There are 65 Medicare Advantage plans meeting your criteria.
2022 / 2023 Medicare Advantage Plan Information
Click here to jump to the Chart Legend |
Plan Name |
Monthly Premium |
Part A&B Maximum Out-Of Pocket |
Part D Deduct- ible | (Donut Hole) Additional Gap Coverage | Plan ID |
Cost-Sharing |
Total Formulary Drugs |
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2022 --
|
H5774 -037 -0 | | | | | |
|
|
|
|
2023 AhorroMax (HMO)
| $0.00 |
$3,650 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $25.00 | $25.00 | 3,012 2023 Formulary |
|
2022 Triple S Advantage Basic (HMO)
| $0.00 |
$3,400 |
No Rx Coverage | H5774 -003 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2023 Basic (HMO)
| $0.00 |
$3,650 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 Triple S Advantage Brillante (HMO-POS)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | H5774 -031 -0 | $0.00 | $0.00 | $5.00 | $5.00 | 3,031
2022 Formulary |
|
|
|
|
2023 Brillante (HMO-POS)
| $0.00 |
$3,650 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $10.00 | $10.00 | 3,012 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 Triple S Advantage Contigo Plus (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands | H5774 -022 -0 | $0.00 | $0.00 | $5.00 | $5.00 | 3,031
2022 Formulary |
|
|
|
|
2023 Contigo Plus (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $0.00 | $0.00 | 3,012 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H5774 -038 -0 | | | | | |
|
|
|
|
2023 Enlace Plus (HMO)
| $0.00 |
$3,650 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $10.00 | $10.00 | 3,012 2023 Formulary |
|
2022 Humana Gold Plus H4007-012 (HMO)
| $0.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | H4007 -012 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,407
2022 Formulary |
|
|
|
|
2023 Humana Gold Plus H4007-012 (HMO)
| $0.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 3,401 2023 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible | Additional Gap Coverage | Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2022 Humana Gold Plus H4007-020 (HMO)
| $0.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | H4007 -020 -0 | $0.00 | $0.00 | $8.00 | $8.00 | 3,407
2022 Formulary |
|
|
|
|
2023 Humana Gold Plus H4007-020 (HMO)
| $0.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 3,401 2023 Formulary |
|
2022 Humana Gold Plus H4007-021 (HMO)
| $0.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | H4007 -021 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,407
2022 Formulary |
|
|
|
|
2023 Humana Gold Plus H4007-021 (HMO)
| $0.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 3,401 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H4007 -024 -0 | | | | | |
|
|
|
|
2023 Humana Gold Plus H4007-024 (HMO)
| $0.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 3,401 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 --
|
H4007 -025 -0 | | | | | |
|
|
|
|
2023 Humana Gold Plus H4007-025 (HMO)
| $0.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 3,401 2023 Formulary |
|
2022 Humana Gold Plus SNP-DE H4007-016 (HMO D-SNP)
| $0.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | H4007 -016 -0 | | | | | 3,407
2022 Formulary |
|
|
|
|
2023 Humana Gold Plus SNP-DE H4007-016 (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,401 2023 Formulary |
|
2022 Humana Gold Plus SNP-DE H4007-018 (HMO D-SNP)
| $0.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | H4007 -018 -0 | | | | | 3,407
2022 Formulary |
|
|
|
|
2023 Humana Gold Plus SNP-DE H4007-018 (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,401 2023 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible | Additional Gap Coverage | Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2022 Humana Gold Plus SNP-DE H4007-019 (HMO D-SNP)
| $0.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | H4007 -019 -0 | | | | | 3,407
2022 Formulary |
|
|
|
|
2023 Humana Gold Plus SNP-DE H4007-019 (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,401 2023 Formulary |
|
2022 Humana Gold Plus SNP-DE H4007-022 (HMO D-SNP)
| $0.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | H4007 -022 -0 | | | | | 3,407
2022 Formulary |
|
|
|
|
2023 Humana Gold Plus SNP-DE H4007-022 (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,401 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H4007 -026 -0 | | | | | |
|
|
|
|
2023 Humana Gold Plus SNP-DE H4007-026 (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,401 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 --
|
