There are 83 Medicare Advantage plans meeting your criteria.
2022 / 2023 Medicare Advantage Plan Information
Click here to jump to the Chart Legend |
Plan Name |
Monthly Premium |
Part A&B Maximum Out-Of Pocket |
Part D Deduct- ible |
(Donut Hole) Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Formulary Drugs |
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
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 Choice Plan 3 (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H2228 -086 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,654
2022 Formulary |
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2023 AARP Medicare Advantage Choice Plan 3 (PPO)
| $0.00 |
$6,700 |
$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 |
-- This plan not offered in 2022 --
|
H2228 -130 -0 | | | | | |
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|
|
2023 AARP Medicare Advantage Choice Rebate (PPO)
| $0.00 |
$7,550 |
$295 | Yes, some additional gap coverage. | $0.00 | $14.00 | $47.00 | $47.00 | 3,682 2023 Formulary |
|
2022 AARP Medicare Advantage Plan 1 (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H1944 -010 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,654
2022 Formulary |
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|
|
2023 AARP Medicare Advantage Flex Plan 1 (HMO-POS)
| $0.00 |
$5,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,682 2023 Formulary |
|
2022 AARP Medicare Advantage Patriot (HMO)
| $0.00 |
$5,500 |
No Rx Coverage |
H1944 -030 -0 | This plan does NOT include Prescription Drug coverage. | |
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2023 AARP Medicare Advantage Patriot (HMO-POS)
| $0.00 |
$5,500 |
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 |
-- This plan not offered in 2022 --
|
H5522 -020 -0 | | | | | |
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2023 Aetna Medicare Advantra Central Value (PPO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,597 2023 Formulary |
|
2022 Aetna Medicare Advantra Credit Value (PPO)
| $0.00 |
$7,550 |
$250 | Yes, some additional gap coverage. |
H5522 -017 -0 | $3.00 | $7.00 | $47.00 | $47.00 | 3,672
2022 Formulary |
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|
|
2023 Aetna Medicare Advantra Credit Value (PPO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,597 2023 Formulary |
|
2022 Aetna Medicare Advantra Eagle (HMO)
| $0.00 |
$4,000 |
No Rx Coverage |
H3959 -041 -0 | This plan does NOT include Prescription Drug coverage. | |
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2023 Aetna Medicare Advantra Eagle (HMO)
| $0.00 |
$4,000 |
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 Advantra Premier (HMO-POS)
| $0.00 |
$5,900 |
$0 | Yes, some additional gap coverage. |
H3959 -032 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,698
2022 Formulary |
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|
2023 Aetna Medicare Advantra Premier (HMO-POS)
| $0.00 |
$5,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,622 2023 Formulary |
|
2022 Aetna Medicare Advantra Silver (HMO)
| $0.00 |
$5,900 |
$0 | Yes, some additional gap coverage. |
H3959 -011 -0 | $0.00 | $0.00 | $42.00 | $42.00 | 3,698
2022 Formulary |
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|
2023 Aetna Medicare Advantra Silver (HMO-POS)
| $0.00 |
$5,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $42.00 | $42.00 | 3,622 2023 Formulary |
|
2022 Aetna Medicare Value (PPO)
| $0.00 |
$6,400 |
$0 | Yes, some additional gap coverage. |
H5521 -261 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,698
2022 Formulary |
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2023 Aetna Medicare Value (PPO)
| $0.00 |
$6,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 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 |
-- This plan not offered in 2022 --
|
H3957 -047 -3 | | | | | |
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2023 Community Blue Medicare HMO Signature (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $42.00 | $42.00 | 3,426 2023 Formulary |
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2022 Complete Blue PPO Signature (PPO)
| $0.00 |
