There are 101 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 |
$5,500 |
No Rx Coverage |
H1944 -030 -0 | This plan does NOT include Prescription Drug coverage. | |
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2024 AARP Medicare Advantage Patriot No Rx PA-MA01 (HMO-POS)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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2023 Aetna Medicare Advantra Eagle (HMO)
| $0.00 |
$4,000 |
No Rx Coverage |
H3959 -057 -0 | This plan does NOT include Prescription Drug coverage. | |
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2024 Aetna Medicare Advantra Eagle (HMO-POS)
| $0.00 |
$4,000 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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2023 Cigna Courage Medicare (HMO)
| $0.00 |
$5,900 |
No Rx Coverage |
H3949 -026 -0 | This plan does NOT include Prescription Drug coverage. | |
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2024 Cigna Courage Medicare (HMO)
| $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 |
-- This plan not offered in 2023 --
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H3954 -162 -0 | | | | | |
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2024 Geisinger Gold Heritage (HMO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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2023 Humana Honor (PPO)
| $0.00 |
$6,700 |
No Rx Coverage |
H5216 -221 -0 | This plan does NOT include Prescription Drug coverage. | |
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2024 Humana USAA Honor (PPO)
| $0.00 |
$6,700 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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2023 Humana Honor (PPO)
| $0.00 |
$3,900 |
No Rx Coverage |
H5216 -116 -0 | This plan does NOT include Prescription Drug coverage. | |
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2024 HumanaChoice H5216-116 (PPO)
| $0.00 |
$3,900 |
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 HumanaChoice R0923-001 (Regional PPO)
| $0.00 |
$4,500 |
No Rx Coverage |
R0923 -001 -0 | This plan does NOT include Prescription Drug coverage. | |
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2024 HumanaChoice R0923-001 (Regional PPO)
| $0.00 |
$4,500 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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2023 Keystone 65 Liberty Medical Only (HMO)
| $0.00 |
$7,550 |
No Rx Coverage |
H3952 -059 -0 | This plan does NOT include Prescription Drug coverage. | |
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2024 Keystone 65 Liberty Medical Only (HMO)
| $0.00 |
$8,300 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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2023 Wellcare Patriot Giveback (HMO)
| $0.00 |
$7,550 |
No Rx Coverage |
H2915 -013 -0 | This plan does NOT include Prescription Drug coverage. | |
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2024 Wellcare Patriot Giveback (HMO)
| $0.00 |
$7,550 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
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Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2023 AARP Medicare Advantage Plan 1 (HMO-POS)
| $0.00 |
$6,900 |
$0 | Yes, some additional gap coverage. |
H1944 -033 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,682
2023 Formulary |
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2024 AARP Medicare Advantage from UHC PA-0005 (HMO-POS)
| $0.00 |
$6,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,634 2024 Formulary |
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-- This plan not offered in 2023 --
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H2406 -071 -0 | | | | | |
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2024 AARP Medicare Advantage from UHC PA-0010 (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,634 2024 Formulary |
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-- This plan not offered in 2023 --
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H2406 -101 -0 | | | | | |
