There are 99 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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H2406 -077 -0 | | | | | |
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2024 AARP Medicare Advantage Patriot No Rx AZ-MA01 (PPO)
| $0.00 |
$4,300 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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2023 Aetna Medicare Eagle Plan (PPO)
| $0.00 |
$5,500 |
No Rx Coverage |
H5521 -329 -0 | This plan does NOT include Prescription Drug coverage. | |
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2024 Aetna Medicare Eagle Plan (PPO)
| $0.00 |
$4,500 |
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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H6586 -005 -0 | | | | | |
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new |
new |
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2024 Devoted LIBERTY CHOICE Arizona (PPO)
| $0.00 |
$6,350 |
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 |
$4,400 |
No Rx Coverage |
H5216 -213 -0 | This plan does NOT include Prescription Drug coverage. | |
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2024 Humana USAA Honor (PPO)
| $0.00 |
$4,900 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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2023 HumanaChoice R7220-001 (Regional PPO)
| $0.00 |
$6,000 |
No Rx Coverage |
R7220 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
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2024 HumanaChoice R7220-001 (Regional PPO)
| $0.00 |
$5,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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2023 Wellcare Patriot Giveback Open (PPO)
| $0.00 |
$4,400 |
No Rx Coverage |
H8553 -002 -0 | This plan does NOT include Prescription Drug coverage. | |
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-- |
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2024 Wellcare Patriot Giveback Open (PPO)
| $0.00 |
$5,000 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2023 AARP Medicare Advantage Plan 1 (HMO-POS)
| $0.00 |
$2,400 |
$0 | Yes, some additional gap coverage. |
H0609 -025 -0 | $0.00 | $8.00 | $45.00 | $45.00 | 3,682
2023 Formulary |
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2024 AARP Medicare Advantage from UHC AZ-0001 (HMO-POS)
| $0.00 |
$2,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $45.00 | $45.00 | 3,634 2024 Formulary |
|
2023 AARP Medicare Advantage Plan 2 (HMO-POS)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. |
H0609 -045 -0 | $0.00 | $10.00 | $45.00 | $45.00 | 3,682
2023 Formulary |
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2024 AARP Medicare Advantage from UHC AZ-0004 (HMO-POS)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $45.00 | $45.00 | 3,634 2024 Formulary |
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-- This plan not offered in 2023 --
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H2406 -062 -0 | | | | | |
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2024 AARP Medicare Advantage from UHC AZ-0007 (PPO)
| $0.00 |
$4,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $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 Aetna Medicare Elite Plan (PPO)
| $0.00 |
$5,900 |
$0 | Yes, some additional gap coverage. |
H5521 -363 -0 | $2.00 | $5.00 | $47.00 | $47.00 | 3,597
2023 Formulary |
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2024 Aetna Medicare Elite Plan (PPO)
| $0.00 |
$5,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,633 2024 Formulary |
|
2023 Aetna Medicare Freedom Plan (PPO)
| $0.00 |
$5,200 |
$0 | Yes, some additional gap coverage. |
H5521 -100 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,597
2023 Formulary |
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2024 Aetna Medicare Freedom Plan (PPO)
| $0.00 |
$3,850 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,633 2024 Formulary |
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2023 Aetna Medicare Platinum Plan (HMO-POS)
| $0.00 |
$6,200 |
$0 | Yes, some additional gap coverage. |
H3931 -129 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,597
2023 Formulary |
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2024 Aetna Medicare Platinum Plan (HMO-POS)
| $0.00 |
$4,800 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $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 Aetna Medicare Premier Plan (HMO-POS)
| $0.00 |