$6,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3916 -038 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,533
2022 Formulary |
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2023 Complete Blue PPO Signature (PPO)
| $0.00 |
$7,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $47.00 | $47.00 | 3,426 2023 Formulary |
|
-- This plan not offered in 2022 --
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H3916 -042 -2 | | | | | |
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2023 Freedom Blue PPO Valor (PPO)
| $0.00 |
$6,000 |
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 Humana Gold Choice H8145-052 (PFFS)
| $7.00 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount |
H8145 -052 -0 | $7.00 | $17.00 | $47.00 | $47.00 | 3,413
2022 Formulary |
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2023 Humana Gold Choice H8145-052 (PFFS)
| $0.00 |
n/a |
$360 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $17.00 | $47.00 | $47.00 | 3,409 2023 Formulary |
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2022 Humana Gold Choice H8145-055 (PFFS)
| $0.00 |
n/a |
No Rx Coverage |
H8145 -055 -0 | This plan does NOT include Prescription Drug coverage. | |
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2023 Humana Gold Choice H8145-055 (PFFS)
| $0.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 HumanaChoice H5216-116 (PPO)
| $0.00 |
$3,900 |
No Rx Coverage |
H5216 -116 -0 | This plan does NOT include Prescription Drug coverage. | |
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2023 Humana Honor (PPO)
| $0.00 |
$3,900 |
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 Humana Honor (PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
H5216 -221 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
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2023 Humana Honor (PPO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2022 --
|
H5525 -059 -0 | | | | | |
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2023 Humana USAA Honor with Rx (PPO)
| $0.00 |
$7,550 |
$250 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,404 2023 Formulary |
|
2022 HumanaChoice H5525-051 (PPO)
| $0.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5525 -051 -1 | $3.00 | $15.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
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2023 HumanaChoice H5525-051 (PPO)
| $0.00 |
$7,550 |
$0 | 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 --
|
H5525 -058 -0 | | | | | |
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|
|
|
2023 HumanaChoice H5525-058 (PPO)
| $0.00 |
$7,550 |
$505 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,404 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H5525 -060 -0 | | | | | |
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2023 HumanaChoice H5525-060 (PPO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,404 2023 Formulary |
|
2022 HumanaChoice R0923-001 (Regional PPO)
| $0.00 |
$4,500 |
No Rx Coverage |
R0923 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2023 HumanaChoice R0923-001 (Regional PPO)
| $0.00 |
$4,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2022 --
|
H3957 -048 -0 | | | | | |
|
|
|
|
2023 Together Blue Medicare HMO Signature (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $47.00 | $47.00 | 3,426 2023 Formulary |
|
2022 UPMC for Life HMO No Rx (HMO)
| $0.00 |
$7,550 |
No Rx Coverage |
H3907 -002 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2023 UPMC for Life HMO No Rx (HMO)
| $0.00 |
$5,000 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 UPMC for Life HMO Premier Rx (HMO)
| $0.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3907 -050 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,703
2022 Formulary |
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|
|
|
2023 UPMC for Life HMO Premier Rx (HMO)
| $0.00 |
$4,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,731 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 --
|
H5533 -013 -0 | | | | | |
|
|
|
|
2023 UPMC for Life PPO Premier Rx (PPO)
| $0.00 |
$6,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,731 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H5533 -012 -0 | | | | | |
