There are 257 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 AARP Medicare Advantage Patriot (HMO-POS)
| $0.00 |
$4,900 |
No Rx Coverage |
H0543 -121 -0 | This plan does NOT include Prescription Drug coverage. | |
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2024 AARP Medicare Advantage Patriot No Rx CA-MA01 (HMO-POS)
| $0.00 |
$4,900 |
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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H0543 -121 -0 | | | | | |
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2024 AARP Medicare Advantage Patriot No Rx CA-MA01 (HMO-POS)
| $0.00 |
$4,900 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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2023 Aetna Medicare Eagle Plan (HMO)
| $0.00 |
$4,200 |
No Rx Coverage |
H4982 -013 -0 | This plan does NOT include Prescription Drug coverage. | |
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2024 Aetna Medicare Eagle Plan (HMO)
| $0.00 |
$4,200 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2023 --
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H4982 -013 -0 | | | | | |
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2024 Aetna Medicare Eagle Plan (HMO)
| $0.00 |
$4,200 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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2023 Aetna Medicare Eagle Plus Plan (PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
H5521 -369 -0 | This plan does NOT include Prescription Drug coverage. | |
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2024 Aetna Medicare Eagle Plus Plan (PPO)
| $0.00 |
$6,700 |
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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H5521 -369 -0 | | | | | |
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2024 Aetna Medicare Eagle Plus Plan (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 Brand New Day Valor Care Plan (HMO)
| $0.00 |
$3,000 |
No Rx Coverage |
H0838 -048 -0 | This plan does NOT include Prescription Drug coverage. | |
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2024 Brand New Day Valor Care Plan (HMO)
| $0.00 |
$3,850 |
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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H0838 -048 -0 | | | | | |
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2024 Brand New Day Valor Care Plan (HMO)
| $0.00 |
$3,850 |
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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H5619 -121 -0 | | | | | |
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2024 Humana USAA Honor (HMO)
| $0.00 |
$4,999 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
-- This plan not offered in 2023 --
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H5619 -121 -0 | | | | | |
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2024 Humana USAA Honor (HMO)
| $0.00 |
$4,999 |
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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H5525 -078 -0 | | | | | |
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2024 Humana USAA Honor (PPO)
| $0.00 |
$5,900 |
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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H5525 -078 -0 | | | | | |
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2024 Humana USAA Honor (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 Imperial Courage Plan (HMO)
| $0.00 |
$2,999 |
No Rx Coverage |
H5496 -016 -0 | This plan does NOT include Prescription Drug coverage. | |
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2024 Imperial Courage Plan (HMO)
| $0.00 |
$2,999 |
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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H5496 -016 -0 | | | | | |
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2024 Imperial Courage Plan (HMO)
| $0.00 |
$2,999 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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2023 AARP Medicare Advantage Rebate (HMO-POS)
| $0.00 |
$800 |
$0 | Yes, some additional gap coverage. |
H0543 -236 -0 | $0.00 | $14.00 | $47.00 | $47.00 | 3,682
2023 Formulary |
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2024 AARP Medicare Advantage from UHC CA-0019 (HMO-POS)
| $0.00 |
$800 |
$0 | 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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H0543 -236 -0 | | | | | |
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2024 AARP Medicare Advantage from UHC CA-0019 (HMO-POS)
| $0.00 |
$800 |
$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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H0294 -037 -0 | | | | | |
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2024 AARP Medicare Advantage from UHC CA-0029 (PPO)
| $0.00 |
$4,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | 3,634 2024 Formulary |
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-- This plan not offered in 2023 --
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H0294 -037 -0 | | | | | |
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2024 AARP Medicare Advantage from UHC CA-0029 (PPO)
