There are 67 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 |
2023 MCS Classicare Patriot (HMO)
| $0.00 |
$3,400 |
No Rx Coverage |
H5577 -016 -0 | This plan does NOT include Prescription Drug coverage. | |
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2024 MCS Classicare Patriot (HMO)
| $0.00 |
$3,400 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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2023 Basic (HMO)
| $0.00 |
$3,650 |
No Rx Coverage |
H5774 -003 -0 | This plan does NOT include Prescription Drug coverage. | |
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2024 Triple S Advantage Basic (HMO)
| $0.00 |
$3,650 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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2023 Optimo (PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
H4005 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
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2024 Triple S Advantage Optimo (PPO)
| $0.00 |
$6,700 |
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 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 | 3,401
2023 Formulary |
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2024 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 | 3,445 2024 Formulary |
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2023 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 | $0.00 | $0.00 | 3,401
2023 Formulary |
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2024 Humana Gold Plus H4007-020 (HMO)
| $0.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $5.00 | $5.00 | 3,445 2024 Formulary |
|
2023 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 | 3,401
2023 Formulary |
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2024 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 | 3,445 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 H4007-024 (HMO)
| $0.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H4007 -024 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,401
2023 Formulary |
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2024 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 | 3,445 2024 Formulary |
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2023 Humana Gold Plus H4007-025 (HMO)
| $0.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H4007 -025 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,401
2023 Formulary |
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2024 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 | 3,445 2024 Formulary |
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-- This plan not offered in 2023 --
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H4007 -028 -0 | | | | | |
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2024 Humana Gold Plus H4007-028 (HMO-POS)
| $0.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 3,445 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 --
|
H4007 -029 -0 | | | | | |
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2024 Humana Gold Plus H4007-029 (HMO)
| $0.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $0.00 | $0.00 | 3,445 2024 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 |
H4007 -016 -0 | | | | | 3,401
2023 Formulary |
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2024 Humana Gold Plus SNP-DE H4007-016 (HMO D-SNP)
| $0.00 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,445 2024 Formulary |
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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 |
H4007 -018 -0 | | | | | 3,401
2023 Formulary |
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2024 Humana Gold Plus SNP-DE H4007-018 (HMO D-SNP)
| $0.00 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,445 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 |
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 |
H4007 -019 -0 | | | | | 3,401
2023 Formulary |
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2024 Humana Gold Plus SNP-DE H4007-019 (HMO D-SNP)
| $0.00 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,445 2024 Formulary |
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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 |
H4007 -026 -0 | | | | | 3,401
2023 Formulary |
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2024 Humana Gold Plus SNP-DE H4007-026 (HMO D-SNP)
| $0.00 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,445 2024 Formulary |
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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 |
H4007 -027 -0 | | | | | 3,401
2023 Formulary |
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2024 Humana Gold Plus SNP-DE H4007-027 (HMO D-SNP)
| $0.00 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,445 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 --
|
H4007 -030 -0 | | | | | |
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2024 Humana Gold Plus SNP-DE H4007-030 (HMO D-SNP)
| $0.00 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,445 2024 Formulary |