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|
|
2023 UPMC for Life PPO Salute (PPO)
| $0.00 |
$5,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 Wellcare Giveback (HMO)
| $0.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2915 -012 -0 | $0.00 | $5.00 | $37.00 | $37.00 | 3,375
2022 Formulary |
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|
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2023 Wellcare Giveback (HMO)
| $0.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $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 Open (PPO)
| $0.00 |
$7,550 |
$350 | Yes, some additional gap coverage. |
H2128 -004 -0 | $0.00 | $5.00 | $37.00 | $37.00 | 3,375
2022 Formulary |
|
new |
new |
|
2023 Wellcare Giveback Open (PPO)
| $0.00 |
$7,550 |
$350 | Yes, some additional gap coverage. | $0.00 | $5.00 | $37.00 | $37.00 | 3,392 2023 Formulary |
|
2022 Wellcare No Premium (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2915 -003 -0 | $0.00 | $5.00 | $37.00 | $37.00 | 3,375
2022 Formulary |
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|
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2023 Wellcare No Premium (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $37.00 | $37.00 | 3,392 2023 Formulary |
|
2022 Wellcare No Premium Open (PPO)
| $0.00 |
$6,700 |
$160 | No additional gap coverage, only the Donut Hole Discount |
H2128 -002 -0 | $0.00 | $7.00 | $37.00 | $37.00 | 3,375
2022 Formulary |
|
new |
new |
|
2023 Wellcare No Premium Open (PPO)
| $0.00 |
$6,700 |
$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 |
2022 Wellcare Patriot Giveback (HMO)
| $0.00 |
$4,900 |
No Rx Coverage |
H2915 -013 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2023 Wellcare Patriot Giveback (HMO)
| $0.00 |
$7,550 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 Wellcare Assist (HMO)
| $36.00 |
$7,550 |
$480 | No additional gap coverage, only the Donut Hole Discount |
H2915 -011 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,375
2022 Formulary |
|
|
|
|
2023 Wellcare Assist (HMO)
| $13.50 |
$6,700 |
$445 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,392 2023 Formulary |
|
2022 Wellcare Assist Open (PPO)
| $24.70 |
$6,700 |
$480 | No additional gap coverage, only the Donut Hole Discount |
H2128 -001 -0 | $0.00 | $20.00 | $43.00 | $43.00 | 3,375
2022 Formulary |
|
new |
new |
|
2023 Wellcare Assist Open (PPO)
| $14.20 |
$6,700 |
$395 | 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 Aetna Medicare Advantra Silver (PPO)
| $14.00 |
$5,900 |
$0 | Yes, some additional gap coverage. |
H5522 -005 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,698
2022 Formulary |
|
|
|
|
2023 Aetna Medicare Advantra Silver (PPO)
| $17.00 |
$6,001 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,622 2023 Formulary |
|
2022 HumanaChoice H5525-017 (PPO)
| $15.00 |
$5,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5525 -017 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
|
|
|
|
2023 HumanaChoice H5525-017 (PPO)
| $18.00 |
$4,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,404 2023 Formulary |
|
2022 AARP Medicare Advantage Choice Plan 1 (PPO)
| $21.00 |
$6,200 |
$0 | Yes, some additional gap coverage. |
H2228 -035 -0 | $0.00 | $8.00 | $47.00 | $47.00 | 3,654
2022 Formulary |
|
|
|
|
2023 AARP Medicare Advantage Choice Plan 1 (PPO)
| $21.00 |
$5,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $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 UPMC for Life HMO Deductible Rx (HMO)
| $22.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3907 -037 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,703
2022 Formulary |
|
|
|
|
2023 UPMC for Life HMO Deductible Rx (HMO)
| $22.00 |
$6,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,731 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H5533 -014 -0 | | | | | |
|
|
|
|
2023 UPMC for Life PPO Rx Choice (PPO)
| $23.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,731 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H2128 -005 -0 | | | | | |
|
new |
new |
|
2023 Wellcare Dual Access Open (PPO D-SNP)
| $24.20 |
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 Aetna Medicare Advantra Cares (HMO D-SNP)