| $0.00 |
$4,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $12.00 | $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 AARP Medicare Advantage Harmony (HMO-POS)
| $0.00 |
$800 |
$0 | Yes, some additional gap coverage. |
H0543 -151 -0 | $0.00 | $0.00 | $35.00 | $35.00 | 3,682
2023 Formulary |
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2024 AARP Medicare Advantage from UHC CA-003P (HMO-POS)
| $0.00 |
$800 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,634 2024 Formulary |
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-- This plan not offered in 2023 --
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H0543 -151 -0 | | | | | |
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2024 AARP Medicare Advantage from UHC CA-003P (HMO-POS)
| $0.00 |
$800 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,634 2024 Formulary |
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2023 AARP Medicare Advantage SecureHorizons Focus (HMO-POS)
| $0.00 |
$800 |
$0 | Yes, some additional gap coverage. |
H0543 -168 -0 | $0.00 | $0.00 | $35.00 | $35.00 | 3,682
2023 Formulary |
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2024 AARP Medicare Advantage from UHC CA-004P (HMO-POS)
| $0.00 |
$800 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 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 |
-- This plan not offered in 2023 --
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H0543 -168 -0 | | | | | |
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2024 AARP Medicare Advantage from UHC CA-004P (HMO-POS)
| $0.00 |
$800 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,634 2024 Formulary |
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-- This plan not offered in 2023 --
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H5521 -419 -0 | | | | | |
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2024 Aetna Medicare Core Plan (PPO)
| $0.00 |
$3,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | 20% | 20% | 3,619 2024 Formulary |
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-- This plan not offered in 2023 --
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H5521 -419 -0 | | | | | |
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2024 Aetna Medicare Core Plan (PPO)
| $0.00 |
$3,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | 20% | 20% | 3,619 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 Plus Plan (HMO)
| $0.00 |
$899 |
$0 | Yes, some additional gap coverage. |
H4982 -001 -0 | $0.00 | $0.00 | $37.00 | $37.00 | 3,622
2023 Formulary |
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2024 Aetna Medicare Plus Plan (HMO)
| $0.00 |
$599 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $37.00 | $37.00 | 3,658 2024 Formulary |
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-- This plan not offered in 2023 --
|
H4982 -001 -0 | | | | | |
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2024 Aetna Medicare Plus Plan (HMO)
| $0.00 |
$599 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $37.00 | $37.00 | 3,658 2024 Formulary |
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-- This plan not offered in 2023 --
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H0523 -022 -0 | | | | | |
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2024 Aetna Medicare Select Plan (HMO)
| $0.00 |
$2,000 |
$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 |
-- This plan not offered in 2023 --
|
H0523 -022 -0 | | | | | |
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2024 Aetna Medicare Select Plan (HMO)
| $0.00 |
$2,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,633 2024 Formulary |
|
2023 Alignment Health AVA (PPO)
| $0.00 |
$3,900 |
$0 | Yes, some additional gap coverage. |
H4961 -007 -0 | $0.00 | $5.00 | $40.00 | $40.00 | 3,467
2023 Formulary |
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2024 Alignment Health AVA (PPO)
| $0.00 |
$3,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $40.00 | $40.00 | 3,517 2024 Formulary |
|
2023 Alignment Health AVA (PPO)
| $0.00 |
$3,900 |
$0 | Yes, some additional gap coverage. |
H4961 -007 -0 | $0.00 | $5.00 | $40.00 | $40.00 | 3,467
2023 Formulary |
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2024 Alignment Health AVA (PPO)
| $0.00 |
$3,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $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 AVA (HMO-POS)
| $0.00 |
$1,999 |
$0 | Yes, some additional gap coverage. |
H3815 -026 -0 | $0.00 | $3.00 | $40.00 | $40.00 | 3,467
2023 Formulary |
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2024 Alignment Health AVA + Instacart (HMO-POS)
| $0.00 |
$1,999 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $40.00 | $40.00 | 3,517 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H3815 -026 -0 | | | | | |
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2024 Alignment Health AVA + Instacart (HMO-POS)
| $0.00 |
$1,999 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $40.00 | $40.00 | 3,517 2024 Formulary |
|
2023 Alignment Health CalPlus + Veterans (HMO)
| $0.00 |
$5,900 |