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2024 AARP Medicare Advantage from UHC PA-0012 (PPO)
| $0.00 |
$8,300 |
$295 | Yes, some additional gap coverage. | $0.00 | $14.00 | $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 |
-- This plan not offered in 2023 --
|
H2406 -102 -0 | | | | | |
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2024 AARP Medicare Advantage from UHC PA-0013 (PPO)
| $0.00 |
$6,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,634 2024 Formulary |
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2023 Aetna Medicare Advantra Credit Value (PPO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H5522 -017 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,597
2023 Formulary |
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2024 Aetna Medicare Advantra Credit Value (PPO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,633 2024 Formulary |
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2023 Aetna Medicare Advantra Philly Prime (HMO)
| $0.00 |
$6,900 |
$0 | Yes, some additional gap coverage. |
H3959 -053 -0 | $0.00 | $0.00 | $37.00 | $37.00 | 3,622
2023 Formulary |
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2024 Aetna Medicare Advantra Philly Prime (HMO-POS)
| $0.00 |
$6,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,633 2024 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2023 Aetna Medicare Advantra Value (HMO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H3959 -052 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,597
2023 Formulary |
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2024 Aetna Medicare Advantra Value (HMO-POS)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | 20% | 20% | 3,633 2024 Formulary |
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-- This plan not offered in 2023 --
|
H5522 -028 -0 | | | | | |
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2024 Aetna Medicare Freedom Core (PPO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | 20% | 20% | 3,633 2024 Formulary |
|
2023 Aetna Medicare Philly Suburban Value (HMO-POS)
| $0.00 |
$8,300 |
$150 | Yes, some additional gap coverage. |
H3931 -105 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,597
2023 Formulary |
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2024 Aetna Medicare Philly Suburban Value (HMO-POS)
| $0.00 |
$8,300 |
$250 | 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 |
-- This plan not offered in 2023 --
|
H5522 -025 -0 | | | | | |
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2024 Aetna Medicare SmartSaver Elite (PPO)
| $0.00 |
$4,850 |
$300 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $10.00 | 25% | 25% | 3,619 2024 Formulary |
|
2023 Aetna Medicare Value (PPO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H5521 -263 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,597
2023 Formulary |
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|
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2024 Aetna Medicare Value (PPO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | 20% | 20% | 3,633 2024 Formulary |
|
2023 Cigna Achieve Medicare (HMO C-SNP)
| $0.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3949 -024 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,524
2023 Formulary |
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2024 Cigna Achieve Medicare (HMO C-SNP)
| $0.00 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $4.00 | $45.00 | $45.00 | 3,535 2024 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2023 Cigna Alliance Medicare (HMO)
| $0.00 |
$5,600 |
$0 | Yes, some additional gap coverage. |
H3949 -031 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,524
2023 Formulary |
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2024 Cigna Preferred Medicare (HMO)
| $0.00 |
$5,600 |
$0 | Yes, some additional gap coverage. | $0.00 | $4.00 | $45.00 | $45.00 | 3,535 2024 Formulary |
|
2023 Cigna True Choice Medicare (PPO)
| $0.00 |
$6,600 |
$0 | Yes, some additional gap coverage. |
H7849 -006 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,524
2023 Formulary |
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|
