There are 96 Medicare Advantage plans meeting your criteria.
Click on the plan name or details button below to access plan details and contact information.
2023 / 2024 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 2023 --
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H1889 -022 -0 | | | | | |
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2024 AARP Medicare Advantage Patriot No Rx GA-MA01 (PPO)
| $0.00 |
$4,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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2023 Aetna Medicare Eagle Plan (PPO)
| $0.00 |
$6,900 |
No Rx Coverage |
H3288 -034 -0 | This plan does NOT include Prescription Drug coverage. | |
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2024 Aetna Medicare Eagle (PPO)
| $0.00 |
$6,350 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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2023 Aetna Medicare Eagle Plus Plan (PPO)
| $0.00 |
$5,900 |
No Rx Coverage |
H2293 -009 -0 | This plan does NOT include Prescription Drug coverage. | |
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new |
new |
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2024 Aetna Medicare Eagle Plus (PPO)
| $0.00 |
$5,900 |
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 |
2023 Anthem MediBlue Service (HMO)
| $0.00 |
$7,550 |
No Rx Coverage |
H5422 -014 -0 | This plan does NOT include Prescription Drug coverage. | |
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2024 Anthem Veteran (HMO)
| $0.00 |
$7,550 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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-- This plan not offered in 2023 --
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H7849 -122 -0 | | | | | |
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2024 Cigna True Choice Courage Medicare (PPO)
| $0.00 |
$3,400 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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2023 Clover Health Valor (PPO)
| $0.00 |
$7,550 |
No Rx Coverage |
H5141 -056 -0 | This plan does NOT include Prescription Drug coverage. | |
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2024 Clover Health Valor (PPO)
| $0.00 |
$7,499 |
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 |
2023 Humana Honor (PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
H5216 -217 -0 | This plan does NOT include Prescription Drug coverage. | |
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2024 Humana USAA Honor (PPO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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2023 HumanaChoice H5216-157 (PPO)
| $0.00 |
$6,100 |
No Rx Coverage |
H5216 -157 -0 | This plan does NOT include Prescription Drug coverage. | |
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2024 HumanaChoice H5216-157 (PPO)
| $0.00 |
$6,100 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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2023 HumanaChoice R3392-001 (Regional PPO)
| $0.00 |
$7,550 |
No Rx Coverage |
R3392 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
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2024 HumanaChoice R3392-001 (Regional PPO)
| $0.00 |
$7,550 |
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 |
2023 UnitedHealthcare Medicare Advantage Patriot (Regional PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
R2604 -005 -0 | This plan does NOT include Prescription Drug coverage. | |
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2024 UHC Medicare Advantage Patriot No Rx GS-MA01 (Regional PPO)
| $0.00 |
$7,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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2023 Wellcare Patriot No Premium (HMO-POS)
| $0.00 |
$3,400 |
No Rx Coverage |
H1112 -034 -0 | This plan does NOT include Prescription Drug coverage. | |
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2024 Wellcare Patriot No Premium (HMO-POS)
| $0.00 |
$3,400 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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-- This plan not offered in 2023 --
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H1889 -021 -0 | | | | | |
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2024 AARP Medicare Advantage from UHC GA-0004 (PPO)
| $0.00 |
$7,550 |
$395 | Yes, some additional gap coverage. | $0.00 | $14.00 | $47.00 | $47.00 | 3,634 2024 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 2023 --
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H5322 -041 -0 | | | | | |