$505 | No additional gap coverage, only the Donut Hole Discount |
H3815 -036 -0 | $0.00 | $20.00 | 25% | 25% | 3,467
2023 Formulary |
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2024 Alignment Health CalPlus + Veterans (HMO)
| $0.00 |
$5,900 |
$545 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | 25% | 25% | 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 |
-- This plan not offered in 2023 --
|
H3815 -036 -0 | | | | | |
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2024 Alignment Health CalPlus + Veterans (HMO)
| $0.00 |
$5,900 |
$545 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | 25% | 25% | 3,517 2024 Formulary |
|
2023 Alignment Health ESRD Balance (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H3815 -033 -0 | $0.00 | $0.00 | $40.00 | $40.00 | 3,467
2023 Formulary |
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2024 Alignment Health ESRD Balance (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 --
|
H3815 -033 -0 | | | | | |
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2024 Alignment Health ESRD Balance (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 |
|
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. |
H3815 -010 -0 | $0.00 | $5.00 | $30.00 | $30.00 | 3,467
2023 Formulary |
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2024 Alignment Health Heart & Diabetes (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $30.00 | $30.00 | 3,517 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H3815 -010 -0 | | | | | |
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2024 Alignment Health Heart & Diabetes (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $30.00 | $30.00 | 3,517 2024 Formulary |
|
2023 Alignment Health My Choice (HMO)
| $0.00 |
$780 |
$0 | Yes, some additional gap coverage. |
H3815 -001 -0 | $0.00 | $5.00 | $30.00 | $30.00 | 3,467
2023 Formulary |
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2024 Alignment Health My Choice (HMO)
| $0.00 |
$498 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $30.00 | $30.00 | 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 |
-- This plan not offered in 2023 --
|
H3815 -001 -0 | | | | | |
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|
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2024 Alignment Health My Choice (HMO)
| $0.00 |
$498 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $30.00 | $30.00 | 3,517 2024 Formulary |
|
2023 Alignment Health My Choice CalPlus (HMO)
| $0.00 |
$3,000 |
$0 | Yes, some additional gap coverage. |
H3815 -007 -0 | $0.00 | $3.00 | $40.00 | $40.00 | 3,467
2023 Formulary |
|
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|
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2024 Alignment Health My Choice CalPlus (HMO)
| $0.00 |
$3,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $40.00 | $40.00 | 3,517 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H3815 -007 -0 | | | | | |
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|
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2024 Alignment Health My Choice CalPlus (HMO)
| $0.00 |
$3,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $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 Platinum (HMO)
| $0.00 |
$698 |
$0 | Yes, some additional gap coverage. |
H3815 -008 -0 | $0.00 | $1.00 | $30.00 | $30.00 | 3,467
2023 Formulary |
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|
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2024 Alignment Health Platinum + Instacart (HMO)
| $0.00 |
$198 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $30.00 | $30.00 | 3,517 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H3815 -008 -0 | | | | | |
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2024 Alignment Health Platinum + Instacart (HMO)
| $0.00 |
$198 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $30.00 | $30.00 | 3,517 2024 Formulary |
|
2023 Alignment Health smartHMO (HMO)
| $0.00 |
$2,499 |
$0 | Yes, some additional gap coverage. |
H3815 -013 -0 | $0.00 | $0.00 | $30.00 | $30.00 | 3,467
2023 Formulary |
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|
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2024 Alignment Health smartHMO (HMO)
| $0.00 |
$2,499 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $30.00 | $30.00 | 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 |
-- This plan not offered in 2023 --
|
H3815 -013 -0 | | | | | |
|
|
|
|
2024 Alignment Health smartHMO (HMO)
| $0.00 |
$2,499 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $30.00 | $30.00 | 3,517 2024 Formulary |
|
2023 Alignment Health the ONE + Rite Aid (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. |
H3815 -034 -0 | $0.00 | $1.00 | $40.00 | $40.00 | 3,467
2023 Formulary |
|
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|
|
2024 Alignment Health the ONE + Rite Aid (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $1.00 | $40.00 | $40.00 | 3,517 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H3815 -034 -0 | | | | | |
|
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|
|
2024 Alignment Health the ONE + Rite Aid (HMO)
| $0.00 |