|
2024 Cigna True Choice Medicare (PPO)
| $0.00 |
$6,600 |
$0 | Yes, some additional gap coverage. | $0.00 | $4.00 | $45.00 | $45.00 | 3,535 2024 Formulary |
|
2023 Clover Health Choice (PPO)
| $0.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5141 -038 -0 | $0.00 | $10.00 | $37.00 | $37.00 | 3,361
2023 Formulary |
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|
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2024 Clover Health Choice (PPO)
| $0.00 |
$7,499 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $8.00 | $47.00 | $47.00 | 3,392 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 --
|
H6018 -003 -0 | | | | | |
|
new |
new |
|
2024 Devoted CHOICE GIVEBACK Pennsylvania (PPO)
| $0.00 |
$8,300 |
$545 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,391 2024 Formulary |
|
2023 Devoted CHOICE Pennsylvania (PPO)
| $0.00 |
$7,200 |
$0 | Yes, some additional gap coverage. |
H6018 -001 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,364
2023 Formulary |
|
new |
new |
|
2024 Devoted CHOICE Pennsylvania (PPO)
| $0.00 |
$7,200 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,391 2024 Formulary |
|
2023 Devoted CORE Pennsylvania (HMO)
| $0.00 |
$6,900 |
$0 | Yes, some additional gap coverage. |
H6852 -001 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,364
2023 Formulary |
|
new |
new |
|
2024 Devoted CORE Pennsylvania (HMO)
| $0.00 |
$6,900 |
$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 |
2023 Devoted GIVEBACK Pennsylvania (HMO)
| $0.00 |
$7,900 |
$250 | Yes, some additional gap coverage. |
H6852 -002 -0 | $0.00 | $7.00 | $47.00 | $47.00 | 3,364
2023 Formulary |
|
new |
new |
|
2024 Devoted GIVEBACK Pennsylvania (HMO)
| $0.00 |
$7,900 |
$250 | Yes, some additional gap coverage. | $0.00 | $7.00 | $47.00 | $47.00 | 3,391 2024 Formulary |
|
2023 Humana Gold Plus H6622-037 (HMO)
| $0.00 |
$6,900 |
$0 | Yes, some additional gap coverage. |
H6622 -037 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,404
2023 Formulary |
|
|
|
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2024 Humana Gold Plus H6622-037 (HMO)
| $0.00 |
$7,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,448 2024 Formulary |
|
2023 Humana USAA Honor with Rx (PPO)
| $0.00 |
$7,550 |
$250 | Yes, some additional gap coverage. |
H5525 -059 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,404
2023 Formulary |
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|
|
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2024 Humana USAA Honor with Rx (PPO)
| $0.00 |
$7,850 |
$250 | 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 |
2023 HumanaChoice H5525-051 (PPO)
| $0.00 |
$7,200 |
$0 | Yes, some additional gap coverage. |
H5525 -051 -2 | $0.00 | $5.00 | $47.00 | $47.00 | 3,404
2023 Formulary |
|
|
|
|
2024 HumanaChoice H5525-051 (PPO)
| $0.00 |
$7,800 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,448 2024 Formulary |
|
2023 HumanaChoice H5525-058 (PPO)
| $0.00 |
$7,550 |
$505 | Yes, some additional gap coverage. |
H5525 -058 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,404
2023 Formulary |
|
|
|
|
2024 HumanaChoice H5525-058 (PPO)
| $0.00 |
$7,000 |
$505 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,448 2024 Formulary |
|
2023 HumanaChoice H5525-060 (PPO)
| $0.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H5525 -060 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,404
2023 Formulary |
|
|
|
|
2024 HumanaChoice H5525-060 (PPO)
| $0.00 |
$8,050 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,448 2024 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2023 Health Partners Medicare Complete (HMO-POS)
| $0.00 |
$7,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H9207 -012 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,601
2023 Formulary |
|
-- |
|
|
2024 Jefferson Health Plans Complete (HMO-POS)
| $0.00 |
$4,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,650 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H1619 -001 -0 | | | | | |
new |
new |
new |
|
2024 Jefferson Health Plans Flex (PPO)
| $0.00 |