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2024 AARP Medicare Advantage from UHC GA-0005 (HMO-POS)
| $0.00 |
$6,300 |
$0 | Yes, some additional gap coverage. | $0.00 | $14.00 | $47.00 | $47.00 | 3,634 2024 Formulary |
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-- This plan not offered in 2023 --
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H3288 -031 -0 | | | | | |
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2024 Aetna Medicare Freedom (PPO)
| $0.00 |
$8,850 |
$150 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,633 2024 Formulary |
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2023 Aetna Medicare Freedom Plus Plan (PPO)
| $0.00 |
$5,500 |
$0 | Yes, some additional gap coverage. |
H2293 -008 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,597
2023 Formulary |
|
new |
new |
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2024 Aetna Medicare Freedom Plus (PPO)
| $0.00 |
$6,350 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,633 2024 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 2023 --
|
H1109 -005 -0 | | | | | |
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2024 Aetna Medicare Select (HMO)
| $0.00 |
$6,350 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,633 2024 Formulary |
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-- This plan not offered in 2023 --
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H5422 -015 -0 | | | | | |
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2024 Anthem Kidney Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $4.00 | $10.00 | $42.00 | $42.00 | 3,562 2024 Formulary |
|
2023 Anthem MediBlue Plus (HMO)
| $0.00 |
$7,100 |
$0 | Yes, some additional gap coverage. |
H5422 -011 -0 | $4.00 | $11.00 | $35.00 | $35.00 | 3,603
2023 Formulary |
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2024 Anthem Medicare Advantage (HMO)
| $0.00 |
$7,100 |
$0 | Yes, some additional gap coverage. | $4.00 | $11.00 | $35.00 | $35.00 | 3,581 2024 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 2023 --
|
H4036 -031 -0 | | | | | |
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2024 Anthem Medicare Advantage (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $4.00 | $13.00 | $35.00 | $35.00 | 3,581 2024 Formulary |
|
2023 Cigna Preferred Medicare (HMO)
| $0.00 |
$6,600 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H0439 -010 -0 | $0.00 | $4.00 | $42.00 | $42.00 | 3,524
2023 Formulary |
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2024 Cigna Preferred Medicare (HMO)
| $0.00 |
$6,750 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $4.00 | $45.00 | $45.00 | 3,535 2024 Formulary |
|
2023 Cigna True Choice Medicare (PPO)
| $0.00 |
$6,900 |
$195 | No additional gap coverage, only the Donut Hole Discount |
H7849 -022 -0 | $0.00 | $12.00 | $42.00 | $42.00 | 3,524
2023 Formulary |
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|
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2024 Cigna True Choice Medicare (PPO)
| $0.00 |
$6,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $8.00 | $45.00 | $45.00 | 3,535 2024 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 2023 --
|
H7849 -119 -0 | | | | | |
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2024 Cigna True Choice Savings Medicare (PPO)
| $0.00 |
$7,450 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $4.00 | $45.00 | $45.00 | 3,535 2024 Formulary |
|
-- This plan not offered in 2023 --
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H9589 -003 -0 | | | | | |
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-- |
-- |
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2024 Clear Spring Health Choice Plan (PPO)
| $0.00 |
$6,700 |
$250 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $42.00 | $42.00 | 3,292 2024 Formulary |
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-- This plan not offered in 2023 --
|
H6672 -005 -0 | | | | | |
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-- |
-- |
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2024 Clear Spring Health Select Plus (HMO)
| $0.00 |
$3,450 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $42.00 | $42.00 | 3,292 2024 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 |
2023 Clover Health LiveHealthy (PPO)
| $0.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5141 -026 -0 | $0.00 | $10.00 | $37.00 | $37.00 | 3,361
2023 Formulary |
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|
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2024 Clover Health LiveHealthy (PPO)
| $0.00 |
