Ada, Oklahoma Medicare Companies and Plans (2022)

Ada, Oklahoma Medicare plans include Advantage plans from private health insurance companies as well as standalone Part D prescription drug coverage. For those that prefer original Medicare, Ada, OK supplemental plans are also available. Medicare plans in Ada, Oklahoma are sold by both large national companies and local insurers.

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The Highlights

  • You can buy Medicare supplement coverage in Ada, Oklahoma if you have original Medicare and want coverage for out-of-pocket costs
  • Ada, OK Medicare options include Advantage, standalone Part D, and Medicare supplement
  • Options for Medicare supplement in Ada, Oklahoma include Medigap Plan M and Medigap Plan N

If you’re eligible for Medicare in Ada, Oklahoma, you have a lot of choices. Major health insurance companies provide Ada, Oklahoma Medicare Advantage plans with a variety of coverage options to choose from. You can choose a plan that includes Ada, OK Part D coverage or buy prescription coverage as a standalone policy.

Ada, Oklahoma Medicare supplement plans are available from a number of companies if you choose to stick with original Medicare. These plans can pay for the out-of-pocket costs that Ada original Medicare plans don’t cover, like coinsurance and deductibles.

Ready to buy Ada, Oklahoma Medicare coverage? Enter your ZIP code to compare Ada, OK Medicare options available to you right now.

Medicare Advantage Companies in Ada, Oklahoma

Medicare Advantage in Ada, Oklahoma is offered by some of the same local health insurance companies you may have been covered by before. Take a look at which companies in Ada, OK offer Medicare Advantage as well as which plans they offer to find the coverage and provider network that’s best for you.

Medicare Advantage Companies in Ada, Oklahoma

Plan Name Monthly Prem. (Parts C & D) Deductible Additional Gap Coverage Preferred Pharmacy Copay/ Coinsurance 30-Day Supply MOOP for Part A & B Benefits
Aetna Medicare Freedom Core Plan (PPO) – H3288-020-0 $0.00 $300 . Tier 1 and 2 exempt Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 27% $7,550
American Health Advantage of Oklahoma (HMO I-SNP) – H3708-001-0 $29.10 $445 No additional gap coverage, only the Donut Hole Discount Tier 1: 25% n/a
Generations Classic (HMO) – H3706-001-0 $0.00 $0 Yes, some additional gap coverage. Preferred Generic: $5.00, Generic: $15.00, Preferred Brand: $42.00, Non-Preferred Drug: 40%, Specialty Tier: 33% $3,900
Generations Classic Choice (HMO-POS) – H3706-021-0 $10.00 $0 Yes, some additional gap coverage. Preferred Generic: $5.00, Generic: $15.00, Preferred Brand: $42.00, Non-Preferred Drug: 40%, Specialty Tier: 33% $3,900
Generations Select (HMO) – H3706-018-0 $29.00 $0 Yes, some additional gap coverage. Preferred Generic: $3.00, Generic: $13.00, Preferred Brand: $40.00, Non-Preferred Drug: 40%, Specialty Tier: 33% $3,900
Generations Value (HMO) – H3706-009-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $3,000
Humana Honor (PPO) – H5216-140-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $4,500
Humana Value Plus H9070-002 (PPO) – H9070-002-0 $21.90 $350 . Tier 1 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $2.00, Generic: $9.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 26% $7,550
HumanaChoice H5216-081 (PPO) – H5216-081-0 $60.00 $195 . Tier 1, 2 and 3 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $7.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $99.00, Specialty Tier: 29% $6,700
HumanaChoice H5216-083 (PPO) – H5216-083-0 $76.00 $195 . Tier 1, 2 and 3 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $8.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: $99.00, Specialty Tier: 29% $6,700
HumanaChoice H5216-139 (PPO) – H5216-139-0 $0.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $99.00, Specialty Tier: 33% $6,700
HumanaChoice H5216-230 (PPO) – H5216-230-0 $29.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $7.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $99.00, Specialty Tier: 33% $4,900
HumanaChoice H9070-006 (PPO) – H9070-006-1 $0.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $7.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $99.00, Specialty Tier: 33% $5,900
HumanaChoice R4845-001 (Regional PPO) – R4845-001-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $3,400
HumanaChoice R4845-002 (Regional PPO) – R4845-002-0 $41.00 $395 . Tier 1 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $4.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 25% $6,700
Lasso Healthcare Growth (MSA) – H1924-001-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. n/a
Lasso Healthcare Growth Plus (MSA) – H1924-004-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. n/a

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Medicare Supplement Companies in Ada, Oklahoma

Original Medicare leaves you with some out-of-pocket costs such as deductibles and coinsurance. With a Ada, Oklahoma Medicare supplement plan, you can get coverage for some or all of those costs. Medicare supplement plans in Oklahoma are standardized, but companies can choose which plans they will sell. Take a look at which companies sell Medicare supplement (Medigap) insurance and which plans they offer.