$7,000 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,650 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H9207 -015 -0 | | | | | |
|
-- |
|
|
2024 Jefferson Health Plans Giveback (HMO-POS)
| $0.00 |
$7,500 |
$200 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,650 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 Keystone 65 Basic Rx (HMO)
| $0.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3952 -055 -0 | $0.00 | $8.00 | $47.00 | $47.00 | 4,419
2023 Formulary |
|
|
|
|
2024 Keystone 65 Basic Rx (HMO)
| $0.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $8.00 | $47.00 | $47.00 | 4,496 2024 Formulary |
|
2023 Keystone 65 Focus Rx (HMO-POS)
| $0.00 |
$6,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3952 -053 -0 | $0.00 | $8.00 | $47.00 | $47.00 | 4,419
2023 Formulary |
|
|
|
|
2024 Keystone 65 Focus Rx (HMO-POS)
| $0.00 |
$6,500 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $8.00 | $47.00 | $47.00 | 4,496 2024 Formulary |
|
2023 Personal Choice 65 Prime Rx (PPO)
| $0.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3909 -014 -0 | $0.00 | $8.00 | $47.00 | $47.00 | 4,419
2023 Formulary |
|
|
|
|
2024 Personal Choice 65 Prime Rx (PPO)
| $0.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $8.00 | $47.00 | $47.00 | 4,496 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 Personal Choice 65 Saver Rx (PPO)
| $0.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3909 -016 -0 | $0.00 | $8.00 | $47.00 | $47.00 | 4,419
2023 Formulary |
|
|
|
|
2024 Personal Choice 65 Saver Rx (PPO)
| $0.00 |
$8,300 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $8.00 | $47.00 | $47.00 | 4,496 2024 Formulary |
|
2023 Provider Partners Pennsylvania Community Plan (HMO I-SNP)
| $41.10 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H4093 -004 -0 | | | | | 3,445
2023 Formulary |
|
-- |
|
|
2024 Provider Partners Pennsylvania Community Plan (HMO I-SNP)
| $0.00 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,460 2024 Formulary |
|
2023 Wellcare Giveback Open (PPO)
| $0.00 |
$7,550 |
$350 | Yes, some additional gap coverage. |
H2128 -004 -0 | $0.00 | $5.00 | $37.00 | $37.00 | 3,392
2023 Formulary |
|
|
|
|
2024 Wellcare Giveback Open (PPO)
| $0.00 |
$7,550 |
$545 | Yes, some additional gap coverage. | $0.00 | $5.00 | $42.00 | $42.00 | 3,371 2024 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2023 Wellcare No Premium (HMO)
| $0.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2915 -016 -0 | $0.00 | $5.00 | $37.00 | $37.00 | 3,392
2023 Formulary |
|
|
|
|
2024 Wellcare No Premium (HMO)
| $0.00 |
$7,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $5.00 | $42.00 | $42.00 | 3,371 2024 Formulary |
|
2023 Wellcare No Premium Open (PPO)
| $0.00 |
$6,700 |
$160 | No additional gap coverage, only the Donut Hole Discount |
H2128 -002 -0 | $0.00 | $7.00 | $37.00 | $37.00 | 3,392
2023 Formulary |
|
|
|
|
2024 Wellcare No Premium Open (PPO)
| $0.00 |
$6,700 |
$160 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $7.00 | $42.00 | $42.00 | 3,371 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H6018 -002 -0 | | | | | |
|
new |
new |
|
2024 Devoted CHOICE PLUS Pennsylvania (PPO)
| $20.90 |
$5,100 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $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 |
2023 Wellcare Assist (HMO)
| $13.50 |
$6,700 |
$445 | No additional gap coverage, only the Donut Hole Discount |
H2915 -011 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,392
2023 Formulary |
|
|
|
|
2024 Wellcare Assist (HMO)
| $21.30 |
$7,550 |
$435 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $20.00 | $47.00 | $47.00 | 3,371 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H3954 -163 -0 | | | | | |
|
|
|
|
2024 Geisinger Gold Value Rx (HMO)
| $23.00 |
$8,850 |
$0 | Yes, some additional gap coverage. | $0.00 | $5.00 | $47.00 | $47.00 | 3,872 2024 Formulary |
|
2023 Personal Choice 65 Elite Rx (PPO)
| $49.00 |
$6,500 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3909 -017 -0 | $0.00 | $8.00 | $47.00 | $47.00 | 4,419
2023 Formulary |
|
|
|
|
2024 Personal Choice 65 Elite Rx (PPO)