$7,999 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $8.00 | $47.00 | $47.00 | 3,392 2024 Formulary |
|
2023 Humana Gold Plus H4141-017 (HMO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H4141 -017 -3 | $0.00 | $0.00 | $47.00 | $47.00 | 3,404
2023 Formulary |
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2024 Humana Gold Plus H4141-017 (HMO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,448 2024 Formulary |
|
2023 Humana Honor (PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
H5216 -286 -0 | This plan does NOT include Prescription Drug coverage. | |
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|
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2024 Humana USAA Honor (PPO)
| $0.00 |
$8,600 |
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 |
2023 HumanaChoice - Diabetes and Heart (PPO C-SNP)
| $0.00 |
n/a |
$145 | Yes, some additional gap coverage. |
H5216 -246 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,404
2023 Formulary |
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|
|
2024 HumanaChoice - Diabetes and Heart (PPO C-SNP)
| $0.00 |
n/a |
$145 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,448 2024 Formulary |
|
2023 HumanaChoice H5216-154 (PPO)
| $0.00 |
$7,550 |
$400 | No additional gap coverage, only the Donut Hole Discount |
H5216 -154 -0 | $5.00 | $15.00 | $47.00 | $47.00 | 3,404
2023 Formulary |
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2024 HumanaChoice H5216-154 (PPO)
| $0.00 |
$8,850 |
$400 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $47.00 | $47.00 | 3,448 2024 Formulary |
|
2023 HumanaChoice H5216-203 (PPO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H5216 -203 -1 | $0.00 | $0.00 | $47.00 | $47.00 | 3,404
2023 Formulary |
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|
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2024 HumanaChoice H5216-203 (PPO)
| $0.00 |
$8,850 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,448 2024 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 |
2023 HumanaChoice H5216-279 (PPO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. |
H5216 -279 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,404
2023 Formulary |
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2024 HumanaChoice H5216-279 (PPO)
| $0.00 |
$3,450 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,448 2024 Formulary |
|
2023 HumanaChoice H5216-345 (PPO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H5216 -345 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,404
2023 Formulary |
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|
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2024 HumanaChoice H5216-345 (PPO)
| $0.00 |
$8,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,448 2024 Formulary |
|
2023 HumanaChoice R3392-004 (Regional PPO)
| $0.00 |
$7,550 |
$195 | No additional gap coverage, only the Donut Hole Discount |
R3392 -004 -0 | $4.00 | $12.00 | $47.00 | $47.00 | 3,404
2023 Formulary |
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|
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2024 HumanaChoice R3392-004 (Regional PPO)
| $0.00 |
$8,850 |
$195 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $12.00 | $47.00 | $47.00 | 3,448 2024 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 2023 --
|
H1889 -020 -0 | | | | | |
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2024 UHC Complete Care GA-0003 (PPO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,634 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H1889 -013 -0 | | | | | |
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2024 UHC Medicare Advantage GA-0002 (PPO)
| $0.00 |
$6,300 |
$295 | Yes, some additional gap coverage. | $0.00 | $14.00 | $47.00 | $47.00 | 3,634 2024 Formulary |
|
2023 Wellcare Giveback (HMO)
| $0.00 |
$8,300 |
$480 | No additional gap coverage, only the Donut Hole Discount |
H1112 -042 -0 | $0.00 | $5.00 | $37.00 | $37.00 | 3,393
2023 Formulary |
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2024 Wellcare Giveback (HMO)
| $0.00 |
$8,850 |
$545 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $42.00 | $42.00 | 3,372 2024 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 |
2023 Wellcare No Premium Open (PPO)
| $0.00 |
$5,500 |
$75 | Yes, some additional gap coverage. |
H0111 -001 -0 | $0.00 | $0.00 | $37.00 | $37.00 | 3,393
2023 Formulary |
|
|
|
|
2024 Wellcare Mutual of Omaha No Premium Open (PPO)
| $0.00 |
$7,500 |
$200 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 3,372 2024 Formulary |
|