| $22.10 |
n/a |
$375 | No additional gap coverage, only the Donut Hole Discount |
H3959 -036 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,672
2022 Formulary |
|
|
|
|
2023 Aetna Medicare Advantra Cares (HMO D-SNP)
| $24.60 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,597 2023 Formulary |
|
2022 Complete Blue PPO Distinct (PPO)
| $25.00 |
$6,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3916 -035 -4 | $0.00 | $5.00 | $47.00 | $47.00 | 3,533
2022 Formulary |
|
|
|
|
2023 Complete Blue PPO Distinct (PPO)
| $25.00 |
$6,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $42.00 | $42.00 | 3,426 2023 Formulary |
|
2022 Wellcare Low Premium Open (PPO)
| $29.00 |
$5,000 |
$100 | No additional gap coverage, only the Donut Hole Discount |
H2128 -003 -0 | $0.00 | $7.00 | $37.00 | $37.00 | 3,375
2022 Formulary |
|
new |
new |
|
2023 Wellcare Low Premium Open (PPO)
| $29.00 |
$5,000 |
$100 | 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 |
2022 Wellcare Dual Access (HMO D-SNP)
| $40.70 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H2915 -002 -0 | $0.00 | $5.00 | $37.00 | $37.00 | 3,375
2022 Formulary |
|
|
|
|
2023 Wellcare Dual Access (HMO D-SNP)
| $31.10 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,394 2023 Formulary |
|
2022 HumanaChoice SNP-DE H5216-227 (PPO D-SNP)
| $24.40 |
n/a |
$425 | No additional gap coverage, only the Donut Hole Discount |
H5216 -227 -0 | $2.00 | $19.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
|
|
|
|
2023 HumanaChoice SNP-DE H5216-227 (PPO D-SNP)
| $32.90 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,404 2023 Formulary |
|
2022 AARP Medicare Advantage Plan 2 (HMO)
| $35.00 |
$5,500 |
$0 | Yes, some additional gap coverage. |
H1944 -011 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,654
2022 Formulary |
|
|
|
|
2023 AARP Medicare Advantage Flex Plan 2 (HMO-POS)
| $33.00 |
$5,200 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,682 2023 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2022 UPMC for Life PPO High Deductible Rx (PPO)
| $35.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5533 -003 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,703
2022 Formulary |
|
|
|
|
2023 UPMC for Life PPO High Deductible Rx (PPO)
| $33.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,731 2023 Formulary |
|
2022 UnitedHealthcare Dual Complete (HMO D-SNP)
| $33.90 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H3113 -009 -0 | | | | | 3,654
2022 Formulary |
|
|
|
|
2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP)
| $33.90 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,682 2023 Formulary |
|
2022 Aetna Medicare Advantra Gold (HMO)
| $27.00 |
$4,500 |
$0 | Yes, some additional gap coverage. |
H3959 -002 -0 | $0.00 | $0.00 | $37.00 | $37.00 | 3,698
2022 Formulary |
|
|
|
|
2023 Aetna Medicare Advantra Gold (HMO)
| $35.00 |
$5,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $37.00 | $37.00 | 3,622 2023 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2022 UPMC for Life HMO Rx Choice (HMO)
| $38.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3907 -049 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,703
2022 Formulary |
|
|
|
|
2023 UPMC for Life HMO Rx Choice (HMO)
| $36.00 |
$4,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,731 2023 Formulary |
|
2022 UnitedHealthcare Dual Complete Select (HMO D-SNP)
| $40.70 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H3113 -014 -0 | | | | | 3,654
2022 Formulary |
|
|
|
|
2023 UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)
| $38.10 |
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)
| $40.60 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H0710 -017 -0 | | | | | 3,654
2022 Formulary |
|
-- |
|
|
2023 UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)
| $41.00 |
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 |
2022 AmeriHealth Caritas VIP Care (HMO D-SNP)
| $40.70 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H4227 -002 -0 | $6.50 | 25% | | | 3,477
2022 Formulary |
|
|
|
|
2023 AmeriHealth Caritas VIP Care (HMO D-SNP)