$3,650 |
$0 | Yes, some additional gap coverage. |
H4835 -004 -0 | $2.00 | $5.00 | $47.00 | $47.00 | 3,597
2023 Formulary |
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2024 Aetna Medicare Premier Plan (HMO-POS)
| $0.00 |
$3,650 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,633 2024 Formulary |
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2023 Aetna Medicare Sunrise Plan (HMO-POS)
| $0.00 |
$2,700 |
$0 | Yes, some additional gap coverage. |
H3931 -146 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,597
2023 Formulary |
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2024 Aetna Medicare Sunrise Plan (HMO-POS)
| $0.00 |
$2,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,633 2024 Formulary |
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2023 Alignment Health AVA (PPO)
| $0.00 |
$3,900 |
$0 | Yes, some additional gap coverage. |
H9614 -001 -0 | $0.00 | $5.00 | $40.00 | $40.00 | 3,467
2023 Formulary |
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new |
new |
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2024 Alignment Health AVA (PPO)
| $0.00 |
$3,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $40.00 | $40.00 | 3,517 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 Alignment Health Heart & Diabetes (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H3443 -003 -0 | $0.00 | $0.00 | $40.00 | $40.00 | 3,467
2023 Formulary |
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|
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2024 Alignment Health Heart & Diabetes (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $40.00 | $40.00 | 3,517 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H3443 -005 -0 | | | | | |
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2024 Alignment Health smartHMO (HMO)
| $0.00 |
$3,900 |
$545 | Yes, some additional gap coverage. | $0.00 | $0.00 | $45.00 | $45.00 | 3,517 2024 Formulary |
|
2023 Alignment Health the ONE (HMO)
| $0.00 |
$2,499 |
$0 | Yes, some additional gap coverage. |
H3443 -002 -0 | $0.00 | $0.00 | $40.00 | $40.00 | 3,467
2023 Formulary |
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2024 Alignment Health the ONE + Walgreens (HMO)
| $0.00 |
$2,499 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $40.00 | $40.00 | 3,517 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 Banner Medicare Advantage Prime (HMO)
| $0.00 |
$2,775 |
$0 | Yes, some additional gap coverage. |
H5843 -002 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,467
2023 Formulary |
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2024 Banner Medicare Advantage Prime (HMO)
| $0.00 |
$2,775 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,494 2024 Formulary |
|
2023 Blue Medicare Advantage Classic (HMO)
| $0.00 |
$2,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H0302 -008 -0 | $0.00 | $9.00 | $47.00 | $47.00 | 3,506
2023 Formulary |
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2024 Blue Best Life Classic (HMO)
| $0.00 |
$2,900 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $9.00 | $47.00 | $47.00 | 3,292 2024 Formulary |
|
2023 Cigna Achieve Medicare (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0354 -027 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,524
2023 Formulary |
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|
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2024 Cigna Achieve Medicare (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 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 |
2023 Cigna Alliance Medicare (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. |
H0354 -028 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,524
2023 Formulary |
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|
|
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2024 Cigna Alliance Medicare (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,535 2024 Formulary |
|
2023 Cigna Preferred Medicare (HMO)
| $0.00 |
$2,300 |
$0 | Yes, some additional gap coverage. |
H0354 -001 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,524
2023 Formulary |
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|
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2024 Cigna Preferred Medicare (HMO)
| $0.00 |
$2,300 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,535 2024 Formulary |
|
2023 Cigna Preferred Savings Medicare (HMO)
| $0.00 |
$3,100 |
$0 | Yes, some additional gap coverage. |