| $25.60 |
$7,250 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $8.00 | $47.00 | $47.00 | 4,496 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 H5525-017 (PPO)
| $18.00 |
$4,900 |
$0 | Yes, some additional gap coverage. |
H5525 -017 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,404
2023 Formulary |
|
|
|
|
2024 HumanaChoice H5525-017 (PPO)
| $26.00 |
$6,300 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,448 2024 Formulary |
|
2023 Aetna Medicare Advantra Premier (HMO)
| $27.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H3959 -033 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,597
2023 Formulary |
|
|
|
|
2024 Aetna Medicare Value Plus (HMO-POS)
| $27.00 |
$7,550 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | 20% | 20% | 3,633 2024 Formulary |
|
2023 Keystone 65 Select Medical Only (HMO)
| $34.50 |
$4,900 |
No Rx Coverage |
H3952 -048 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2024 Keystone 65 Select Medical Only (HMO)
| $27.50 |
$5,650 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2023 Wellcare Dual Access Open (PPO D-SNP)
| $24.20 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H2128 -005 -0 | | | | | 3,394
2023 Formulary |
|
|
|
|
2024 Wellcare Dual Access Open (PPO D-SNP)
| $29.20 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,353 2024 Formulary |
|
2023 UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)
| $38.10 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H3113 -014 -0 | | | | | 3,682
2023 Formulary |
|
|
|
|
2024 UHC Dual Complete PA-V001 (HMO-POS D-SNP)
| $29.50 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,634 2024 Formulary |
|
2023 Cigna Preferred Medicare (HMO)
| $31.00 |
$5,900 |
$0 | Yes, some additional gap coverage. |
H3949 -030 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,524
2023 Formulary |
|
|
|
|
2024 Cigna Preferred Plus Medicare (HMO)
| $31.00 |
$6,300 |
$0 | Yes, some additional gap coverage. | $0.00 | $4.00 | $45.00 | $45.00 | 3,535 2024 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2023 UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)
| $41.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H0710 -017 -0 | | | | | 3,682
2023 Formulary |
|
-- |
|
|
2024 UHC Nursing Home Plan EX-F002 (PPO I-SNP)
| $32.20 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,634 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H0710 -067 -0 | | | | | |
|
-- |
|
|
2024 UHC Care Advantage PA-E001 (PPO I-SNP)
| $35.60 |
n/a |
$0 | No additional gap coverage, only the Donut Hole Discount | $2.00 | $12.00 | $47.00 | $47.00 | 3,634 2024 Formulary |
|
2023 AARP Medicare Advantage Plan 2 (HMO-POS)
| $27.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H1944 -009 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,682
2023 Formulary |
|
|
|
|
2024 AARP Medicare Advantage from UHC PA-0001 (HMO-POS)
| $37.00 |
$5,900 |
$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 Silver (HMO)
| $47.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H3931 -070 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,597
2023 Formulary |
|
|
|
|
2024 Aetna Medicare Silver (HMO-POS)
| $37.00 |
$7,550 |
$250 | Yes, some additional gap coverage. | $0.00 | $10.00 | 20% | 20% | 3,619 2024 Formulary |
|
2023 Cigna TotalCare Plus (HMO D-SNP)
| $24.70 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H3949 -009 -0 | | | | | 3,524
2023 Formulary |
|
|
|
|
2024 Cigna TotalCare Plus (HMO D-SNP)
| $38.40 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,535 2024 Formulary |
|
2023 Highmark Wholecare Medicare Assured Ruby (HMO D-SNP)
| $41.10 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H5932 -013 -0 | $4.00 | $13.00 | $45.00 | $45.00 | 3,391
2023 Formulary |
|
|
|
|
2024 Highmark Wholecare Medicare Assured Ruby (HMO D-SNP)
| $38.80 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $20.00 | $47.00 | $47.00 | 3,426 2024 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2023 Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP)
| $34.20 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H6622 -078 -2 | | | | | 3,404