$3,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $1.00 | $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 Anthem MediBlue Diabetes Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0544 -004 -0 | $0.00 | $0.00 | $30.00 | $30.00 | 3,157
2023 Formulary |
|
|
|
|
2024 Anthem I Carelon Chronic Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $30.00 | $30.00 | 3,221 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H0544 -004 -0 | | | | | |
|
|
|
|
2024 Anthem I Carelon Chronic Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $30.00 | $30.00 | 3,221 2024 Formulary |
|
2023 Anthem MediBlue Care On Site (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0544 -005 -0 | $0.00 | $0.00 | $35.00 | $35.00 | 3,157
2023 Formulary |
|
|
|
|
2024 Anthem I Carelon Home Care (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $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 |
-- This plan not offered in 2023 --
|
H0544 -005 -0 | | | | | |
|
|
|
|
2024 Anthem I Carelon Home Care (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,221 2024 Formulary |
|
2023 Anthem MediBlue ESRD Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0544 -015 -0 | $0.00 | $0.00 | $30.00 | $30.00 | 3,157
2023 Formulary |
|
|
|
|
2024 Anthem I Carelon Kidney Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $30.00 | $30.00 | 3,221 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H0544 -015 -0 | | | | | |
|
|
|
|
2024 Anthem I Carelon Kidney Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $30.00 | $30.00 | 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 Anthem MediBlue Lung Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0544 -014 -0 | $0.00 | $0.00 | $30.00 | $30.00 | 3,157
2023 Formulary |
|
|
|
|
2024 Anthem I Carelon Lung Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $30.00 | $30.00 | 3,221 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H0544 -014 -0 | | | | | |
|
|
|
|
2024 Anthem I Carelon Lung Care (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $30.00 | $30.00 | 3,221 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H4161 -011 -0 | | | | | |
|
new |
new |
|
2024 Anthem I Carelon Medicare Advantage (HMO)
| $0.00 |
$499 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $30.00 | $30.00 | 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 --
|
H4161 -011 -0 | | | | | |
|
new |
new |
|
2024 Anthem I Carelon Medicare Advantage (HMO)
| $0.00 |
$499 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $30.00 | $30.00 | 3,221 2024 Formulary |
|
2023 Anthem MediBlue Value Plus (HMO)
| $0.00 |
$800 |
$0 | Yes, some additional gap coverage. |
H0544 -002 -0 | $0.00 | $0.00 | $30.00 | $30.00 | 3,157
2023 Formulary |
|
|
|
|
2024 Anthem I Carelon Medicare Advantage 2 (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $30.00 | $30.00 | 3,221 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H0544 -002 -0 | | | | | |
|
|
|
|
2024 Anthem I Carelon Medicare Advantage 2 (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $30.00 | $30.00 | 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 --
|
H4161 -012 -0 | | | | | |
|
new |
new |
|
2024 Anthem I Carelon Premium Savings (HMO)
| $0.00 |
$1,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $30.00 | $30.00 | 3,221 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H4161 -012 -0 | | | | | |
|
new |
new |
|
2024 Anthem I Carelon Premium Savings (HMO)
| $0.00 |
$1,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $30.00 | $30.00 | 3,221 2024 Formulary |
|
2023 Anthem MediBlue StartSmart Plus (HMO)
| $0.00 |
$3,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H0544 -007 -0 | $5.00 | $14.50 | $45.00 | $45.00 | 3,157
2023 Formulary |
|
|
|
|
2024 Anthem I Carelon Premium Savings 2 (HMO)
| $0.00 |
$3,500 |
$0 | Yes, some additional gap coverage. | $5.00 | $14.50 | $45.00 | $45.00 | 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 --
|
H0544 -007 -0 | | | | | |
|
|
|
|
2024 Anthem I Carelon Premium Savings 2 (HMO)
| $0.00 |
$3,500 |
$0 | Yes, some additional gap coverage. | $5.00 | $14.50 | $45.00 | $45.00 | 3,221 2024 Formulary |
|
2023 Anthem MediBlue Plus (HMO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H0544 -061 -0 | $0.00 | $15.00 | $42.00 | $42.00 | 3,583
2023 Formulary |
|
|
|
|
2024 Anthem Medicare Advantage (HMO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $15.00 | $42.00 | $42.00 | 3,557 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H0544 -061 -0 | | | | | |
|
|
|
|
2024 Anthem Medicare Advantage (HMO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $15.00 | $42.00 | $42.00 | 3,557 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 --
|
H4161 -009 -0 | | | | | |
|
new |
new |
|
2024 Anthem Prime (HMO)
| $0.00 |
$499 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $42.00 | $42.00 | 3,557 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H4161 -009 -0 | | | | | |
|
new |
new |
|
2024 Anthem Prime (HMO)
| $0.00 |
$499 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $42.00 | $42.00 | 3,557 2024 Formulary |
|
2023 Anthem MediBlue Select (HMO)
| $0.00 |
$800 |
$0 | Yes, some additional gap coverage. |