H0354 -029 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,524
2023 Formulary |
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|
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2024 Cigna Preferred Savings Medicare (HMO)
| $0.00 |
$3,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 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 |
2023 Cigna True Choice Medicare (PPO)
| $0.00 |
$4,200 |
$0 | Yes, some additional gap coverage. |
H7849 -065 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,524
2023 Formulary |
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|
|
2024 Cigna True Choice Medicare (PPO)
| $0.00 |
$4,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,535 2024 Formulary |
|
2023 Cigna True Choice Savings Medicare (PPO)
| $0.00 |
$5,600 |
$0 | Yes, some additional gap coverage. |
H7849 -066 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,524
2023 Formulary |
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2024 Cigna True Choice Savings Medicare (PPO)
| $0.00 |
$5,600 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,535 2024 Formulary |
|
2023 Devoted CHOICE Arizona (PPO)
| $0.00 |
$5,000 |
$0 | Yes, some additional gap coverage. |
H6586 -003 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,364
2023 Formulary |
|
new |
new |
|
2024 Devoted CHOICE Arizona (PPO)
| $0.00 |
$5,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,391 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 --
|
H8173 -016 -0 | | | | | |
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|
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2024 Devoted CORE Arizona (HMO)
| $0.00 |
$2,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,391 2024 Formulary |
|
2023 Devoted GIVEBACK Arizona (HMO)
| $0.00 |
$3,900 |
$0 | Yes, some additional gap coverage. |
H8173 -013 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,364
2023 Formulary |
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|
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2024 Devoted GIVEBACK Arizona (HMO)
| $0.00 |
$3,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 3,391 2024 Formulary |
|
2023 Dialysis Plus (HMO-POS C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H4869 -003 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,288
2023 Formulary |
|
new |
new |
|
2024 Dialysis Plus (HMO-POS C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $40.00 | $40.00 | 3,582 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 --
|
H4869 -009 -0 | | | | | |
|
new |
new |
|
2024 Essential Care (HMO-POS)
| $0.00 |
$8,850 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
-- This plan not offered in 2023 --
|
H4869 -010 -0 | | | | | |
|
new |
new |
|
2024 Gold Circle (HMO-POS C-SNP)
| $0.00 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,582 2024 Formulary |
|
2023 Honest Care (HMO)
| $0.00 |
$3,000 |
$0 | Yes, some additional gap coverage. |
H4869 -005 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,288
2023 Formulary |
|
new |
new |
|
2024 Honest Care (HMO-POS)
| $0.00 |
$3,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $40.00 | $40.00 | 3,582 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 H0028-021 (HMO)
| $0.00 |
$2,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H0028 -021 -0 | $2.00 | $10.00 | $42.00 | $42.00 | 3,404
2023 Formulary |
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|
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2024 Humana Gold Plus H0028-021 (HMO)
| $0.00 |
$3,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $10.00 | $42.00 | $42.00 | 3,448 2024 Formulary |
|
2023 Humana Gold Plus H0028-052 (HMO)
| $0.00 |
$2,800 |
$0 | Yes, some additional gap coverage. |
H0028 -052 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,404
2023 Formulary |
|
|
|
|
2024 Humana Gold Plus H0028-052 (HMO)
| $0.00 |
$2,800 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,448 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H5216 -338 -0 | | | | | |
|
|
|
|
2024 Humana USAA Honor with Rx (PPO)
| $0.00 |
$6,100 |
$480 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 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 H5216-137 (PPO)
| $0.00 |
$7,350 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H5216 -137 -0 | $7.00 | $17.00 | $45.00 | $45.00 | 3,404
2023 Formulary |
|
|
|
|
2024 HumanaChoice H5216-137 (PPO)
| $0.00 |
$7,350 |