H4007 -027 -0 | | | | | |
|
|
|
|
2023 Humana Gold Plus SNP-DE H4007-027 (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,401 2023 Formulary |
|
2022 Triple S Advantage Magno (HMO-POS)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | H5774 -027 -0 | $0.00 | $0.00 | $5.00 | $5.00 | 3,031
2022 Formulary |
|
|
|
|
2023 Magno (HMO-POS)
| $0.00 |
$3,650 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $5.00 | $5.00 | 3,012 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H5577 -050 -0 | | | | | |
|
|
|
|
2023 MCS Classicare Acceso (HMO-POS)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $5.00 | $5.00 | 3,263 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 MCS Classicare Activo (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | H5577 -031 -0 | $0.00 | $0.00 | $6.00 | $6.00 | 3,233
2022 Formulary |
|
|
|
|
2023 MCS Classicare Activo (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $5.00 | $5.00 | 3,263 2023 Formulary |
|
2022 MCS Classicare Efectivo (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | H5577 -005 -0 | $0.00 | $0.00 | $4.00 | $4.00 | 3,233
2022 Formulary |
|
|
|
|
2023 MCS Classicare Efectivo (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $4.00 | $4.00 | 3,263 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H5577 -049 -0 | | | | | |
|
|
|
|
2023 MCS Classicare Electrico (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $5.00 | $5.00 | 3,263 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 --
|
H5577 -047 -0 | | | | | |
|
|
|
|
2023 MCS Classicare En Tu Casa (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $5.00 | $5.00 | 3,263 2023 Formulary |
|
2022 MCS Classicare En Tu Hogar (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | H5577 -043 -0 | $0.00 | $0.00 | $5.00 | $5.00 | 3,233
2022 Formulary |
|
|
|
|
2023 MCS Classicare En Tu Hogar (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $5.00 | $5.00 | 3,263 2023 Formulary |
|
2022 MCS Classicare Essential (HMO-POS)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | H5577 -008 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,233
2022 Formulary |
|
|
|
|
2023 MCS Classicare Essential (HMO-POS)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $0.00 | $0.00 | 3,263 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 --
|
H5577 -053 -0 | | | | | |
|
|
|
|
2023 MCS Classicare Exacto (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $0.00 | $0.00 | 3,263 2023 Formulary |
|
2022 MCS Classicare MediCa$h (HMO)
| $0.00 |
$6,700 |
$480 | No additional gap coverage, only the Donut Hole Discount | H5577 -014 -0 | | | | | 3,233
2022 Formulary |
|
|
|
|
2023 MCS Classicare Freedom (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $2.00 | $3.00 | $10.00 | $10.00 | 3,263 2023 Formulary |
|
2022 MCS Classicare Hero (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | H5577 -044 -0 | $5.00 | $10.00 | $30.00 | $30.00 | 3,233
2022 Formulary |
|
|
|
|
2023 MCS Classicare Hero (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $5.00 | $10.00 | $30.00 | $30.00 | 3,263 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 --
|
H5577 -052 -0 | | | | | |
|
|
|
|
2023 MCS Classicare InteliCare (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $0.00 | $0.00 | 3,263 2023 Formulary |
|
2022 MCS Classicare MediOnly (HMO)
| $0.00 |
$3,400 |
No Rx Coverage | H5577 -016 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2023 MCS Classicare Patriot (HMO)
| $0.00 |
$3,400 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 MCS Classicare Platino @Home (HMO D-SNP)
| $0.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | H5577 -037 -0 | | | | | 3,233
2022 Formulary |
|
|
|
|
2023 MCS Classicare Platino @Home (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,263 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 MCS Classicare Platino Ideal (HMO D-SNP)
| $0.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | H5577 -002 -0 | | | | | 3,233
2022 Formulary |
|
|
|
|
2023 MCS Classicare Platino Ideal (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,263 2023 Formulary |
|
2022 MCS Classicare Platino MasCa$h (HMO D-SNP)
| $0.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | H5577 -029 -0 | | | | | 3,233
2022 Formulary |
|
|
|
|
2023 MCS Classicare Platino MasCa$h (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,263 2023 Formulary |
|
2022 MCS Classicare Platino Progreso (HMO D-SNP)
| $0.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | H5577 -017 -0 | | | | | 3,233
2022 Formulary |
|
|
|
|