2023 Wellcare No Premium (HMO)
| $0.00 |
$8,300 |
$0 | Yes, some additional gap coverage. |
H1112 -038 -0 | $0.00 | $5.00 | $34.00 | $34.00 | 3,393
2023 Formulary |
|
|
|
|
2024 Wellcare No Premium (HMO)
| $0.00 |
$6,350 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 3,372 2024 Formulary |
|
2023 Humana Together in Health (PPO I-SNP)
| $34.80 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H5216 -242 -0 | $4.00 | $12.00 | $47.00 | $47.00 | 3,409
2023 Formulary |
|
|
|
|
2024 Humana Together in Health (PPO I-SNP)
| $18.00 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,448 2024 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 2023 --
|
H3291 -003 -0 | | | | | |
|
-- |
|
|
2024 PruittHealth Premier Advantage (HMO I-SNP)
| $20.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $7.00 | $45.00 | $45.00 | 3,702 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H2406 -031 -0 | | | | | |
|
|
|
|
2024 UHC Nursing Home Plan EX-F005 (PPO I-SNP)
| $20.00 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,634 2024 Formulary |
|
2023 UnitedHealthcare Medicare Silver (Regional PPO C-SNP)
| $9.50 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
R2604 -002 -0 | | | | | 3,682
2023 Formulary |
|
|
|
|
2024 UHC Complete Care GS-001A (Regional PPO C-SNP)
| $20.70 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,634 2024 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 |
2023 Cigna Preferred GA Medicare (HMO)
| $20.00 |
$7,100 |
$280 | No additional gap coverage, only the Donut Hole Discount |
H0439 -003 -2 | $3.00 | $12.00 | $42.00 | $42.00 | 3,524
2023 Formulary |
|
|
|
|
2024 Cigna Preferred GA Medicare (HMO)
| $25.00 |
$7,900 |
$200 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $12.00 | $45.00 | $45.00 | 3,535 2024 Formulary |
|
2023 Aetna Medicare Value Plus Plan (PPO)
| $28.00 |
$8,300 |
$505 | No additional gap coverage, only the Donut Hole Discount |
H2293 -001 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,597
2023 Formulary |
|
new |
new |
|
2024 Aetna Medicare Value Plus (PPO)
| $25.20 |
$8,300 |
$300 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,633 2024 Formulary |
|
2023 Aetna Medicare Preferred Premium Plan (PPO)
| $32.00 |
$8,300 |
$150 | Yes, some additional gap coverage. |
H3288 -042 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,597
2023 Formulary |
|
|
|
|
2024 Aetna Medicare Preferred Premium (PPO)
| $28.00 |
$8,300 |
$150 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,633 2024 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 |
2023 Cigna Preferred Plus Medicare (HMO)
| $25.00 |
$5,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H0439 -006 -0 | $0.00 | $4.00 | $42.00 | $42.00 | 3,524
2023 Formulary |
|
|
|
|
2024 Cigna Preferred Plus Medicare (HMO)
| $28.00 |
$7,200 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $4.00 | $45.00 | $45.00 | 3,535 2024 Formulary |
|
2023 UnitedHealthcare Medicare Gold (Regional PPO C-SNP)
| $15.00 |
n/a |
$0 | Yes, some additional gap coverage. |
R2604 -003 -0 | $0.00 | $12.00 | $47.00 | $47.00 | 3,682
2023 Formulary |
|
|
|
|
2024 UHC Complete Care GS-0002 (Regional PPO C-SNP)
| $28.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | 3,634 2024 Formulary |
|
2023 Anthem MediBlue Enhanced Care (HMO D-SNP)
| $17.20 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H5422 -018 -0 | $5.00 | $15.00 | $47.00 | $47.00 | 3,603
2023 Formulary |
|
|
|
|
2024 Anthem Dual Advantage (HMO D-SNP)
| $29.20 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,581 2024 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 |
2023 Aetna Medicare Dual Select Plan (HMO D-SNP)
| $19.30 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H5302 -020 -0 | | | | | 3,597
2023 Formulary |
|
|
|
|
2024 Aetna Medicare Dual Select (HMO D-SNP)
| $30.10 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,633 2024 Formulary |
|
2023 Aetna Medicare Dual Preferred Plan (HMO D-SNP)
| $19.10 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H5302 -013 -0 | | | | | 3,597
2023 Formulary |
|
|
|
|
2024 Aetna Medicare Dual Preferred (HMO D-SNP)
| $30.40 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,633 2024 Formulary |
|
2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP)
| $35.90 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H5322 -030 -0 | | | | | 3,682
2023 Formulary |
|
|
|
|
2024 UHC Dual Complete GA-D002 (HMO-POS D-SNP)
| $31.20 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,634 2024 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 2023 --
|