$500 | No additional gap coverage, only the Donut Hole Discount | $7.00 | $17.00 | $45.00 | $45.00 | 3,448 2024 Formulary |
|
2023 HumanaChoice H5216-265 (PPO)
| $0.00 |
$4,500 |
$0 | Yes, some additional gap coverage. |
H5216 -265 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,404
2023 Formulary |
|
|
|
|
2024 HumanaChoice H5216-265 (PPO)
| $0.00 |
$4,800 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,448 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H5216 -371 -0 | | | | | |
|
|
|
|
2024 HumanaChoice H5216-371 (PPO)
| $0.00 |
$6,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $2.00 | $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 SCAN Balance (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H1822 -002 -0 | $0.00 | $0.00 | $37.00 | $37.00 | 3,458
2023 Formulary |
|
|
|
|
2024 SCAN Balance (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $37.00 | $37.00 | 3,535 2024 Formulary |
|
2023 SCAN Classic (HMO)
| $0.00 |
$2,800 |
$0 | Yes, some additional gap coverage. |
H1822 -001 -0 | $0.00 | $0.00 | $37.00 | $37.00 | 3,458
2023 Formulary |
|
|
|
|
2024 SCAN Classic (HMO)
| $0.00 |
$2,800 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $37.00 | $37.00 | 3,535 2024 Formulary |
|
2023 SCAN Embrace (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H1822 -005 -0 | $0.00 | $0.00 | $37.00 | $37.00 | 3,458
2023 Formulary |
|
|
|
|
2024 SCAN Embrace (HMO-POS I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $37.00 | $37.00 | 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 |
2023 SCAN Heart First (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H1822 -003 -0 | $0.00 | $0.00 | $37.00 | $37.00 | 3,458
2023 Formulary |
|
|
|
|
2024 SCAN Heart First (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $37.00 | $37.00 | 3,535 2024 Formulary |
|
2023 SCAN Venture (HMO)
| $0.00 |
$2,999 |
$0 | Yes, some additional gap coverage. |
H1822 -004 -0 | $0.00 | $0.00 | $40.00 | $40.00 | 3,458
2023 Formulary |
|
|
|
|
2024 SCAN Venture (HMO)
| $0.00 |
$2,999 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $40.00 | $40.00 | 3,535 2024 Formulary |
|
2023 Super Plus (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H4869 -001 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,288
2023 Formulary |
|
new |
new |
|
2024 Super Plus (HMO-POS C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $40.00 | $40.00 | 3,582 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 Chronic Complete (HMO-POS C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0609 -043 -0 | $0.00 | $8.00 | $45.00 | $45.00 | 3,682
2023 Formulary |
|
|
|
|
2024 UHC Complete Care AZ-003P (HMO-POS C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $45.00 | $45.00 | 3,634 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H0351 -064 -0 | | | | | |
|
|
|
|
2024 Wellcare Giveback (HMO)
| $0.00 |
$4,400 |
$545 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $15.00 | $42.00 | $42.00 | 3,372 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H0351 -063 -0 | | | | | |
|
|
|
|
2024 Wellcare No Premium (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $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 |
$5,000 |
$200 | Yes, some additional gap coverage. |
H8553 -001 -0 | $0.00 | $5.00 | $37.00 | $37.00 | 3,392
2023 Formulary |
|
-- |
|
|
2024 Wellcare No Premium Open (PPO)
| $0.00 |
$4,500 |
$300 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 3,372 2024 Formulary |
|
2023 Wellcare Specialty No Premium (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0351 -038 -0 | $0.00 | $5.00 | $37.00 | $37.00 | 3,393
2023 Formulary |
|
|
|
|
2024 Wellcare Specialty No Premium (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $4.00 | $42.00 | $42.00 | 3,371 2024 Formulary |
|
2023 Amerivantage Diabetes Care Plus (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H1423 -002 -0 | $0.00 | $7.50 | $35.00 | $35.00 | 3,157
2023 Formulary |
|
|
|
|
2024 Wellpoint Chronic Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $35.00 | $35.00 | 3,221 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 Amerivantage Diabetes Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H2593 -006 -0 | $0.00 | $7.50 | $40.00 | $40.00 | 3,157
2023 Formulary |
|
-- |
|
|
2024 Wellpoint Chronic Care 2 (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $40.00 | $40.00 | 3,221 2024 Formulary |
|
2023 Amerivantage Comfort Plus (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H1423 -007 -0 | $0.00 | $7.50 | $40.00 | $40.00 | 3,157