Medicare Supplement Companies in Ada, Oklahoma

Company Plans
AARP – UnitedHealthcare Insurance Company (Level 1) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
AARP – UnitedHealthcare Insurance Company (Level 1/Household) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
AARP – UnitedHealthcare Insurance Company (Level 2) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
AARP – UnitedHealthcare Insurance Company (Level 2/Household) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
AARP – UnitedHealthcare Insurance Company (Standard) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
AARP – UnitedHealthcare Insurance Company (Standard/Household) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
Accendo Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Aetna Health Insurance Company Medigap Plan A,
Medigap Plan B,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
American Benefit Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
American Financial Security Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Atlantic Coast Life Insurance Company Medigap Plan A,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Bankers Fidelity Assurance Company (Preferred) Medigap Plan A,
Medigap Plan F,
Medigap Plan G
Bankers Fidelity Assurance Company (Standard) Medigap Plan A,
Medigap Plan F,
Medigap Plan G
Bankers Fidelity Life Insurance Company (Preferred) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan K,
Medigap Plan N
Bankers Fidelity Life Insurance Company (Standard) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan K,
Medigap Plan N
BlueCross BlueShield of Oklahoma Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Capitol Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Catholic Life Insurance Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Central States Health and Life Co. of Omaha Medigap Plan A,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Cigna Health & Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
Colonial Penn Life Insurance Company Medigap Plan A,
Medigap Plan B,
Medigap Plan D,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan M,
Medigap Plan N
Colonial Penn Life Insurance Company (Substandard) Medigap Plan A,
Medigap Plan B,
Medigap Plan D,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan M,
Medigap Plan N
Combined Insurance Company of America Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Elips Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Everence Association Inc. Medigap Plan A,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan L,
Medigap Plan N
Federal Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Garden State Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan M,
Medigap Plan N
Globe Life and Accident Insurance Company (Direct to Consumer) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Great Southern Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
Great Southern Life Insurance Company (Class 1) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
Guarantee Trust Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Humana Healthy Living (Humana Insurance Company) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan K,
Medigap Plan N
Humana Healthy Living (Humana Insurance Company) (Household) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan K,
Medigap Plan N
Independence American Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Manhattan Life Assurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Manhattan Life Insurance Company Medigap Plan A,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Medico Insurance Company Medigap Plan A,
Medigap Plan D,
Medigap Plan F
Members Health Insurance Company Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan G,
Medigap Plan M,
Medigap Plan N
Mutual of Omaha Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Nassau Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
National Guardian Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
National Health Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
National Health Insurance Company (Household) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
New Era Life Insurance Company Medigap Plan A,
Medigap Plan C,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan M,
Medigap Plan N
Old Surety Life Insurance Company Medigap Plan A,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G
Oxford Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Pan-American Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Physicians Life Insurance Company (Issue Age) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible
Prosperity Life Group (Preferred) Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Prosperity Life Group (Standard) Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Puritan Life Insurance Company of America Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Sentinel Security Life Insurance Company Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Shenandoah Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Southern Guaranty Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
State Farm Mutual Automobile Insurance Company Medigap Plan A,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
State Mutual Insurance Company (Bronze) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan M,
Medigap Plan N
State Mutual Insurance Company (Gold and Silver) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan M,
Medigap Plan N
Transamerica Life Insurance Company (Direct) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan M,
Medigap Plan N
USAA Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Union Security Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
United American Insurance Company Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
United Commercial Travelers of America Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
United Insurance Company of America Medigap Plan A,
Medigap Plan D,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
United States Fire Insurance Company Medigap Plan A,
Medigap Plan B,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
Wisconsin Physicians Service Insurance Corporation Medigap Plan A,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
Physicians Life Insurance Company (Attained Age) Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible

Ada, Oklahoma Standard Medicare Plan Coverage

Wondering what’s covered by each of the standard Oklahoma Medicare supplement plans? Take a look at all of the Ada, Oklahoma Medicare supplement plans with coverage details.

