare Premier 1 (PPO)
| $120.00 |
$5,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $42.00 | $42.00 | 3,622 2023 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2022 MedMutual Advantage Premium (PPO)
| $134.00 |
$3,450 |
$55 | Yes, some additional gap coverage. |
H4497 -003 -1 | $0.00 | $5.00 | $42.00 | $42.00 | 3,490
2022 Formulary |
|
|
|
|
2023 MedMutual Advantage Premium (PPO)
| $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 SummaCare Medicare Emerald (HMO-POS)
| $180.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H3660 -028 -0 | $0.00 | $8.00 | $39.00 | $39.00 | 3,510
2022 Formulary |
|
|
|
|
2023 SummaCare Medicare Emerald (HMO-POS)
| $170.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $39.00 | $39.00 | 3,518 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 Humana Gold Plus H6622-070 (HMO)
| $21.00 |
$3,950 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H6622 -070 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
|
|
|
|
-- Members will be assigned to Humana Gold Plus H6622-014 (HMO-POS) H6622-014 --
| | | | | |
|
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 (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 --
|
| | | | |
|
2022 Paramount Elite Enhanced (HMO)
| $68.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H3653 -004 -0 | $0.00 | $15.00 | $45.00 | $45.00 | 4,209
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|
2022 Paramount Elite Standard (HMO)
| $0.00 |
$4,900 |
$50 | Yes, some additional gap coverage. |
H3653 -015 -0 | $0.00 | $20.00 | $45.00 | $45.00 | 3,193
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 Paramount Elite Prime (HMO)
| $28.00 |
$4,400 |
$0 | Yes, some additional gap coverage. |
H3653 -022 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,193
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|
2022 CareSource Advantage (HMO)
| $25.00 |
$5,600 |
$75 | No additional gap coverage, only the Donut Hole Discount |
H6396 -011 -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 |
$150 | No additional gap coverage, only the Donut Hole Discount |
H6396 -013 -0 | $5.00 | $15.00 | $45.00 | $45.00 | 3,490
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|