2023 Formulary |
|
|
|
|
2024 Wellpoint I Carelon Home Care (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $40.00 | $40.00 | 3,221 2024 Formulary |
|
2023 Amerivantage Comfort (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H2593 -003 -0 | $0.00 | $7.50 | $40.00 | $40.00 | 3,157
2023 Formulary |
|
-- |
|
|
2024 Wellpoint I Carelon Home Care 2 (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $40.00 | $40.00 | 3,221 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 Amerivantage ESRD Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H2593 -040 -0 | $0.00 | $7.50 | $40.00 | $40.00 | 3,157
2023 Formulary |
|
-- |
|
|
2024 Wellpoint I Carelon Kidney Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $40.00 | $40.00 | 3,221 2024 Formulary |
|
2023 Amerivantage Lung Care Plus (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H1423 -001 -0 | $0.00 | $7.50 | $40.00 | $40.00 | 3,157
2023 Formulary |
|
|
|
|
2024 Wellpoint Lung Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $40.00 | $40.00 | 3,221 2024 Formulary |
|
2023 Amerivantage Lung Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H2593 -005 -0 | $0.00 | $7.50 | $40.00 | $40.00 | 3,157
2023 Formulary |
|
-- |
|
|
2024 Wellpoint Lung Care 2 (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $40.00 | $40.00 | 3,221 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 Amerivantage Classic Plus (HMO)
| $0.00 |
$2,700 |
$0 | Yes, some additional gap coverage. |
H1423 -004 -0 | $0.00 | $7.50 | $40.00 | $40.00 | 3,157
2023 Formulary |
|
|
|
|
2024 Wellpoint Medicare Advantage 1 (HMO)
| $0.00 |
$2,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $40.00 | $40.00 | 3,221 2024 Formulary |
|
2023 Amerivantage Classic (HMO)
| $0.00 |
$8,300 |
$0 | Yes, some additional gap coverage. |
H2593 -001 -0 | $0.00 | $7.50 | $40.00 | $40.00 | 3,157
2023 Formulary |
|
-- |
|
|
2024 Wellpoint Medicare Advantage 2 (HMO)
| $0.00 |
$8,300 |
$0 | Yes, some additional gap coverage. | $0.00 | $7.50 | $40.00 | $40.00 | 3,221 2024 Formulary |
|
2023 Amerivantage Smart Value Plus (HMO)
| $0.00 |
$3,400 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H1423 -005 -0 | $5.00 | $10.50 | $40.00 | $40.00 | 3,157
2023 Formulary |
|
|
|
|
2024 Wellpoint Premium Savings (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $5.00 | $10.50 | $40.00 | $40.00 | 3,221 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 --
|
H3443 -006 -0 | | | | | |
|
|
|
|
2024 Alignment Health Heart & Diabetes Plus (HMO C-SNP)
| $6.60 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,517 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H0351 -062 -0 | | | | | |
|
|
|
|
2024 Wellcare Assist (HMO)
| $16.20 |
$3,400 |
$545 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,371 2024 Formulary |
|
2023 AARP Medicare Advantage Plus (HMO-POS)
| $15.00 |
$4,300 |
$0 | Yes, some additional gap coverage. |
H5253 -035 -0 | $0.00 | $8.00 | $45.00 | $45.00 | 3,682
2023 Formulary |
|
|
|
|
2024 AARP Medicare Advantage from UHC AZ-0013 (HMO-POS)
| $20.00 |
$4,300 |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $45.00 | $45.00 | 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 Banner Medicare Advantage Plus (PPO)
| $25.00 |
$4,350 |
$0 | Yes, some additional gap coverage. |
H7273 -002 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,467
2023 Formulary |
|
-- |
|
|
2024 Banner Medicare Advantage Plus (PPO)
| $20.00 |
$4,350 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,494 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H3931 -167 -0 | | | | | |
|
|
|
|
2024 Aetna Medicare Value Plus Plan (HMO-POS)
| $25.00 |
$2,700 |
$400 | Yes, some additional gap coverage. | $0.00 | $10.00 | 20% | 20% | 3,619 2024 Formulary |
|
2023 Super Complete (HMO C-SNP)
| $42.60 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H4869 -002 -0 | 25% | 25% | 25% | 25% | 3,288
2023 Formulary |
|
new |
new |
|
2024 Super Complete (HMO-POS C-SNP)
| $25.80 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,582 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 --
|
H2406 -078 -0 | | | | | |
|
|
|
|
2024 AARP Medicare Advantage from UHC AZ-0011 (PPO)
| $27.00 |
$3,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,634 2024 Formulary |
|
2023 Wellcare Dual Liberty (HMO D-SNP)
| $25.20 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H5590 -008 -0 | | | | | 3,394