H0544 -058 -0 | $0.00 | $0.00 | $42.00 | $42.00 | 3,583
2023 Formulary |
|
|
|
|
2024 Anthem Select (HMO)
| $0.00 |
$800 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $42.00 | $42.00 | 3,557 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 --
|
H0544 -058 -0 | | | | | |
|
|
|
|
2024 Anthem Select (HMO)
| $0.00 |
$800 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $42.00 | $42.00 | 3,557 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H1993 -007 -0 | | | | | |
|
|
|
|
2024 Astiva Health C-SNP Deluxe (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $28.00 | $28.00 | 3,404 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H1993 -007 -0 | | | | | |
|
|
|
|
2024 Astiva Health C-SNP Deluxe (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $28.00 | $28.00 | 3,404 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 --
|
H1993 -010 -0 | | | | | |
|
|
|
|
2024 Astiva Health Premier Plan (HMO)
| $0.00 |
$1,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $35.00 | $35.00 | 3,404 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H1993 -010 -0 | | | | | |
|
|
|
|
2024 Astiva Health Premier Plan (HMO)
| $0.00 |
$1,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $35.00 | $35.00 | 3,404 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H1993 -001 -0 | | | | | |
|
|
|
|
2024 Astiva Health Savings Plan (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $15.00 | $45.00 | $45.00 | 3,404 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 --
|
H1993 -001 -0 | | | | | |
|
|
|
|
2024 Astiva Health Savings Plan (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $15.00 | $45.00 | $45.00 | 3,404 2024 Formulary |
|
2023 Blue Shield 65 Plus (HMO)
| $0.00 |
$1,200 |
$0 | Yes, some additional gap coverage. |
H0504 -015 -0 | $0.00 | $5.00 | $38.00 | $38.00 | 3,677
2023 Formulary |
|
|
|
|
2024 Blue Shield 65 Plus (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $38.00 | $38.00 | 3,671 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H0504 -015 -0 | | | | | |
|
|
|
|
2024 Blue Shield 65 Plus (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $38.00 | $38.00 | 3,671 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 Blue Shield 65 Plus Plan 2 (HMO)
| $0.00 |
$2,000 |
$0 | Yes, some additional gap coverage. |
H0504 -021 -0 | $0.00 | $10.00 | $40.00 | $40.00 | 3,677
2023 Formulary |
|
|
|
|
2024 Blue Shield 65 Plus Plan 2 (HMO)
| $0.00 |
$1,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $40.00 | $40.00 | 3,671 2024 Formulary |
|
2023 Blue Shield 65 Plus Plan 2 (HMO)
| $0.00 |
$2,000 |
$0 | Yes, some additional gap coverage. |
H0504 -021 -0 | $0.00 | $10.00 | $40.00 | $40.00 | 3,677
2023 Formulary |
|
|
|
|
2024 Blue Shield 65 Plus Plan 2 (HMO)
| $0.00 |
$1,400 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $40.00 | $40.00 | 3,671 2024 Formulary |
|
2023 Blue Shield AdvantageOptimum Plan (HMO)
| $0.00 |
$1,200 |
$0 | Yes, some additional gap coverage. |
H5928 -004 -0 | $0.00 | $3.00 | $40.00 | $40.00 | 3,290
2023 Formulary |
|
|
|
|
2024 Blue Shield AdvantageOptimum Plan (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $40.00 | $40.00 | 3,272 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 --
|
H5928 -004 -0 | | | | | |
|
|
|
|
2024 Blue Shield AdvantageOptimum Plan (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $40.00 | $40.00 | 3,272 2024 Formulary |
|
2023 Blue Shield Inspire (HMO)
| $0.00 |
$899 |
$0 | Yes, some additional gap coverage. |
H0504 -043 -0 | $0.00 | $3.00 | $35.00 | $35.00 | 3,455
2023 Formulary |
|
|
|
|
2024 Blue Shield Inspire (HMO)
| $0.00 |
$699 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $35.00 | $35.00 | 3,431 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H0504 -043 -0 | | | | | |
|
|
|
|
2024 Blue Shield Inspire (HMO)
| $0.00 |
$699 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $35.00 | $35.00 | 3,431 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 Brand New Day Classic Care I Plan (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. |
H0838 -050 -1 | $0.00 | $0.00 | $47.00 | $47.00 | 3,467
2023 Formulary |
|
|
|
|
2024 Brand New Day Classic Care I Plan (HMO)
| $0.00 |
$1,199 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,494 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H0838 -050 -1 | | | | | |
|
|
|
|
2024 Brand New Day Classic Care I Plan (HMO)
| $0.00 |
$1,199 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,494 2024 Formulary |
|
2023 Brand New Day Embrace Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H0838 -039 -1 | $0.00 | $9.00 | $47.00 | $47.00 | 3,467
2023 Formulary |
|
|
|
|
2024 Brand New Day Embrace Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $9.00 | $47.00 | $47.00 | 3,494 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 --
|
H0838 -039 -1 | | | | | |
|
|
|
|
2024 Brand New Day Embrace Care Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $9.00 | $47.00 | $47.00 | 3,494 2024 Formulary |
|
2023 Brand New Day Part B Savings Plan (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. |
H0838 -049 -0 | $0.00 | $12.00 | $47.00 | $47.00 | 3,467