H2293 -022 -0 | | | | | |
|
new |
new |
|
2024 Aetna Medicare Dual Select Choice (PPO D-SNP)
| $31.80 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,633 2024 Formulary |
|
2023 Anthem MediBlue Extra (HMO)
| $24.50 |
$5,900 |
$505 | No additional gap coverage, only the Donut Hole Discount |
H5422 -013 -0 | $5.00 | $15.00 | $47.00 | $47.00 | 3,603
2023 Formulary |
|
|
|
|
2024 Anthem Extra Help (HMO)
| $32.00 |
$5,900 |
$545 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $47.00 | $47.00 | 3,581 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H2293 -021 -0 | | | | | |
|
new |
new |
|
2024 Aetna Medicare Dual Choice (PPO D-SNP)
| $33.60 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,633 2024 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 |
2023 Cigna TotalCare (HMO D-SNP)
| $26.30 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H0439 -002 -0 | | | | | 3,524
2023 Formulary |
|
|
|
|
2024 Cigna TotalCare (HMO D-SNP)
| $34.50 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,535 2024 Formulary |
|
2023 UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)
| $37.30 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H0710 -033 -0 | | | | | 3,682
2023 Formulary |
|
-- |
|
|
2024 UHC Nursing Home Plan GA-F001 (PPO I-SNP)
| $34.90 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,634 2024 Formulary |
|
2023 Wellcare Assist (HMO)
| $28.10 |
$3,650 |
$475 | No additional gap coverage, only the Donut Hole Discount |
H1112 -043 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,392
2023 Formulary |
|
|
|
|
2024 Wellcare Assist (HMO)
| $35.00 |
$3,650 |
$410 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,371 2024 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 |
2023 Clover Health LiveHealthy Value (PPO)
| $37.30 |
$6,600 |
$395 | No additional gap coverage, only the Donut Hole Discount |
H5141 -045 -0 | $0.00 | 22% | 22% | 22% | 3,361
2023 Formulary |
|
|
|
|
2024 Clover Health LiveHealthy Value (PPO)
| $35.50 |
$7,499 |
$545 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $8.00 | 23% | 23% | 3,392 2024 Formulary |
|
2023 Cigna TotalCare Plus (HMO D-SNP)
| $26.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H0439 -012 -0 | | | | | 3,524
2023 Formulary |
|
|
|
|
2024 Cigna TotalCare Plus (HMO D-SNP)
| $37.80 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,535 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H5322 -042 -0 | | | | | |
|
|
|
|
2024 AARP Medicare Advantage from UHC GA-0006 (HMO-POS)
| $39.00 |
$4,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,634 2024 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 |
2023 UnitedHealthcare Dual Complete Choice LP (PPO D-SNP)
| $37.30 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H3256 -001 -0 | | | | | 3,682
2023 Formulary |
|
|
|
|
2024 UHC Dual Complete GA-S001 (PPO D-SNP)
| $41.60 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,634 2024 Formulary |
|
2023 Wellcare Dual Liberty (HMO D-SNP)
| $36.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H1112 -033 -0 | | | | | 3,394
2023 Formulary |
|
|
|
|
2024 Wellcare Dual Liberty (HMO D-SNP)
| $42.10 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,353 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H4036 -032 -0 | | | | | |
|
|
|
|
2024 Anthem Full Dual Advantage (PPO D-SNP)
| $43.00 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,581 2024 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 |
2023 Humana Gold Plus SNP-DE H4141-003 (HMO D-SNP)
| $37.30 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H4141 -003 -0 | | | | | 3,404
2023 Formulary |
|
|
|
|
2024 Humana Gold Plus SNP-DE H4141-003 (HMO D-SNP)
| $43.50 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,448 2024 Formulary |
|
2023 Wellcare Dual Access (HMO D-SNP)
| $37.20 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H1112 -006 -0 | | | | | 3,394
2023 Formulary |
|
|
|
|
2024 Wellcare All Dual (HMO D-SNP)
| $44.10 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,353 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H5422 -019 -0 | | | | | |
|
|
|
|
2024 Anthem Full Dual Advantage (HMO D-SNP)
| $44.20 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,581 2024 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 |
2023 Anthem MediBlue Dual Advantage (HMO D-SNP)
| $37.30 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H5422 -007 -0 | $10.00 | $20.00 | $47.00 | $47.00 | 3,603
2023 Formulary |
|
|
|
|
2024 Anthem Full Dual Advantage 2 (HMO D-SNP)