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2023 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 | 3,263
2023 Formulary |
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2024 MCS Classicare Efectivo (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $4.00 | $4.00 | 3,279 2024 Formulary |
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2023 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 | 3,263
2023 Formulary |
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2024 MCS Classicare En Tu Hogar (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $5.00 | $5.00 | 3,279 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 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 | 3,263
2023 Formulary |
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2024 MCS Classicare Essential (HMO-POS)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $0.00 | $0.00 | 3,279 2024 Formulary |
|
2023 MCS Classicare Exacto (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H5577 -053 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,263
2023 Formulary |
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2024 MCS Classicare Exacto (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $0.00 | $0.00 | 3,279 2024 Formulary |
|
2023 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 | 3,263
2023 Formulary |
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2024 MCS Classicare Hero (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $5.00 | $10.00 | $30.00 | $30.00 | 3,279 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 MCS Classicare InteliCare (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H5577 -052 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,263
2023 Formulary |
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2024 MCS Classicare InteliCare (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $0.00 | $0.00 | 3,279 2024 Formulary |
|
2023 MCS Classicare Platino Ideal (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H5577 -002 -0 | | | | | 3,263
2023 Formulary |
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2024 MCS Classicare Platino Ideal (HMO D-SNP)
| $0.00 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,279 2024 Formulary |
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2023 MCS Classicare Platino MasCa$h (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H5577 -029 -0 | | | | | 3,263
2023 Formulary |
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2024 MCS Classicare Platino MasCa$h (HMO D-SNP)
| $0.00 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,279 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 --
|
H5577 -054 -3 | | | | | |
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2024 MCS Classicare Platino Maximo (HMO D-SNP)
| $0.00 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,279 2024 Formulary |
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2023 MCS Classicare Platino Progreso (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H5577 -017 -0 | | | | | 3,263
2023 Formulary |
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2024 MCS Classicare Platino Progreso (HMO D-SNP)
| $0.00 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,279 2024 Formulary |
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2023 MCS Classicare Platino Total (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H5577 -046 -0 | | | | | 3,263
2023 Formulary |
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2024 MCS Classicare Platino Total (HMO D-SNP)
| $0.00 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,279 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 MCS Classicare Primero (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5577 -038 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,263
2023 Formulary |
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2024 MCS Classicare Primero (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $0.00 | $0.00 | 3,279 2024 Formulary |
|
2023 MMM Balance (HMO-POS)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. |
H4004 -063 -0 | $0.00 | $0.00 | $3.00 | $3.00 | 3,398
2023 Formulary |
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2024 MMM Balance (HMO-POS)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | $1.00 | $2.00 | $10.00 | $10.00 | 3,445 2024 Formulary |
|
2023 MMM Deluxe (HMO-POS)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. |
H4003 -055 -0 | $0.00 | $0.00 | $5.00 | $5.00 | 3,398
2023 Formulary |
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2024 MMM Deluxe (HMO-POS)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | $3.00 | $4.00 | $10.00 | $10.00 | 3,445 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 MMM Diamante Platino (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H4003 -017 -0 | | | | | 3,398
2023 Formulary |
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2024 MMM Diamante Platino (HMO D-SNP)
| $0.00 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,445 2024 Formulary |
|
2023 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 | 3,398
2023 Formulary |