2023 Formulary |
|
|
|
|
2024 Brand New Day Part B Savings Plan (HMO)
| $0.00 |
$3,200 |
$0 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | 3,494 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H0838 -049 -0 | | | | | |
|
|
|
|
2024 Brand New Day Part B Savings Plan (HMO)
| $0.00 |
$3,200 |
$0 | Yes, some additional gap coverage. | $0.00 | $12.00 | $47.00 | $47.00 | 3,494 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 Central Health Focus Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5649 -006 -0 | $0.00 | $0.00 | $35.00 | $35.00 | 3,467
2023 Formulary |
|
|
|
|
2024 Central Health Focus Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,494 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H5649 -006 -0 | | | | | |
|
|
|
|
2024 Central Health Focus Plan (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,494 2024 Formulary |
|
2023 Central Health Medicare Plan (HMO)
| $0.00 |
$990 |
$0 | Yes, some additional gap coverage. |
H5649 -001 -0 | $0.00 | $0.00 | $35.00 | $35.00 | 3,467
2023 Formulary |
|
|
|
|
2024 Central Health Medicare Plan (HMO)
| $0.00 |
$1,100 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,494 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 --
|
H5649 -001 -0 | | | | | |
|
|
|
|
2024 Central Health Medicare Plan (HMO)
| $0.00 |
$1,100 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,494 2024 Formulary |
|
2023 Central Health Premier Plan I (HMO)
| $0.00 |
$899 |
$0 | Yes, some additional gap coverage. |
H5649 -020 -1 | $0.00 | $0.00 | $35.00 | $35.00 | 3,467
2023 Formulary |
|
|
|
|
2024 Central Health Premier Plan I (HMO)
| $0.00 |
$3,200 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,494 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H5649 -020 -1 | | | | | |
|
|
|
|
2024 Central Health Premier Plan I (HMO)
| $0.00 |
$3,200 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,494 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 Central Health Savings Plan (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. |
H5649 -019 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,467
2023 Formulary |
|
|
|
|
2024 Central Health Savings Plan (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,494 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H5649 -019 -0 | | | | | |
|
|
|
|
2024 Central Health Savings Plan (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,494 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H6170 -001 -0 | | | | | |
new |
new |
new |
|
2024 Champion Advantage (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $47.00 | $47.00 | 3,332 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 --
|
H6170 -001 -0 | | | | | |
new |
new |
new |
|
2024 Champion Advantage (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $8.00 | $47.00 | $47.00 | 3,332 2024 Formulary |
|
2023 Clever Care Fortune Medicare Advantage (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. |
H7607 -007 -1 | $0.00 | $0.00 | $35.00 | $35.00 | 3,506
2023 Formulary |
|
-- |
|
|
2024 Clever Care Active (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,582 2024 Formulary |
|
2023 Clever Care Longevity Medicare Advantage (HMO)
| $0.00 |
$1,700 |
$0 | Yes, some additional gap coverage. |
H7607 -002 -1 | $0.00 | $0.00 | $35.00 | $35.00 | 3,506
2023 Formulary |
|
-- |
|
|
2024 Clever Care Longevity (HMO)
| $0.00 |
$1,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 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 Clever Care Value Medicare Advantage (HMO)
| $0.00 |
$5,000 |
$0 | Yes, some additional gap coverage. |
H7607 -008 -1 | $0.00 | $10.00 | $47.00 | $47.00 | 3,506
2023 Formulary |
|
-- |
|
|
2024 Clever Care Value (HMO)
| $0.00 |
$2,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,582 2024 Formulary |
|
2023 Humana Gold Plus H5619-021 (HMO)
| $0.00 |
$600 |
$0 | Yes, some additional gap coverage. |
H5619 -021 -0 | $0.00 | $0.00 | $35.00 | $35.00 | 3,404
2023 Formulary |
|
|
|
|
2024 Humana Gold Plus H5619-021 (HMO)
| $0.00 |
$800 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,448 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H5619 -021 -0 | | | | | |
|
|
|
|
2024 Humana Gold Plus H5619-021 (HMO)
| $0.00 |
$800 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 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 Humana Gold Plus H5619-146 (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. |
H5619 -146 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,404
2023 Formulary |
|
|
|
|
2024 Humana Gold Plus H5619-146 (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,448 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H5619 -146 -0 | | | | | |
|
|
|
|
2024 Humana Gold Plus H5619-146 (HMO)
| $0.00 |
$2,500 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,448 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H5525 -057 -0 | | | | | |
|
|
|
|
2024 Humana USAA Honor with Rx (PPO)
| $0.00 |
$6,100 |
$350 | Yes, some additional gap coverage. | $0.00 | $5.00 | $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 --
|
H5525 -057 -0 | | | | | |
|
|
|
|
2024 Humana USAA Honor with Rx (PPO)
| $0.00 |