| $44.20 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,581 2024 Formulary |
|
2023 HumanaChoice H5216-280 (PPO)
| $36.70 |
$7,550 |
$505 | Yes, some additional gap coverage. |
H5216 -280 -1 | $0.00 | $20.00 | $47.00 | $47.00 | 3,404
2023 Formulary |
|
|
|
|
2024 HumanaChoice H5216-280 (PPO)
| $44.20 |
$8,850 |
$545 | Yes, some additional gap coverage. | $0.00 | $20.00 | $47.00 | $47.00 | 3,448 2024 Formulary |
|
2023 HumanaChoice SNP-DE H5216-205 (PPO D-SNP)
| $37.30 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H5216 -205 -0 | | | | | 3,404
2023 Formulary |
|
|
|
|
2024 HumanaChoice SNP-DE H5216-205 (PPO D-SNP)
| $44.20 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,448 2024 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 |
2023 HumanaChoice SNP-DE H5216-206 (PPO D-SNP)
| $37.30 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H5216 -206 -0 | | | | | 3,404
2023 Formulary |
|
|
|
|
2024 HumanaChoice SNP-DE H5216-206 (PPO D-SNP)
| $44.20 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,448 2024 Formulary |
|
2023 PruittHealth Premier (HMO I-SNP)
| $37.30 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H3291 -001 -0 | | | | | 3,683
2023 Formulary |
|
-- |
|
|
2024 PruittHealth Premier (HMO I-SNP)
| $44.20 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,665 2024 Formulary |
|
2023 PruittHealth Premier D-SNP (HMO D-SNP)
| $37.30 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H3291 -002 -0 | | | | | 3,683
2023 Formulary |
|
-- |
|
|
2024 PruittHealth Premier D-SNP (HMO D-SNP)
| $44.20 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,665 2024 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 |
2023 UnitedHealthcare Assisted Living Plan (PPO I-SNP)
| $28.40 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H0710 -054 -0 | $2.00 | $12.00 | $47.00 | $47.00 | 3,682
2023 Formulary |
|
-- |
|
|
2024 UHC Care Advantage GA-E001 (PPO I-SNP)
| $44.20 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $12.00 | $47.00 | $47.00 | 3,634 2024 Formulary |
|
2023 UnitedHealthcare Dual Complete Choice Select LP (PPO D-SNP)
| $32.30 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H3256 -002 -0 | | | | | 3,682
2023 Formulary |
|
|
|
|
2024 UHC Dual Complete GA-V001 (PPO D-SNP)
| $44.20 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,634 2024 Formulary |
|
2023 Wellcare Dual Access Open (PPO D-SNP)
| $37.30 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H0111 -004 -0 | | | | | 3,394
2023 Formulary |
|
|
|
|
2024 Wellcare Dual Access Open (PPO D-SNP)
| $44.20 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,353 2024 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 2023 --
|
H4036 -030 -0 | | | | | |
|
|
|
|
2024 Anthem Medicare Advantage 2 (PPO)
| $59.00 |
$6,050 |
$0 | Yes, some additional gap coverage. | $4.00 | $13.00 | $35.00 | $35.00 | 3,581 2024 Formulary |
|
2023 UnitedHealthcare Medicare Advantage Choice (Regional PPO)
| $49.00 |
$6,700 |
$295 | Yes, some additional gap coverage. |
R2604 -001 -0 | $0.00 | $14.00 | $47.00 | $47.00 | 3,682
2023 Formulary |
|
|
|
|
2024 UHC Medicare Advantage GS-0001 (Regional PPO)
| $62.00 |
$6,300 |
$345 | Yes, some additional gap coverage. | $0.00 | $14.00 | $47.00 | $47.00 | 3,634 2024 Formulary |
|
2023 HumanaChoice R3392-002 (Regional PPO)
| $103.00 |
$6,700 |
$340 | No additional gap coverage, only the Donut Hole Discount |
R3392 -002 -0 | $7.00 | $17.00 | $47.00 | $47.00 | 3,404
2023 Formulary |
|
|
|
|
2024 HumanaChoice R3392-002 (Regional PPO)
| $92.00 |
$8,850 |
$340 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $17.00 | $47.00 | $47.00 | 3,448 2024 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 |
2023 AARP Medicare Advantage Choice Rebate (PPO)
| $0.00 |
$7,550 |
$395 | Yes, some additional gap coverage. |
H6528 -041 -0 | $0.00 | $14.00 | $47.00 | $47.00 | 3,682
2023 Formulary |
|
|
|
|
-- Members will be assigned to AARP Medicare Advantage from UHC GA-0004 (PPO) H1889-021 --
| | | | | |
|
2023 AARP Medicare Advantage Plus Plan 1 (HMO-POS)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H8748 -008 -0 | $0.00 | $14.00 | $47.00 | $47.00 | 3,682
2023 Formulary |
|
|
|
|
-- Members will be assigned to AARP Medicare Advantage from UHC GA-0005 (HMO-POS) H5322-041 --
| | | | | |
|
2023 AARP Medicare Advantage Plus Plan 2 (HMO-POS)
| $32.00 |
$4,900 |
$0 | Yes, some additional gap coverage. |
H8748 -009 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,682
2023 Formulary |
|
|
|
|
-- Members will be assigned to AARP Medicare Advantage from UHC GA-0006 (HMO-POS) H5322-042 --
| | | | | |