| $41.10 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | $8.00 | 25% | | | 3,501 2023 Formulary |
|
2022 Gateway Health Medicare Assured Diamond (HMO D-SNP)
| $40.70 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H5932 -001 -0 | $0.00 | $20.00 | $41.00 | $41.00 | 3,320
2022 Formulary |
|
|
|
|
2023 Highmark Wholecare Medicare Assured Diamond (HMO D-SNP)
| $41.10 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $11.00 | $35.00 | $35.00 | 3,391 2023 Formulary |
|
2022 Gateway Health Medicare Assured Ruby (HMO D-SNP)
| $40.70 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H5932 -009 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,320
2022 Formulary |
|
|
|
|
2023 Highmark Wholecare Medicare Assured Ruby (HMO D-SNP)
| $41.10 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $13.00 | $42.00 | $42.00 | 3,391 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 Value Plus H5216-117 (PPO)
| $36.50 |
$6,700 |
$480 | No additional gap coverage, only the Donut Hole Discount |
H5216 -117 -0 | $3.00 | $20.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
|
|
|
|
2023 Humana Value Plus H5216-117 (PPO)
| $41.10 |
$7,000 |
$505 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,404 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H4093 -001 -0 | | | | | |
|
-- |
|
|
2023 Provider Partners Pennsylvania Advantage Plan (HMO I-SNP)
| $41.10 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,445 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H4093 -004 -0 | | | | | |
|
-- |
|
|
2023 Provider Partners Pennsylvania Community Plan (HMO I-SNP)
| $41.10 |
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 |
-- This plan not offered in 2022 --
|
H0710 -067 -0 | | | | | |
|
-- |
|
|
2023 UnitedHealthcare Assisted Living Plan (PPO I-SNP)
| $41.10 |
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 --
|
H1889 -007 -0 | | | | | |
|
|
|
|
2023 UnitedHealthcare Dual Complete Choice (PPO D-SNP)
| $41.10 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,682 2023 Formulary |
|
2022 UPMC for Life Complete Care (HMO D-SNP)
| $40.70 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount |
H4279 -001 -0 | $5.00 | $10.00 | $25.00 | $25.00 | 3,703
2022 Formulary |
|
|
|
|
2023 UPMC for Life Complete Care (HMO D-SNP)
| $41.10 |
n/a |
$505 | Yes, some additional gap coverage. | $6.00 | $12.00 | $30.00 | $30.00 | 3,731 2023 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2022 AARP Medicare Advantage Choice Plan 2 (PPO)
| $46.00 |
$5,900 |
$0 | Yes, some additional gap coverage. |
H2228 -036 -0 | $0.00 | $8.00 | $47.00 | $47.00 | 3,654
2022 Formulary |
|
|
|
|
2023 AARP Medicare Advantage Choice Plan 2 (PPO)
| $44.00 |
$5,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,682 2023 Formulary |
|
2022 Aetna Medicare Silver (HMO)
| $65.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H3931 -070 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,672
2022 Formulary |
|
|
|
|
2023 Aetna Medicare Silver (HMO)
| $47.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,597 2023 Formulary |
|
2022 Security Blue HMO-POS Basic (HMO-POS)
| $52.00 |
$5,900 |
No Rx Coverage |
H3957 -043 -2 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2023 Security Blue HMO-POS Basic (HMO-POS)
| $49.00 |
$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 |
-- This plan not offered in 2022 --
|
H3957 -044 -4 | | | | | |
|
|
|
|
2023 Security Blue HMO-POS ValueRx (HMO-POS)
| $54.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $13.00 | $45.00 | $45.00 | 3,426 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H5525 -005 -0 | | | | | |
|
|
|
|
2023 HumanaChoice H5525-005 (PPO)
| $58.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $47.00 | $47.00 | 3,404 2023 Formulary |
|
2022 Freedom Blue PPO ValueRx (PPO)
| $71.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3916 -033 -0 | $0.00 | $13.00 | $45.00 | $45.00 | 3,533
2022 Formulary |
|
|
|
|
2023 Freedom Blue PPO ValueRx (PPO)
| $68.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $13.00 | $45.00 | $45.00 | 3,426 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 R0923-002 (Regional PPO)
| $72.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