2023 MCS Classicare Platino Progreso (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,263 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 --
|
H5577 -046 -0 | | | | | |
|
|
|
|
2023 MCS Classicare Platino Total (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,263 2023 Formulary |
|
2022 MCS Classicare Primero (HMO C-SNP)
| $0.00 |
n/a |
$0 | Many Generics, Some Brands | H5577 -038 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,233
2022 Formulary |
|
|
|
|
2023 MCS Classicare Primero (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $0.00 | $0.00 | 3,263 2023 Formulary |
|
2022 MCS Classicare SuperRx (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | H5577 -039 -0 | $0.00 | $5.00 | $15.00 | $15.00 | 3,314
2022 Formulary |
|
|
|
|
2023 MCS Classicare SuperRx (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $15.00 | $15.00 | 3,316 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 MMM Balance (HMO-POS)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | H4004 -063 -0 | $2.00 | $3.00 | $10.00 | $10.00 | 3,327
2022 Formulary |
|
|
|
|
2023 MMM Balance (HMO-POS)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $3.00 | $3.00 | 3,398 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H4003 -055 -0 | | | | | |
|
|
|
|
2023 MMM Deluxe (HMO-POS)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $5.00 | $5.00 | 3,398 2023 Formulary |
|
2022 MMM Diamante Platino (HMO D-SNP)
| $0.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | H4003 -017 -0 | | | | | 3,327
2022 Formulary |
|
|
|
|
2023 MMM Diamante Platino (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,398 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 MMM Dinamico (HMO-POS)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | H4003 -051 -0 | $0.00 | $0.00 | $6.00 | $6.00 | 3,327
2022 Formulary |
|
|
|
|
2023 MMM Dinamico (HMO-POS)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $5.00 | $5.00 | 3,398 2023 Formulary |
|
2022 MMM Elite (HMO-POS)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | H4003 -034 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,327
2022 Formulary |
|
|
|
|
2023 MMM Elite (HMO-POS)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $0.00 | $0.00 | 3,398 2023 Formulary |
|
-- This plan not offered in 2022 --
|
H4003 -057 -0 | | | | | |
|
|
|
|
2023 MMM Flexi Max (HMO-POS)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $5.00 | $5.00 | 3,398 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 MMM Grande Platino (HMO D-SNP)
| $0.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | H4003 -049 -0 | | | | | 3,327
2022 Formulary |
|
|
|
|
2023 MMM Grande Platino (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,398 2023 Formulary |
|
2022 MMM Integral (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics, Few Brands | H4003 -052 -0 | $0.00 | $0.00 | $10.00 | $10.00 | 3,327
2022 Formulary |
|
|
|
|
2023 MMM Integral (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $10.00 | $10.00 | 3,398 2023 Formulary |
|
2022 MMM Plenitud (HMO-POS)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | H4004 -065 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,327
2022 Formulary |
|
|
|
|
2023 MMM Plenitud (HMO-POS)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $0.00 | $0.00 | 3,398 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 MMM Bono Platino (HMO D-SNP)
| $0.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | H4004 -062 -0 | | | | | 3,327
2022 Formulary |
|
|
|
|
2023 MMM Relax Platino (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,398 2023 Formulary |
|
2022 MMM Supremo (HMO C-SNP)
| $0.00 |
n/a |
$0 | Some Generics, Few Brands | H4003 -009 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,327
2022 Formulary |
|
|
|
|
2023 MMM Supremo (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $0.00 | $0.00 | 3,398 2023 Formulary |
|
2022 MMM Valor Platino (HMO D-SNP)
| $0.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | H4003 -047 -0 | | | | | 3,327
2022 Formulary |
|
|
|
|
2023 MMM Valor Platino (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,398 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 Optimo (PPO)
| $0.00 |
$6,700 |
No Rx Coverage | H4005 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
-- |
|
|
|
2023 Optimo (PPO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2022 Optimo Plus (PPO)
| $99.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | H4005 -004 -0 | $0.00 | $0.00 | $25.00 | $25.00 | 3,031
2022 Formulary |
-- |
|
|
|