|
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 |
2023 Aetna Medicare Freedom Plan (PPO)
| $0.00 |
$8,300 |
$150 | Yes, some additional gap coverage. |
H3288 -032 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,597
2023 Formulary |
|
|
|
|
-- Members will be assigned to Aetna Medicare Freedom (PPO) H3288-031 --
| | | | | |
|
2023 Aetna Medicare Select Plan (HMO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H1109 -006 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,597
2023 Formulary |
|
|
|
|
-- Members will be assigned to Aetna Medicare Select (HMO) H1109-005 --
| | | | | |
|
2023 Anthem MediBlue Dual Access (PPO D-SNP)
| $37.30 |
n/a |
$440 | No additional gap coverage, only the Donut Hole Discount |
H7728 -011 -0 | $10.00 | $20.00 | $47.00 | $47.00 | 3,603
2023 Formulary |
|
|
|
|
-- Members will be assigned to Anthem Full Dual Advantage (PPO D-SNP) H4036-032 --
| | | | | |
|
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 |
2023 Anthem MediBlue Essential (HMO)
| $38.00 |
$3,450 |
$0 | Yes, some additional gap coverage. |
H5422 -008 -0 | $5.00 | $15.00 | $35.00 | $35.00 | 3,603
2023 Formulary |
|
|
|
|
-- Members will be assigned to Anthem Medicare Advantage (HMO) H5422-011 --
| | | | | |
|
2023 Anthem MediBlue Access Basic (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H7728 -006 -0 | $4.00 | $13.00 | $35.00 | $35.00 | 3,603
2023 Formulary |
|
|
|
|
-- Members will be assigned to Anthem Medicare Advantage (PPO) H4036-031 --
| | | | | |
|
2023 Anthem MediBlue Access (PPO)
| $59.00 |
$6,050 |
$0 | Yes, some additional gap coverage. |
H7728 -005 -0 | $4.00 | $13.00 | $35.00 | $35.00 | 3,603
2023 Formulary |
|
|
|
|
-- Members will be assigned to Anthem Medicare Advantage 2 (PPO) H4036-030 --
| | | | | |
|
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 |
2023 UnitedHealthcare Chronic Complete (PPO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H6528 -039 -0 | $0.00 | $12.00 | $47.00 | $47.00 | 3,682
2023 Formulary |
|
|
|
|
-- Members will be assigned to UHC Complete Care GA-0003 (PPO C-SNP) H1889-020 --
| | | | | |
|
2023 UnitedHealthcare Medicare Advantage Choice Plan 1 (PPO)
| $0.00 |
$6,700 |
$275 | Yes, some additional gap coverage. |
H6528 -006 -0 | $0.00 | $14.00 | $47.00 | $47.00 | 3,682
2023 Formulary |
|
|
|
|
-- Members will be assigned to UHC Medicare Advantage GA-0002 (PPO) H1889-013 --
| | | | | |
|
2023 UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
| $28.30 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H2228 -013 -0 | | | | | 3,682
2023 Formulary |
|
|
|
|
-- Members will be assigned to UHC Nursing Home Plan EX-F005 (PPO I-SNP) H2406-031 --
| | | | | |
|
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 |
2023 Wellcare Low Premium Open (PPO)
| $55.00 |
$6,700 |
$150 | Yes, some additional gap coverage. |
H0111 -002 -0 | $0.00 | $0.00 | $35.00 | $35.00 | 3,393
2023 Formulary |
|
|
|
|
-- Members will be assigned to Wellcare Mutual of Omaha No Premium Open (PPO) H0111-001 --
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2023 Wellcare Premium Enhanced Open (PPO)
| $85.00 |
$6,000 |
$75 | Yes, some additional gap coverage. |
H0111 -003 -0 | $0.00 | $0.00 | $37.00 | $37.00 | 3,393
2023 Formulary |
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-- Members will be assigned to Wellcare Mutual of Omaha No Premium Open (PPO) H0111-001 --
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2023 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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-- This plan not offered in 2024 --
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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 |
2023 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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-- This plan not offered in 2024 --
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2023 Essence Advantage (HMO-POS)
| $0.00 |
$6,350 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5372 -001 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,290
2023 Formulary |
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-- This plan not offered in 2024 --
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2023 Essence Advantage Choice (PPO)
| $0.00 |
$6,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H8229 -001 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,290
2023 Formulary |
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-- This plan not offered in 2024 --
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