$6,100 |
$350 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,448 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H5525 -075 -0 | | | | | |
|
|
|
|
2024 HumanaChoice H5525-075 (PPO)
| $0.00 |
$4,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $47.00 | $47.00 | 3,448 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H5525 -075 -0 | | | | | |
|
|
|
|
2024 HumanaChoice H5525-075 (PPO)
| $0.00 |
$4,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $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 Imperial Dynamic Plan (HMO)
| $0.00 |
$899 |
$0 | Yes, some additional gap coverage. |
H5496 -012 -0 | $0.00 | $3.00 | $30.00 | $30.00 | 3,346
2023 Formulary |
|
|
|
|
2024 Imperial Dynamic Plan (HMO)
| $0.00 |
$298 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $30.00 | $30.00 | 3,404 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H5496 -012 -0 | | | | | |
|
|
|
|
2024 Imperial Dynamic Plan (HMO)
| $0.00 |
$298 |
$0 | Yes, some additional gap coverage. | $0.00 | $3.00 | $30.00 | $30.00 | 3,404 2024 Formulary |
|
2023 Imperial Senior Value (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5496 -005 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,387
2023 Formulary |
|
|
|
|
2024 Imperial Senior Value (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,404 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 --
|
H5496 -005 -0 | | | | | |
|
|
|
|
2024 Imperial Senior Value (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,404 2024 Formulary |
|
2023 Imperial Strong (HMO)
| $0.00 |
$8,300 |
$505 | No additional gap coverage, only the Donut Hole Discount |
H5496 -014 -0 | | | | | 3,346
2023 Formulary |
|
|
|
|
2024 Imperial Strong (HMO)
| $0.00 |
$8,850 |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,404 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H5496 -014 -0 | | | | | |
|
|
|
|
2024 Imperial Strong (HMO)
| $0.00 |
$8,850 |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,404 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 Imperial Traditional (HMO)
| $0.00 |
$2,999 |
$0 | Yes, some additional gap coverage. |
H5496 -007 -0 | $0.00 | $5.00 | $45.00 | $45.00 | 3,346
2023 Formulary |
|
|
|
|
2024 Imperial Traditional (HMO)
| $0.00 |
$1,349 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,404 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H5496 -007 -0 | | | | | |
|
|
|
|
2024 Imperial Traditional (HMO)
| $0.00 |
$1,349 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $45.00 | $45.00 | 3,404 2024 Formulary |
|
2023 Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. |
H0524 -003 -0 | $0.00 | $3.00 | $35.00 | $35.00 | 3,388
2023 Formulary |
|
|
|
|
2024 Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $40.00 | $40.00 | 3,403 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 --
|
H0524 -003 -0 | | | | | |
|
|
|
|
2024 Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
| $0.00 |
$999 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $40.00 | $40.00 | 3,403 2024 Formulary |
|
2023 Kaiser Permanente Sr Advantage LA, Orange Value (HMO)
| $0.00 |
$1,999 |
$0 | Yes, some additional gap coverage. |
H0524 -078 -0 | $0.00 | $3.00 | $35.00 | $35.00 | 3,388
2023 Formulary |
|
|
|
|
2024 Kaiser Permanente Sr Advantage LA, Orange Value (HMO)
| $0.00 |
$1,999 |
$0 | Yes, some additional gap coverage. | $0.00 | $7.00 | $40.00 | $40.00 | 3,403 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H0524 -078 -0 | | | | | |
|
|
|
|
2024 Kaiser Permanente Sr Advantage LA, Orange Value (HMO)
| $0.00 |
$1,999 |
$0 | Yes, some additional gap coverage. | $0.00 | $7.00 | $40.00 | $40.00 | 3,403 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 Align Connect (HMO C-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H3274 -003 -0 | $2.00 | $15.00 | $45.00 | $45.00 | 3,833
2023 Formulary |
|
new |
new |
|
2024 Memory Care (HMO C-SNP)
| $0.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $45.00 | $45.00 | 3,702 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H3274 -003 -0 | | | | | |
|
new |
new |
|
2024 Memory Care (HMO C-SNP)
| $0.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $45.00 | $45.00 | 3,702 2024 Formulary |
|
2023 Molina Medicare Choice Care (HMO)
| $0.00 |
$8,300 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5810 -014 -0 | $3.00 | $12.00 | $47.00 | $47.00 | 3,221
2023 Formulary |
|
-- |
|
|
2024 Molina Medicare Choice Care (HMO)
| $0.00 |
$8,300 |
$0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 3,248 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 --
|
H5810 -014 -0 | | | | | |
|
-- |
|
|
2024 Molina Medicare Choice Care (HMO)
| $0.00 |
$8,300 |
$0 | No additional gap coverage, only the Donut Hole Discount | $3.00 | $12.00 | $47.00 | $47.00 | 3,248 2024 Formulary |
|
2023 Molina Medicare Choice Care Select (HMO)
| $0.00 |
$8,300 |
$450 | No additional gap coverage, only the Donut Hole Discount |
H5810 -015 -0 | $15.00 | $20.00 | $47.00 | $47.00 | 3,221
2023 Formulary |
|
-- |
|
|
2024 Molina Medicare Choice Care Select (HMO)
| $0.00 |
$8,300 |