R0923 -002 -0 | $6.00 | $20.00 | $47.00 | $47.00 | 3,416
2022 Formulary |
|
|
|
|
2023 HumanaChoice R0923-002 (Regional PPO)
| $71.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $20.00 | $47.00 | $47.00 | 3,404 2023 Formulary |
|
2022 UPMC for Life HMO Rx (HMO)
| $81.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H3907 -029 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,703
2022 Formulary |
|
|
|
|
2023 UPMC for Life HMO Rx (HMO)
| $81.00 |
$5,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,731 2023 Formulary |
|
2022 HumanaChoice H5216-120 (PPO)
| $128.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5216 -120 -0 | $5.00 | $15.00 | $47.00 | $47.00 | 3,413
2022 Formulary |
|
|
|
|
2023 HumanaChoice H5216-120 (PPO)
| $123.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $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 Freedom Blue PPO Select (PPO)
| $130.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3916 -024 -0 | $0.00 | $13.00 | $45.00 | $45.00 | 4,151
2022 Formulary |
|
|
|
|
2023 Freedom Blue PPO Select (PPO)
| $127.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $13.00 | $45.00 | $45.00 | 4,141 2023 Formulary |
|
2022 UPMC for Life PPO Rx Enhanced (PPO)
| $136.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5533 -005 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,703
2022 Formulary |
|
|
|
|
2023 UPMC for Life PPO Rx Enhanced (PPO)
| $134.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,731 2023 Formulary |
|
2022 Security Blue HMO-POS Standard (HMO-POS)
| $164.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3957 -045 -2 | $0.00 | $13.00 | $44.00 | $44.00 | 4,151
2022 Formulary |
|
|
|
|
2023 Security Blue HMO-POS Standard (HMO-POS)
| $159.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $13.00 | $44.00 | $44.00 | 4,141 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 Gold Plan (PPO)
| $170.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H5521 -122 -0 | $2.00 | $5.00 | $47.00 | $47.00 | 3,672
2022 Formulary |
|
|
|
|
2023 Aetna Medicare Gold Plan (PPO)
| $176.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,597 2023 Formulary |
|
2022 Security Blue HMO-POS Deluxe (HMO-POS)
| $224.00 |
$4,500 |
$0 | Yes, some additional gap coverage. |
H3957 -046 -2 | $0.00 | $13.00 | $42.00 | $42.00 | 4,151
2022 Formulary |
|
|
|
|
2023 Security Blue HMO-POS Deluxe (HMO-POS)
| $220.00 |
$4,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $13.00 | $42.00 | $42.00 | 4,141 2023 Formulary |
|
2022 Freedom Blue PPO Classic (PPO)
| $253.00 |
$4,500 |
$0 | Yes, some additional gap coverage. |
H3916 -002 -0 | $0.00 | $13.00 | $45.00 | $45.00 | 4,151
2022 Formulary |
|
|
|
|
2023 Freedom Blue PPO Classic (PPO)
| $250.00 |
$4,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $13.00 | $45.00 | $45.00 | 4,141 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 UPMC for Life HMO Rx Enhanced (HMO)
| $302.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3907 -006 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,703
2022 Formulary |
|
|
|
|
2023 UPMC for Life HMO Rx Enhanced (HMO)
| $295.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $47.00 | $47.00 | 3,731 2023 Formulary |
|
2022 HumanaChoice H5525-007 (PPO)
| $55.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5525 -007 -0 | $5.00 | $15.00 | $47.00 | $47.00 | 3,408
2022 Formulary |
|
|
|
|
-- Members will be assigned to HumanaChoice H5525-005 (PPO) H5525-005 --
| | | | | |
|
2022 UPMC for Life HMO Salute (HMO)
| $0.00 |
$6,700 |
No Rx Coverage |
H3907 -053 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
-- Members will be assigned to UPMC for Life HMO No Rx (HMO) H3907-002 --
| | | | | |
|
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 Security Blue HMO-POS ValueRx (HMO-POS)
| $57.00 |
$5,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3957 -044 -1 | $0.00 | $13.00 | $45.00 | $45.00 | 3,533
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|
2022 Community Blue Medicare HMO Signature (HMO)
| $0.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3957 -047 -2 | $0.00 | $5.00 | $47.00 | $47.00 | 3,533
2022 Formulary |
|
|
|
|
-- This plan not offered in 2023 --
|
| | | | |
|