2023 Formulary |
|
|
|
|
2024 Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP)
| $38.90 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,448 2024 Formulary |
|
2023 Aetna Medicare Longevity Plan (HMO I-SNP)
| $41.00 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H3959 -066 -0 | | | | | 3,597
2023 Formulary |
|
|
|
|
2024 Aetna Medicare Longevity Plan (HMO I-SNP)
| $39.00 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,633 2024 Formulary |
|
2023 UPMC for Life Complete Care (HMO D-SNP)
| $41.10 |
n/a |
$505 | Yes, some additional gap coverage. |
H7123 -001 -0 | $8.00 | $15.00 | $25.00 | $25.00 | 3,731
2023 Formulary |
|
|
|
|
2024 UPMC for Life Complete Care (HMO D-SNP)
| $39.20 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | $10.00 | $15.00 | $40.00 | $40.00 | 3,819 2024 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP)
| $33.90 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H3113 -009 -0 | | | | | 3,682
2023 Formulary |
|
|
|
|
2024 UHC Dual Complete PA-S002 (HMO-POS D-SNP)
| $39.90 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,634 2024 Formulary |
|
2023 Aetna Medicare Advantra Cares (HMO D-SNP)
| $32.70 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H3959 -035 -0 | | | | | 3,597
2023 Formulary |
|
|
|
|
2024 Aetna Medicare Advantra Cares (HMO D-SNP)
| $40.20 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,633 2024 Formulary |
|
2023 Geisinger Gold Secure Rx (HMO D-SNP)
| $41.10 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H3954 -097 -0 | | | | | 3,924
2023 Formulary |
|
|
|
|
2024 Geisinger Gold Secure Rx (HMO D-SNP)
| $40.20 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,872 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 Highmark Wholecare Medicare Assured Diamond (HMO D-SNP)
| $41.10 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H5932 -012 -0 | $4.00 | $12.00 | $38.00 | $38.00 | 3,391
2023 Formulary |
|
|
|
|
2024 Highmark Wholecare Medicare Assured Diamond (HMO D-SNP)
| $40.20 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | $4.00 | $13.00 | $42.00 | $42.00 | 3,426 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H5216 -373 -0 | | | | | |
|
|
|
|
2024 HumanaChoice SNP-DE H5216-373 (PPO D-SNP)
| $40.20 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,448 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H9207 -016 -0 | | | | | |
|
-- |
|
|
2024 Jefferson Health Plans Dual Pearl (HMO D-SNP)
| $40.20 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,640 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 Health Partners Medicare Prime (HMO-POS)
| $41.10 |
$7,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H9207 -002 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,601
2023 Formulary |
|
-- |
|
|
2024 Jefferson Health Plans Prime (HMO-POS)
| $40.20 |
$7,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,650 2024 Formulary |
|
2023 Health Partners Medicare Special (HMO D-SNP)
| $41.10 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H9207 -004 -0 | | | | | 3,588
2023 Formulary |
|
-- |
|
|
2024 Jefferson Health Plans Special (HMO D-SNP)
| $40.20 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,640 2024 Formulary |
|
2023 Keystone First VIP Choice (HMO D-SNP)
| $41.10 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H4227 -001 -0 | $7.75 | 25% | | | 3,501
2023 Formulary |
|
|
|
|
2024 Keystone First VIP Choice (HMO D-SNP)
| $40.20 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,538 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 Provider Partners Pennsylvania Advantage Plan (HMO I-SNP)
| $41.10 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H4093 -001 -0 | | | | | 3,445
2023 Formulary |
|
-- |
|
|
2024 Provider Partners Pennsylvania Advantage Plan (HMO I-SNP)
| $40.20 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,460 2024 Formulary |
|
2023 UnitedHealthcare Dual Complete Choice (PPO D-SNP)
| $41.10 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H1889 -007 -0 | | | | | 3,682
2023 Formulary |
|
|
|
|
2024 UHC Dual Complete PA-S001 (PPO D-SNP)