2023 Optimo Plus (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $25.00 | $25.00 | 3,012 2023 Formulary |
|
2022 Triple S Advantage Platino Advance (HMO D-SNP)
| $0.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | H5774 -026 -0 | $14.00 | $15.00 | $42.00 | $42.00 | 2,752
2022 Formulary |
|
|
|
|
2023 Platino Advance (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $15.00 | $42.00 | $42.00 | 2,766 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 Triple S Advantage Platino Alcance (HMO D-SNP)
| $0.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | H5774 -035 -0 | $14.00 | $15.00 | $42.00 | $42.00 | 2,752
2022 Formulary |
|
|
|
|
2023 Platino Alcance (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | $14.00 | $15.00 | $42.00 | $42.00 | 2,766 2023 Formulary |
|
2022 Triple S Advantage Platino Blindao (HMO D-SNP)
| $0.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | H5774 -028 -0 | $10.00 | $15.00 | $42.00 | $42.00 | 2,752
2022 Formulary |
|
|
|
|
2023 Platino Blindao (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $15.00 | $42.00 | $42.00 | 2,766 2023 Formulary |
|
2022 Triple S Advantage Platino Plus (HMO D-SNP)
| $0.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | H5774 -024 -0 | $14.00 | $15.00 | $42.00 | $42.00 | 2,752
2022 Formulary |
|
|
|
|
2023 Platino Plus (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | $14.00 | $15.00 | $42.00 | $42.00 | 2,766 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 Triple S Advantage Platino Ultra (HMO D-SNP)
| $0.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | H5774 -025 -0 | $14.00 | $15.00 | $42.00 | $42.00 | 2,752
2022 Formulary |
|
|
|
|
2023 Platino Ultra (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | $14.00 | $15.00 | $42.00 | $42.00 | 2,766 2023 Formulary |
|
2022 PMC Max (HMO-POS)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | H4004 -056 -0 | $0.00 | $0.00 | $5.00 | $5.00 | 3,327
2022 Formulary |
|
|
|
|
2023 PMC Max (HMO-POS)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $5.00 | $5.00 | 3,398 2023 Formulary |
|
2022 PMC Premier Platino (HMO D-SNP)
| $0.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | H4004 -048 -0 | | | | | 3,327
2022 Formulary |
|
|
|
|
2023 PMC Premier Platino (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,398 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 Triple S Advantage Real (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | H5774 -005 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,031
2022 Formulary |
|
|
|
|
2023 Real (HMO)
| $0.00 |
$3,650 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $0.00 | $0.00 | 3,012 2023 Formulary |
|
2022 MMM Unico (HMO-POS)
| $15.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | H4003 -019 -0 | $0.00 | $0.00 | $1.00 | $1.00 | 3,327
2022 Formulary |
|
|
|
|
2023 MMM Unico (HMO-POS)
| $15.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $0.00 | $0.00 | 3,398 2023 Formulary |
|
2022 HumanaChoice Value H2029-001 (PPO)
| $43.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | H2029 -001 -0 | $0.00 | $0.00 | $35.00 | $35.00 | 3,407
2022 Formulary |
|
-- |
|
|
2023 HumanaChoice Value H2029-001 (PPO)
| $38.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $25.00 | $25.00 | 3,401 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 --
|
H4005 -007 -0 | | | | | |
-- |
|
|
|
2023 Optimo Xtra (PPO)
| $40.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $15.00 | $15.00 | 3,012 2023 Formulary |
|
2022 MCS Classicare Platino Recarga (HMO D-SNP)
| $0.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | H5577 -036 -0 | | | | | 3,233
2022 Formulary |
|
|
|
|
-- Members will be assigned to MCS Classicare Platino MasCa$h (HMO D-SNP) H5577-029 --
| | | | | |
|
2022 MMM Poderoso (HMO-POS)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | H4004 -064 -0 | $10.00 | $11.00 | $30.00 | $30.00 | 3,327
2022 Formulary |
|
|
|
|
-- Members will be assigned to MMM Balance (HMO-POS) H4004-063 --
| | | | | |
|
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 MMM Extra (HMO-POS)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | H4003 -044 -0 | $2.00 | $5.00 | $30.00 | $30.00 | 3,327
2022 Formulary |
|
|
|
|
-- Members will be assigned to MMM Dinamico (HMO-POS) H4003-051 --
| | | | | |
|
2022 MMM Relax Platino (HMO D-SNP)
| $0.00 |
n/a |
$480 | No additional gap coverage, only the Donut Hole Discount | H4004 -061 -0 | | | | | 3,327
2022 Formulary |
|
|
|
|
-- Members will be assigned to MMM Relax Platino (HMO D-SNP) H4004-062 --
| | | | | |
|