Ada, Oklahoma Standard Medicare Plan Coverage

Plan Name Monthly Cost Copays Coinsurance Deductibles Plan Benefits
Medigap Plan A Premiums range from $86-$1,020 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services $1,484 Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: No
Part A deductible: No
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: No
Medigap Plan B Premiums range from $101-$801 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services $0 Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: No
Part A deductible: Yes
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: No
Medigap Plan C Premiums range from $112-$959 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services $0 Hospital (Part A) deductible,
$0 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: Yes
Part B excess charges: No
Foreign travel emergency: Yes
Medigap Plan D Premiums range from $104-$870 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services $0 Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: Yes
Medigap Plan F Premiums range from $115-$985 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services $0 Hospital (Part A) deductible,
$0 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: Yes
Part B excess charges: Yes
Foreign travel emergency: Yes
Medigap Plan F-high deductible Premiums range from $27-$307 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services after you pay $2,370 deductible $2,370 total plan deductible.
After, you pay: $0 Hospital (Part A) deductible,
$0 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: Yes
Part B excess charges: Yes
Foreign travel emergency: Yes
Medigap Plan G Premiums range from $98-$851 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services $0 Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: No
Part B excess charges: Yes
Foreign travel emergency: Yes
Medigap Plan G-high deductible Premiums range from $27-$307 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services after you pay $2,370 deductible $2,370 total plan deductible.
After, you pay: $0 Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: No
Part B excess charges: Yes
Foreign travel emergency: Yes
Medigap Plan K Premiums range from $43-$277 depending on your age, sex, health status, and when you buy. 10% Generally your cost for approved Part B services up to $6,220. Then, you’ll pay $0 for the rest of the year. $742 (50% of Part A deductible) Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: No
Medigap Plan L Premiums range from $63-$535 depending on your age, sex, health status, and when you buy. 5% Generally your cost for approved Part B services up to $3,110. Then, you’ll pay $0 for the rest of the year. $371 (25% of Part A deductible) Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: No
Medigap Plan M Premiums range from $71-$620 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services $742 (50% of Part A deductible) Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: Yes
Medigap Plan N Premiums range from $71-$677 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services with some $20 and $50 copays $0 Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: Yes

Standalone Medicare Part D Plans in Ada, Oklahoma

Prescription drug coverage for Medicare in Ada, Oklahoma is covered by a Part D plan. You can purchase Part D coverage in Ada, Oklahoma as a standalone plan if it’s not included in your Medicare Advantage coverage. Take a look at the options for standalone Part D plans here.