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2024 MMM Elite (HMO-POS)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $3.00 | $3.00 | 3,445 2024 Formulary |
|
2023 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 | 3,398
2023 Formulary |
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2024 MMM Plenitud (HMO-POS)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $5.00 | $5.00 | 3,445 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 --
|
H4004 -067 -0 | | | | | |
|
|
|
|
2024 MMM Plus Platino (HMO D-SNP)
| $0.00 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,445 2024 Formulary |
|
2023 MMM Relax Platino (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H4004 -062 -0 | | | | | 3,398
2023 Formulary |
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|
|
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2024 MMM Relax Platino (HMO D-SNP)
| $0.00 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,445 2024 Formulary |
|
2023 MMM Supremo (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H4003 -009 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,398
2023 Formulary |
|
|
|
|
2024 MMM Supremo (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $5.00 | $5.00 | 3,445 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 --
|
H4004 -066 -0 | | | | | |
|
|
|
|
2024 MMM Valioso (HMO-POS)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | $5.00 | $6.00 | $15.00 | $15.00 | 3,445 2024 Formulary |
|
2023 MMM Grande Platino (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H4003 -049 -0 | | | | | 3,398
2023 Formulary |
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|
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2024 MMM Valor Platino (HMO D-SNP)
| $0.00 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,445 2024 Formulary |
|
2023 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 | 3,398
2023 Formulary |
|
|
|
|
2024 PMC Max (HMO-POS)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | $1.00 | $2.00 | $7.00 | $7.00 | 3,445 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 PMC Premier Platino (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H4004 -048 -0 | | | | | 3,398
2023 Formulary |
|
|
|
|
2024 PMC Premier Platino (HMO D-SNP)
| $0.00 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,445 2024 Formulary |
|
2023 AhorroMax (HMO)
| $0.00 |
$3,650 |
$0 | Yes, some additional gap coverage. |
H5774 -037 -0 | $0.00 | $0.00 | $25.00 | $25.00 | 3,012
2023 Formulary |
|
|
|
|
2024 Triple S Advantage AhorroMax (HMO)
| $0.00 |
$3,650 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $25.00 | $25.00 | 3,028 2024 Formulary |
|
2023 Brillante (HMO-POS)
| $0.00 |
$3,650 |
$0 | Yes, some additional gap coverage. |
H5774 -031 -0 | $0.00 | $0.00 | $10.00 | $10.00 | 3,012
2023 Formulary |
|
|
|
|
2024 Triple S Advantage Brillante (HMO-POS)
| $0.00 |
$3,650 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $25.00 | $25.00 | 3,028 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 Contigo Plus (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5774 -022 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,012
2023 Formulary |
|
|
|
|
2024 Triple S Advantage Contigo Plus (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $0.00 | $0.00 | 3,028 2024 Formulary |
|
2023 Enlace Plus (HMO)
| $0.00 |
$3,650 |
$0 | Yes, some additional gap coverage. |
H5774 -038 -0 | $0.00 | $0.00 | $10.00 | $10.00 | 3,012
2023 Formulary |
|
|
|
|
2024 Triple S Advantage Enlace Plus (HMO)
| $0.00 |
$3,650 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $10.00 | $10.00 | 3,028 2024 Formulary |
|
2023 Magno (HMO-POS)
| $0.00 |
$3,650 |
$0 | Yes, some additional gap coverage. |
H5774 -027 -0 | $0.00 | $0.00 | $5.00 | $5.00 | 3,012
2023 Formulary |
|
|
|
|
2024 Triple S Advantage Magno (HMO-POS)
| $0.00 |
$3,650 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $5.00 | $5.00 | 3,028 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 Optimo Plus (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H4005 -004 -0 | $0.00 | $0.00 | $25.00 | $25.00 | 3,012
2023 Formulary |
|
|
|
|
2024 Triple S Advantage Optimo Plus (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $25.00 | $25.00 | 3,028 2024 Formulary |
|
2023 Platino Advance (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H5774 -026 -0 | $10.00 | $15.00 | $42.00 | $42.00 | 2,766
2023 Formulary |
|
|
|
|
2024 Triple S Advantage Platino Advance (HMO D-SNP)
| $0.00 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | $16.00 | $17.00 | $42.00 | $42.00 | 2,800 2024 Formulary |
|
2023 Platino Blindao (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H5774 -028 -0 | $10.00 | $15.00 | $42.00 | $42.00 | 2,766
2023 Formulary |
|
|
|
|
2024 Triple S Advantage Platino Blindao (HMO D-SNP)
| $0.00 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | $16.00 | $17.00 | $42.00 | $42.00 | 2,800 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 Platino Alcance (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H5774 -035 -0 | $14.00 | $15.00 | $42.00 | $42.00 | 2,766
2023 Formulary |
|
|
|
|