| $40.20 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,634 2024 Formulary |
|
2023 Wellcare Dual Access (HMO D-SNP)
| $31.10 |
n/a |
$505 | No additional gap coverage, only the Donut Hole Discount |
H2915 -002 -0 | | | | | 3,394
2023 Formulary |
|
|
|
|
2024 Wellcare Dual Access (HMO D-SNP)
| $40.20 |
n/a |
$545 | No additional gap coverage, only the Donut Hole Discount | | | | | 3,353 2024 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2023 HumanaChoice R0923-002 (Regional PPO)
| $71.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
R0923 -002 -0 | $6.00 | $20.00 | $47.00 | $47.00 | 3,404
2023 Formulary |
|
|
|
|
2024 HumanaChoice R0923-002 (Regional PPO)
| $46.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount | $6.00 | $20.00 | $47.00 | $47.00 | 3,448 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H2406 -048 -0 | | | | | |
|
|
|
|
2024 AARP Medicare Advantage from UHC PA-0009 (PPO)
| $49.00 |
$6,300 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,634 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H1619 -002 -0 | | | | | |
new |
new |
new |
|
2024 Jefferson Health Plans Flex Plus (PPO)
| $49.00 |
$5,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $10.00 | $47.00 | $47.00 | 3,650 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 Keystone 65 Select Rx (HMO)
| $55.50 |
$4,900 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3952 -049 -0 | $0.00 | $7.00 | $47.00 | $47.00 | 4,419
2023 Formulary |
|
|
|
|
2024 Keystone 65 Select Rx (HMO)
| $50.50 |
$5,650 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $7.00 | $47.00 | $47.00 | 4,496 2024 Formulary |
|
2023 HumanaChoice H5525-005 (PPO)
| $58.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5525 -005 -0 | $5.00 | $15.00 | $47.00 | $47.00 | 3,404
2023 Formulary |
|
|
|
|
2024 HumanaChoice H5525-005 (PPO)
| $53.00 |
$8,300 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $47.00 | $47.00 | 3,448 2024 Formulary |
|
2023 Aetna Medicare Premier (HMO-POS)
| $67.00 |
$6,900 |
$0 | Yes, some additional gap coverage. |
H3931 -064 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,597
2023 Formulary |
|
|
|
|
2024 Aetna Medicare Premier (HMO-POS)
| $57.00 |
$6,900 |
$250 | 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 Advantra Premier Plus (PPO)
| $48.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H5522 -014 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,622
2023 Formulary |
|
|
|
|
2024 Aetna Medicare Advantra Premier Plus (PPO)
| $59.00 |
$5,900 |
$0 | Yes, some additional gap coverage. | $0.00 | $0.00 | $47.00 | $47.00 | 3,658 2024 Formulary |
|
-- This plan not offered in 2023 --
|
H8145 -163 -0 | | | | | |
|
|
|
|
2024 Humana Gold Choice H8145-163 (PFFS)
| $75.00 |
n/a |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2023 Aetna Medicare Premier Plus (HMO-POS)
| $97.00 |
$6,900 |
$0 | Yes, some additional gap coverage. |
H3931 -004 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,622
2023 Formulary |
|
|
|
|
2024 Aetna Medicare Premier Plus (HMO-POS)
| $87.00 |
$6,900 |
$250 | 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 HumanaChoice H5216-120 (PPO)
| $123.00 |
$6,700 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H5216 -120 -0 | $5.00 | $15.00 | $47.00 | $47.00 | 3,404
2023 Formulary |
|
|
|
|
2024 HumanaChoice H5216-120 (PPO)
| $123.00 |
$7,600 |
$0 | No additional gap coverage, only the Donut Hole Discount | $5.00 | $15.00 | $47.00 | $47.00 | 3,448 2024 Formulary |
|
2023 Personal Choice 65 Medical Only (PPO)
| $163.00 |
$5,000 |
No Rx Coverage |
H3909 -007 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2024 Personal Choice 65 Medical Only (PPO)
| $138.00 |
$5,000 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2023 Aetna Medicare Gold Plan (PPO)
| $176.00 |
$7,550 |
$0 | Yes, some additional gap coverage. |
H5521 -122 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,597
2023 Formulary |
|
|
|
|
2024 Aetna Medicare Gold Plan (PPO)
| $145.00 |
$7,550 |
$250 | 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 Keystone 65 Preferred Medical Only (HMO)