Standalone Medicare Part D Plans in Ada, Oklahoma

Plan Details Tiers
SilverScript SmartRx (PDP)
S5601 – 198 – 0
by Aetna Medicare
Monthly Premium: $7.80
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $19.00
Tier 3: $46.00
Tier 4: 45%
Tier 5: 25%
Clear Spring Health Premier Rx (PDP)
S6946 – 049 – 0
by Clear Spring Health
Monthly Premium: $13.70
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $3.00
Tier 3: $40.00
Tier 4: 42%
Tier 5: 25%
WellCare Wellness Rx (PDP)
S4802 – 192 – 0
by WellCare
Monthly Premium: $15.70
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $6.00
Tier 3: $40.00
Tier 4: 46%
Tier 5: 25%
Humana Walmart Value Rx Plan (PDP)
S5884 – 202 – 0
by Humana
Monthly Premium: $17.20
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $4.00
Tier 3: 16%
Tier 4: 33%
Tier 5: 25%
WellCare Value Script (PDP)
S4802 – 156 – 0
by WellCare
Monthly Premium: $17.70
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $6.00
Tier 3: $43.00
Tier 4: 47%
Tier 5: 25%
Blue Cross MedicareRx Choice (PDP)
S5715 – 018 – 0
by Blue Cross and Blue Shield of Oklahoma
Monthly Premium: $21.00
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $4.00
Tier 3: $47.00
Tier 4: 35%
Tier 5: 25%
Cigna Secure-Essential Rx (PDP)
S5617 – 302 – 0
by Cigna
Monthly Premium: $24.00
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $2.00
Tier 3: 18%
Tier 4: 45%
Tier 5: 25%
Express Scripts Medicare – Value (PDP)
S5660 – 125 – 0
by Express Scripts Medicare
Monthly Premium: $26.20
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $3.00
Tier 3: $30.00
Tier 4: 50%
Tier 5: 25%
AARP MedicareRx Saver Plus (PDP)
S5921 – 368 – 0
by UnitedHealthcare
Monthly Premium: $26.60
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $5.00
Tier 3: $31.00
Tier 4: 40%
Tier 5: 25%
WellCare Medicare Rx Select (PDP)
S5810 – 300 – 0
by WellCare
Monthly Premium: $26.60
Annual Deductable: $400
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $3.00
Tier 3: $47.00
Tier 4: 42%
Tier 5: 25%
SilverScript Choice (PDP)
S5601 – 046 – 0
by Aetna Medicare
Monthly Premium: $26.70
Annual Deductable: $235
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $5.00
Tier 3: $35.00
Tier 4: 40%
Tier 5: 28%
Express Scripts Medicare – Saver (PDP)
S5660 – 239 – 0
by Express Scripts Medicare
Monthly Premium: $26.80
Annual Deductable: $285
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $2.00
Tier 2: $7.00
Tier 3: $35.00
Tier 4: 50%
Tier 5: 28%
WellCare Classic (PDP)
S4802 – 014 – 0
by WellCare
Monthly Premium: $26.80
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $3.00
Tier 3: $30.00
Tier 4: 33%
Tier 5: 25%
Clear Spring Health Value Rx (PDP)
S6946 – 020 – 0
by Clear Spring Health
Monthly Premium: $27.00
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $3.00
Tier 3: $42.00
Tier 4: 33%
Tier 5: 25%
Mutual of Omaha Rx Premier (PDP)
S7126 – 092 – 0
by Mutual of Omaha Rx
Monthly Premium: $28.00
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $2.00
Tier 3: 23%
Tier 4: 42%
Tier 5: 25%
Humana Basic Rx Plan (PDP)
S5884 – 144 – 0
by Humana
Monthly Premium: $28.10
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $1.00
Tier 3: 20%
Tier 4: 35%
Tier 5: 25%
CommunityCare Prescription Drug Plan (PDP)
S1894 – 001 – 0
by CommunityCare Prescription Drug Plan (PDP)
Monthly Premium: $28.20
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $4.00
Tier 3: 10%
Tier 4: 25%
Tier 5: 25%
WellCare Medicare Rx Saver (PDP)
S5810 – 057 – 0
by WellCare
Monthly Premium: $28.40
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $5.00
Tier 3: $38.00
Tier 4: 37%
Tier 5: 25%
Cigna Secure Rx (PDP)
S5617 – 113 – 0
by Cigna
Monthly Premium: $29.70
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $2.00
Tier 3: $28.00
Tier 4: 50%
Tier 5: 25%
Blue Cross MedicareRx Basic (PDP)
S5715 – 015 – 0
by Blue Cross and Blue Shield of Oklahoma
Monthly Premium: $31.30
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $4.00
Tier 3: 13%
Tier 4: 46%
Tier 5: 25%
AARP MedicareRx Walgreens (PDP)
S5921 – 404 – 0
by UnitedHealthcare
Monthly Premium: $33.30
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $6.00
Tier 3: $40.00
Tier 4: 40%
Tier 5: 25%
Elixir RxPlus (PDP)
S7694 – 023 – 0
by Elixir Insurance
Monthly Premium: $44.30
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $7.00
Tier 3: 15%
Tier 4: 32%
Tier 5: 25%
Cigna Secure-Extra Rx (PDP)
S5617 – 268 – 0
by Cigna
Monthly Premium: $49.10
Annual Deductable: $100
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $4.00
Tier 2: $10.00
Tier 3: $42.00
Tier 4: 50%
Tier 5: 31%
Humana Premier Rx Plan (PDP)
S5884 – 169 – 0
by Humana
Monthly Premium: $60.70
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $4.00
Tier 3: $45.00
Tier 4: 49%
Tier 5: 25%
Express Scripts Medicare – Choice (PDP)
S5660 – 214 – 0
by Express Scripts Medicare
Monthly Premium: $75.60
Annual Deductable: $100
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $2.00
Tier 2: $7.00
Tier 3: $42.00
Tier 4: 50%
Tier 5: 31%
WellCare Medicare Rx Value Plus (PDP)
S5768 – 146 – 0
by WellCare
Monthly Premium: $87.90
Annual Deductable: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $4.00
Tier 3: $47.00
Tier 4: 48%
Tier 5: 33%
SilverScript Plus (PDP)
S5601 – 109 – 0
by Aetna Medicare
Monthly Premium: $88.60
Annual Deductable: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $0.00
Tier 2: $2.00
Tier 3: $47.00
Tier 4: 50%
Tier 5: 33%
AARP MedicareRx Preferred (PDP)
S5820 – 022 – 0
by UnitedHealthcare
Monthly Premium: $88.70
Annual Deductable: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $5.00
Tier 2: $10.00
Tier 3: $45.00
Tier 4: 40%
Tier 5: 33%
Blue Cross MedicareRx Value (PDP)
S5715 – 010 – 0
by Blue Cross and Blue Shield of Oklahoma
Monthly Premium: $89.10
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $0.00
Tier 2: $8.00
Tier 3: $40.00
Tier 4: 44%
Tier 5: 25%
Mutual of Omaha Rx Plus (PDP)
S7126 – 022 – 0
by Mutual of Omaha Rx
Monthly Premium: $93.70
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $2.00
Tier 3: 20%
Tier 4: 34%
Tier 5: 25%

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