2023 Formulary |
|
|
|
|
2024 Wellcare Dual Liberty (HMO D-SNP)
| $27.50 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,353 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H1822 -006 -0 | | | | | |
|
|
|
|
2024 SCAN Strive (HMO C-SNP)
| $34.90 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 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 |
2023 HumanaChoice H5216-224 (PPO)
| $23.00 |
$3,900 |
$0 | Yes, some additional gap coverage. |
H5216 -224 -0 | $0.00 | $0.00 | $45.00 | $45.00 | 3,404
2023 Formulary |
|
|
|
|
2024 HumanaChoice H5216-224 (PPO)
| $35.00 |
$4,150 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,448 2024 Formulary |
|
2023 Dialysis Complete (HMO-POS C-SNP)
| $42.60 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H4869 -004 -0 | | | | | 3,288
2023 Formulary |
|
new |
new |
|
2024 Dialysis Complete (HMO-POS C-SNP)
| $37.80 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,582 2024 Formulary |
|
2023 UnitedHealthcare Nursing Home Plan (PPO I-SNP)
| $42.60 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H0710 -005 -0 | | | | | 3,682
2023 Formulary |
|
-- |
|
|
2024 UHC Nursing Home Plan AZ-F001 (PPO I-SNP)
| $38.90 |
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 Banner Medicare Advantage Dual (HMO D-SNP)
| $41.60 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H4931 -007 -0 | | | | | 3,467
2023 Formulary |
|
|
|
|
2024 Banner Medicare Advantage Dual (HMO D-SNP)
| $43.20 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,494 2024 Formulary |
|
2023 Banner Medicare Advantage Dual (HMO D-SNP)
| $42.60 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H4931 -015 -0 | | | | | 3,467
2023 Formulary |
|
|
|
|
2024 Banner Medicare Advantage Dual (HMO D-SNP)
| $43.20 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,494 2024 Formulary |
|
2023 Humana Value Plus H5216-197 (PPO)
| $36.30 |
$7,550 |
$450 | No additional gap coverage, only the Donut Hole Discount |
H5216 -197 -0 | $6.00 | $16.00 | 23% | 23% | 3,404
2023 Formulary |
|
|
|
|
2024 Humana Value Plus H5216-197 (PPO)
| $43.20 |
$7,550 |
$545 | No additional gap coverage, only the Donut Hole Discount | $18.00 | $19.00 | 21% | 21% | 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 Mercy Care Advantage (HMO D-SNP)
| $42.60 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H5580 -004 -0 | | | | | 3,258
2023 Formulary |
|
|
|
|
2024 Mercy Care Advantage (HMO D-SNP)
| $43.20 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,291 2024 Formulary |
|
2023 Mercy Care Advantage (HMO D-SNP)
| $42.60 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H5580 -005 -0 | | | | | 3,258
2023 Formulary |
|
|
|
|
2024 Mercy Care Advantage (HMO D-SNP)
| $43.20 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,291 2024 Formulary |
|
2023 UnitedHealthcare Dual Complete LP (HMO-POS D-SNP)
| $42.60 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H0321 -002 -0 | | | | | 3,682
2023 Formulary |
|
|
|
|
2024 UHC Dual Complete AZ-S001 (HMO-POS D-SNP)
| $43.20 |
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 |
2023 BlueJourney (PPO)
| $68.00 |
$3,600 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5140 -002 -0 | $0.00 | $9.00 | $47.00 | $47.00 | 3,506
2023 Formulary |
|
|
|
|
2024 BlueJourney (PPO)
| $60.00 |
$3,600 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $9.00 | $47.00 | $47.00 | 3,292 2024 Formulary |
|
2023 Aetna Medicare Platinum Plan (PPO)
| $83.00 |
$6,500 |
$175 | Yes, some additional gap coverage. |
H5521 -184 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,597
2023 Formulary |
|
|
|
|
2024 Aetna Medicare Essentials Plan (PPO)
| $73.00 |
$6,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | 20% | 20% | 3,619 2024 Formulary |
|
2023 HumanaChoice R7220-002 (Regional PPO)
| $56.00 |
$6,700 |
$505 | No additional gap coverage, only the Donut Hole Discount |
R7220 -002 -0 | $12.00 | $15.00 | 21% | 21% | 3,409
2023 Formulary |
|
|
|
|
2024 HumanaChoice R7220-002 (Regional PPO)
| $75.00 |
$7,800 |
$540 | No additional gap coverage, only the Donut Hole Discount | $18.00 | $19.00 | 22% | 22% | 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 H5216-335 (PPO)
| $96.00 |
$2,900 |
$0 | Yes, some additional gap coverage. |
H5216 -335 -0 | $0.00 | $2.00 | $45.00 | $45.00 | 3,404
2023 Formulary |
|
|
|
|
2024 HumanaChoice H5216-335 (PPO)
| $107.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $2.00 | $45.00 | $45.00 | 3,448 2024 Formulary |