$450 | No additional gap coverage, only the Donut Hole Discount | $15.00 | $20.00 | $47.00 | $47.00 | 3,248 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H5810 -015 -0 | | | | | |
|
-- |
|
|
2024 Molina Medicare Choice Care Select (HMO)
| $0.00 |
$8,300 |
$450 | No additional gap coverage, only the Donut Hole Discount | $15.00 | $20.00 | $47.00 | $47.00 | 3,248 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 PHP (HMO C-SNP)
| $0.00 |
n/a |
$505 | Yes, some additional gap coverage. |
H5852 -001 -0 | 15% | 15% | 25% | 25% | 3,288
2023 Formulary |
|
-- |
|
|
2024 PHP (HMO C-SNP)
| $0.00 |
n/a |
$475 | Yes, some additional gap coverage. | 15% | 15% | 25% | 25% | 3,332 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H5852 -001 -0 | | | | | |
|
-- |
|
|
2024 PHP (HMO C-SNP)
| $0.00 |
n/a |
$475 | Yes, some additional gap coverage. | 15% | 15% | 25% | 25% | 3,332 2024 Formulary |
|
2023 Align Thrive (HMO I-SNP)
| $0.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H3274 -002 -0 | $2.00 | $15.00 | $45.00 | $45.00 | 3,833
2023 Formulary |
|
new |
new |
|
2024 Premier Care (HMO I-SNP)
| $0.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $45.00 | $45.00 | 3,702 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 --
|
H3274 -002 -0 | | | | | |
|
new |
new |
|
2024 Premier Care (HMO I-SNP)
| $0.00 |
n/a |
$400 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | $45.00 | $45.00 | 3,702 2024 Formulary |
|
2023 SCAN Affirm partnered with Included LGBTQ+ Health (HMO)
| $0.00 |
$499 |
$0 | Yes, some additional gap coverage. |
H5425 -092 -0 | $0.00 | $0.00 | $30.00 | $30.00 | 3,458
2023 Formulary |
|
|
|
|
2024 SCAN Affirm partnered with Included LGBTQ+ Health (HMO)
| $0.00 |
$199 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,535 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H5425 -092 -0 | | | | | |
|
|
|
|
2024 SCAN Affirm partnered with Included LGBTQ+ Health (HMO)
| $0.00 |
$199 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 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 Balance (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5425 -034 -0 | $0.00 | $0.00 | $25.00 | $25.00 | 3,458
2023 Formulary |
|
|
|
|
2024 SCAN Balance (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $30.00 | $30.00 | 3,535 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H5425 -034 -0 | | | | | |
|
|
|
|
2024 SCAN Balance (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $30.00 | $30.00 | 3,535 2024 Formulary |
|
2023 SCAN Classic (HMO)
| $0.00 |
$499 |
$0 | Yes, some additional gap coverage. |
H5425 -006 -0 | $0.00 | $0.00 | $25.00 | $25.00 | 3,458
2023 Formulary |
|
|
|
|
2024 SCAN Classic (HMO)
| $0.00 |
$199 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 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 --
|
H5425 -006 -0 | | | | | |
|
|
|
|
2024 SCAN Classic (HMO)
| $0.00 |
$199 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,535 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H5425 -115 -0 | | | | | |
|
|
|
|
2024 SCAN Compass (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,535 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H5425 -115 -0 | | | | | |
|
|
|
|
2024 SCAN Compass (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 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 Embrace (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H5425 -086 -0 | $0.00 | $0.00 | $37.00 | $37.00 | 3,458
2023 Formulary |
|
|
|
|
2024 SCAN Embrace (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $37.00 | $37.00 | 3,535 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H5425 -086 -0 | | | | | |
|
|
|
|
2024 SCAN Embrace (HMO I-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 Healthy at Home (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. |
H9104 -006 -0 | $0.00 | $0.00 | $42.00 | $42.00 | 3,458
2023 Formulary |
|
-- |
-- |
|
2024 SCAN Healthy at Home (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $42.00 | $42.00 | 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 --
|
H9104 -006 -0 | | | | | |
|
-- |
-- |
|
2024 SCAN Healthy at Home (HMO I-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $42.00 | $42.00 | 3,535 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H5425 -028 -0 | | | | | |
|
|
|
|
2024 SCAN Heart First (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,535 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H5425 -028 -0 | | | | | |
|
|
|
|
2024 SCAN Heart First (HMO C-SNP)
| $0.00 |
n/a |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 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 --
|
H5425 -116 -0 | | | | | |
|
|
|
|
2024 SCAN Navigate (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,535 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H5425 -116 -0 | | | | | |
|
|
|
|
2024 SCAN Navigate (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,535 2024 Formulary |
|
2023 SCAN Venture (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. |
H5425 -084 -0 | $0.00 | $0.00 | $30.00 | $30.00 | 3,458
2023 Formulary |
|
|
|
|
2024 SCAN Venture (HMO)
| $0.00 |
$1,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $35.00 | $35.00 | 3,535 2024 Formulary |
|