2024 Triple S Advantage Platino Enlace (HMO D-SNP)
| $0.00 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | $16.00 | $17.00 | $42.00 | $42.00 | 2,800 2024 Formulary |
|
2023 Platino Plus (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H5774 -024 -0 | $14.00 | $15.00 | $42.00 | $42.00 | 2,766
2023 Formulary |
|
|
|
|
2024 Triple S Advantage Platino Plus (HMO D-SNP)
| $0.00 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | $16.00 | $17.00 | $42.00 | $42.00 | 2,800 2024 Formulary |
|
2023 Real (HMO)
| $0.00 |
$3,650 |
$0 | Yes, some additional gap coverage. |
H5774 -005 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,012
2023 Formulary |
|
|
|
|
2024 Triple S Advantage Real (HMO)
| $0.00 |
$3,650 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $0.00 | $0.00 | 3,028 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 MMM Unico (HMO-POS)
| $15.00 |
$3,250 |
$0 | Yes, some additional gap coverage. |
H4003 -019 -0 | $0.00 | $0.00 | $0.00 | $0.00 | 3,398
2023 Formulary |
|
|
|
|
2024 MMM Unico (HMO-POS)
| $15.00 |
$3,250 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $3.00 | $3.00 | 3,445 2024 Formulary |
|
2023 Optimo Xtra (PPO)
| $40.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H4005 -007 -0 | $0.00 | $0.00 | $15.00 | $15.00 | 3,012
2023 Formulary |
|
|
|
|
2024 Optimo Xtra (PPO)
| $30.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $15.00 | $15.00 | 3,028 2024 Formulary |
|
2023 HumanaChoice Value H2029-001 (PPO)
| $38.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2029 -001 -0 | $0.00 | $0.00 | $25.00 | $25.00 | 3,401
2023 Formulary |
|
-- |
|
|
2024 HumanaChoice Value H2029-001 (PPO)
| $44.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $0.00 | $25.00 | $25.00 | 3,445 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 H4007-022 (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H4007 -022 -0 | | | | | 3,401
2023 Formulary |
|
|
|
|
-- Members will be assigned to Humana Gold Plus SNP-DE H4007-026 (HMO D-SNP) H4007-026 --
| | | | | |
|
2023 MCS Classicare Activo (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H5577 -031 -0 | $0.00 | $0.00 | $5.00 | $5.00 | 3,263
2023 Formulary |
|
|
|
|
-- Members will be assigned to MCS Classicare Efectivo (HMO) H5577-005 --
| | | | | |
|
2023 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 | 3,316
2023 Formulary |
|
|
|
|
-- Members will be assigned to MCS Classicare Efectivo (HMO) H5577-005 --
| | | | | |
|
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 MCS Classicare Electrico (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H5577 -049 -0 | $0.00 | $0.00 | $5.00 | $5.00 | 3,263
2023 Formulary |
|
|
|
|
-- Members will be assigned to MCS Classicare Efectivo (HMO) H5577-005 --
| | | | | |
|
2023 MCS Classicare En Tu Casa (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H5577 -047 -0 | $0.00 | $0.00 | $5.00 | $5.00 | 3,263
2023 Formulary |
|
|
|
|
-- Members will be assigned to MCS Classicare En Tu Hogar (HMO) H5577-043 --
| | | | | |
|
2023 MCS Classicare Acceso (HMO-POS)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H5577 -050 -0 | $0.00 | $0.00 | $5.00 | $5.00 | 3,263
2023 Formulary |
|
|
|
|
-- Members will be assigned to MCS Classicare Essential (HMO-POS) H5577-008 --
| | | | | |
|
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 MCS Classicare Freedom (HMO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H5577 -014 -0 | $2.00 | $3.00 | $10.00 | $10.00 | 3,263
2023 Formulary |
|
|
|
|
-- Members will be assigned to MCS Classicare Hero (HMO) H5577-044 --
| | | | | |
|
2023 MCS Classicare Platino @Home (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H5577 -037 -0 | | | | | 3,263
2023 Formulary |
|
|
|
|
-- Members will be assigned to MCS Classicare Platino Total (HMO D-SNP) H5577-046 --
| | | | | |
|
2023 MMM Dinamico (HMO-POS)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. |
H4003 -051 -0 | $0.00 | $0.00 | $5.00 | $5.00 | 3,398
2023 Formulary |
|
|
|
|
-- Members will be assigned to MMM Deluxe (HMO-POS) H4003-055 --
| | | | | |
|
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 MMM Flexi Max (HMO-POS)
| $0.00 |
$3,250 |
$0 | Yes, some additional gap coverage. |
H4003 -057 -0 | $0.00 | $0.00 | $5.00 | $5.00 | 3,398
2023 Formulary |
|
|
|
|
-- Members will be assigned to MMM Deluxe (HMO-POS) H4003-055 --
| | | | | |
|
2023 MMM Integral (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H4003 -052 -0 | $0.00 | $0.00 | $10.00 | $10.00 | 3,398
2023 Formulary |
|
|
|
|
-- Members will be assigned to MMM Supremo (HMO C-SNP) H4003-009 --
| | | | | |
|
2023 MMM Valor Platino (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H4003 -047 -0 | | | | | 3,398
2023 Formulary |
|
|
|
|
-- Members will be assigned to MMM Valor Platino (HMO D-SNP) H4003-049 --
| | | | | |
|
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 Platino Ultra (HMO D-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H5774 -025 -0 | $14.00 | $15.00 | $42.00 | $42.00 | 2,766
2023 Formulary |
|
|
|
|
-- Members will be assigned to Platino Plus (HMO D-SNP) H5774-024 --
| | | | | |
|