|
2023 HumanaChoice H5216-034 (PPO)
| $118.00 |
$7,550 |
$225 | No additional gap coverage, only the Donut Hole Discount |
H5216 -034 -0 | $5.00 | $15.00 | $45.00 | $45.00 | 3,404
2023 Formulary |
|
|
|
|
2024 HumanaChoice H5216-034 (PPO)
| $125.00 |
$7,550 |
$225 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $45.00 | $45.00 | 3,448 2024 Formulary |
|
2023 AARP Medicare Advantage Walgreens Plan 1 (PPO)
| $0.00 |
$4,500 |
$0 | Yes, some additional gap coverage. |
H2228 -075 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,682
2023 Formulary |
|
|
|
|
-- Members will be assigned to AARP Medicare Advantage from UHC AZ-0007 (PPO) H2406-062 --
| | | | | |
|
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 Walgreens Plan 2 (PPO)
| $25.00 |
$3,500 |
$0 | Yes, some additional gap coverage. |
H2228 -096 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,682
2023 Formulary |
|
|
|
|
-- Members will be assigned to AARP Medicare Advantage from UHC AZ-0011 (PPO) H2406-078 --
| | | | | |
|
2023 AARP Medicare Advantage Patriot (PPO)
| $0.00 |
$4,300 |
No Rx Coverage |
H2228 -095 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
-- Members will be assigned to AARP Medicare Advantage Patriot No Rx AZ-MA01 (PPO) H2406-077 --
| | | | | |
|
2023 Imperial Insurance Traditional Plus (HMO)
| $0.00 |
$8,300 |
$505 | No additional gap coverage, only the Donut Hole Discount |
H2793 -007 -0 | | | | | 3,346
2023 Formulary |
|
|
|
|
-- Members will be assigned to Imperial Insurance Company Traditional (HMO) H2793-003 --
| | | | | |
|
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 Giveback (HMO)
| $0.00 |
$4,400 |
$350 | No additional gap coverage, only the Donut Hole Discount |
H0351 -060 -1 | $0.00 | $15.00 | $42.00 | $42.00 | 3,392
2023 Formulary |
|
|
|
|
-- Members will be assigned to Wellcare Giveback (HMO) H0351-064 --
| | | | | |
|
2023 Wellcare No Premium (HMO)
| $0.00 |
$3,450 |
$0 | Yes, some additional gap coverage. |
H0351 -058 -1 | $0.00 | $8.00 | $37.00 | $37.00 | 3,392
2023 Formulary |
|
|
|
|
-- Members will be assigned to Wellcare No Premium (HMO) H0351-063 --
| | | | | |
|
2023 Amerivantage Heart Care Plus (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H1423 -003 -0 | $0.00 | $7.50 | $40.00 | $40.00 | 3,157
2023 Formulary |
|
|
|
|
-- Members will be assigned to Wellpoint Chronic Care (HMO C-SNP) H1423-002 --
| | | | | |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2023 Amerivantage Heart Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H2593 -013 -0 | $0.00 | $7.50 | $40.00 | $40.00 | 3,157
2023 Formulary |
|
-- |
|
|
-- Members will be assigned to Wellpoint Chronic Care 2 (HMO C-SNP) H2593-006 --
| | | | | |
|
2023 Wellcare Assist (HMO)
| $12.20 |
$3,400 |
$505 | No additional gap coverage, only the Donut Hole Discount |
H0351 -059 -1 | $0.00 | $20.00 | $47.00 | $47.00 | 3,392
2023 Formulary |
|
|
|
|
-- This plan not offered in 2024 --
|
| | | | |
|
2023 Lasso Healthcare Growth (MSA)
| $0.00 |
n/a |
No Rx Coverage |
H1924 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
-- This plan not offered in 2024 --
|
| | | | |
|
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. | |
|
|
|
|
-- This plan not offered in 2024 --
|
| | | | |
|
2023 Imperial Insurance Company Traditional (HMO)
| $0.00 |
$2,999 |
$0 | Yes, some additional gap coverage. |
H2793 -003 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,346
2023 Formulary |
|
|
|
|
-- This plan not offered in 2024 --
|
| | | | |
|
2023 Imperial Insurance Value (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H2793 -005 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,387
2023 Formulary |
|
|
|
|
-- This plan not offered in 2024 --
|
| | | | |
|
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 Imperial Courage Plan (HMO)
| $0.00 |
$2,999 |
No Rx Coverage |
H2793 -008 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
-- This plan not offered in 2024 --
|
| | | | |
|
2023 BluePathway Plan 2 (HMO)
| $0.00 |
$2,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H6936 -005 -0 | $0.00 | $7.00 | $47.00 | $47.00 | 3,506
2023 Formulary |
|
|
|
|
-- This plan not offered in 2024 --
|
| | | | |
|
2023 Amerivantage Choice (PPO)
| $0.00 |
$6,050 |
$0 | Yes, some additional gap coverage. |
H8343 -009 -0 | $0.00 | $12.00 | $37.00 | $37.00 | 3,583
2023 Formulary |
|
|
|
|
-- This plan not offered in 2024 --
|
| | | | |
|