| $176.00 |
$3,800 |
No Rx Coverage |
H3952 -008 -0 | This plan does NOT include Prescription Drug coverage. | |
|
|
|
|
2024 Keystone 65 Preferred Medical Only (HMO)
| $175.00 |
$3,800 |
No Rx Coverage | This plan does NOT include Prescription Drug coverage. | |
|
2023 Keystone 65 Preferred Rx (HMO)
| $214.00 |
$3,800 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3952 -020 -0 | $0.00 | $7.00 | $47.00 | $47.00 | 4,419
2023 Formulary |
|
|
|
|
2024 Keystone 65 Preferred Rx (HMO)
| $179.00 |
$3,800 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $7.00 | $47.00 | $47.00 | 4,496 2024 Formulary |
|
2023 Personal Choice 65 Rx (PPO)
| $277.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H3909 -001 -0 | $0.00 | $7.00 | $47.00 | $47.00 | 4,419
2023 Formulary |
|
|
|
|
2024 Personal Choice 65 Rx (PPO)
| $247.00 |
$5,000 |
$0 | No additional gap coverage, only the Donut Hole Discount | $0.00 | $7.00 | $47.00 | $47.00 | 4,496 2024 Formulary |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2023 AARP Medicare Advantage Choice Plan 1 (PPO)
| $43.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H2228 -037 -0 | $0.00 | $0.00 | $47.00 | $47.00 | 3,682
2023 Formulary |
|
|
|
|
-- Members will be assigned to AARP Medicare Advantage from UHC PA-0009 (PPO) H2406-048 --
| | | | | |
|
2023 AARP Medicare Advantage Choice Plan 2 (PPO)
| $0.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H2228 -085 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,682
2023 Formulary |
|
|
|
|
-- Members will be assigned to AARP Medicare Advantage from UHC PA-0010 (PPO) H2406-071 --
| | | | | |
|
2023 AARP Medicare Advantage Choice Rebate (PPO)
| $0.00 |
$7,550 |
$295 | Yes, some additional gap coverage. |
H2228 -130 -0 | $0.00 | $14.00 | $47.00 | $47.00 | 3,682
2023 Formulary |
|
|
|
|
-- Members will be assigned to AARP Medicare Advantage from UHC PA-0012 (PPO) H2406-101 --
| | | | | |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2023 AARP Medicare Advantage Choice Plan 3 (PPO)
| $0.00 |
$6,900 |
$0 | Yes, some additional gap coverage. |
H2228 -131 -0 | $0.00 | $10.00 | $47.00 | $47.00 | 3,682
2023 Formulary |
|
|
|
|
-- Members will be assigned to AARP Medicare Advantage from UHC PA-0013 (PPO) H2406-102 --
| | | | | |
|
2023 Aetna Medicare Value Plus (PPO)
| $45.00 |
$6,700 |
$0 | Yes, some additional gap coverage. |
H5522 -021 -0 | $0.00 | $5.00 | $47.00 | $47.00 | 3,597
2023 Formulary |
|
|
|
|
-- Members will be assigned to Aetna Medicare Advantra Premier Plus (PPO) H5522-014 --
| | | | | |
|
2023 Cigna Preferred Plus Medicare (HMO)
| $118.00 |
$4,900 |
$0 | Yes, some additional gap coverage. |
H3949 -013 -0 | $0.00 | $5.00 | $42.00 | $42.00 | 3,524
2023 Formulary |
|
|
|
|
-- Members will be assigned to Cigna Preferred Plus Medicare (HMO) H3949-030 --
| | | | | |
|
Plan Name |
Monthly Premium |
Parts A&B MOOP |
Part D Deduct- ible |
Additional Gap Coverage |
Plan ID |
Cost-Sharing |
Total Drugs |
Cust. Serv. |
Plan Exper. |
Cost Info. |
Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
2023 Wellcare Giveback (HMO)
| $0.00 |
$7,550 |
$0 | No additional gap coverage, only the Donut Hole Discount |
H2915 -012 -0 | $0.00 | $5.00 | $37.00 | $37.00 | 3,392
2023 Formulary |
|
|
|
|
-- Members will be assigned to Wellcare No Premium (HMO) H2915-016 --
| | | | | |
|
2023 Wellcare Assist Open (PPO)
| $14.20 |
$6,700 |
$395 | No additional gap coverage, only the Donut Hole Discount |
H2128 -001 -0 | $0.00 | $20.00 | $47.00 | $47.00 | 3,392
2023 Formulary |
|
|
|
|
-- Members will be assigned to Wellcare No Premium Open (PPO) H2128-002 --
| | | | | |
|
2023 Wellcare Low Premium Open (PPO)
| $29.00 |
$5,000 |
$100 | No additional gap coverage, only the Donut Hole Discount |
H2128 -003 -0 | $0.00 | $7.00 | $37.00 | $37.00 | 3,392
2023 Formulary |
|
|
|
|
-- Members will be assigned to Wellcare No Premium Open (PPO) H2128-002 --
| | | | | |
|
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 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 --
|
| | | | |
|
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 --
|
| | | | |
|