Amador County, California Medicare Companies and Plans (2021)

Eligible residents can buy Amador County Medicare plans from multiple insurance companies. Medicare plans available in Amador County include Medicare Advantage (Part C), Part D prescription drug coverage, and Medicare Supplement (Medigap) plans. The best way to choose the right Medicare coverage in Amador County, CA is to compare coverage and rates from multiple companies.

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UPDATED: Oct 12, 2021

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The Highlights

  • Medicare Advantage plans in Amador County, California may include dental, vision, and hearing coverage
  • Medicare supplement plans in Amador County are designed to cover out-of-pocket costs not paid for by original Medicare
  • Standalone Medicare Part D plans in Amador County can help cover the cost of prescriptions

Amador County, California Medicare plans are widely available, and Medicare-eligible residents can compare options that include Medicare Advantage, standalone Medicare Part D, and Medicare Supplement plans to fill the gaps in original Medicare.

Whether you are just looking for Medigap coverage in Amador County to avoid out-of-pocket costs not covered by your Medicare Part A and B or want to sign up for Medicare Advantage instead, comparing your options is the best way to find affordable Amador County, CA Medicare coverage that suits your needs.

Ready to find cheap Medicare rates in Amador County, CA? Enter your ZIP code to compare Amador County, California Medicare plans today.

Medicare Advantage Companies in Amador County, California

A Medicare Advantage plan in Amador County, CA can provide additional coverage above and beyond original Medicare and allows you to choose your plan, coverage, and network. Take a look at the companies that offer Medicare Advantage plans in Amador County, California.

Medicare Advantage Companies in Amador County, California

Plan Name Monthly Prem. (Parts C & D) Deductible Additional Gap Coverage Preferred Pharmacy Copay/ Coinsurance 30-Day Supply MOOP for Part A & B Benefits
AARP Medicare Advantage SecureHorizons (HMO) – H0543-140-0 $61.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $6,700
Kaiser Permanente Sr Adv Enhanced Sac., Sonoma (HMO) – H0524-013-0 $75.00 $0 Yes, some additional gap coverage. Preferred Generic: $3.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Brand: $100.00, Specialty Tier: 33%, Vaccines: $0.00 $5,400
Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) – H0524-051-0 $15.00 $0 Yes, some additional gap coverage. Preferred Generic: $5.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Brand: $100.00, Specialty Tier: 33%, Vaccines: $0.00 $6,700
Senior Advantage Medicare Medi-Cal Plan North (HMO D-SNP) – H0524-030-0 $0.00 for people who qualify for both Medicare and Medicaid. $0 for people who qualify for both Medicare and Medicaid. No additional gap coverage, only the Donut Hole Discount Tier 1: 15%, Tier 2: 15%, Tier 3: 15%, Tier 4: 15%, Tier 5: 15%, Tier 6: 15% n/a
UnitedHealthcare Medicare Advantage Assure (HMO) – H0543-202-0 $17.10 $445 No additional gap coverage, only the Donut Hole Discount Tier 1: 25%, Tier 2: 25%, Tier 3: 25%, Tier 4: 25%, Tier 5: 25% $7,550

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Medicare Supplement Companies in Amador County, California

If you choose original Medicare in Amador County, CA, you can get coverage for out-of-pocket costs like deductibles, co-pays, and coinsurance with a Amador County Medicare Supplement plan. Take a look at which companies offer Medicare Supplement plans in Amador County, CA and which plans are available.

Medicare Supplement Companies in Amador County, California

Company Plans
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
Anthem BlueCross – California Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Blue Shield of California Life & Health Insurance Company Medigap Plan A,
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
Cigna Health & Life Insurance Company (w/ 11% HHD) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
Cigna Health & Life Insurance Company (w/ 6% HHD) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
Combined Insurance Company of America Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Continental Life Insurance Company of Brentwood, Tennessee (Aetna) Medigap Plan A,
Medigap Plan B,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
Everence Association Inc. 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 G,
Medigap Plan G-high deductible,
Medigap Plan N
Health Net Life Insurance Company (Not Los Angeles and San Diego) Medigap Plan A,
Medigap Plan D,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
Humana (Humana Insurance Company) Medigap Plan A,
Medigap Plan A,
Medigap Plan B,
Medigap Plan B,
Medigap Plan C,
Medigap Plan C,
Medigap Plan F,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan K,
Medigap Plan L,
Medigap Plan L,
Medigap Plan N,
Medigap Plan N
Humana Achieve (Humana Benefit Plan of Illinois, Inc. dba Humana Benefit Insurance Plan of Illinois, Inc.) Medigap Plan A,
Medigap Plan A,
Medigap Plan F,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan G-high deductible,
Medigap Plan N,
Medigap Plan N
Humana Achieve (Humana Benefit Plan of Illinois, Inc. dba Humana Benefit Insurance Plan of Illinois, Inc.) (Household) Medigap Plan A,
Medigap Plan A,
Medigap Plan F,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan G-high deductible,
Medigap Plan N,
Medigap Plan N
Independence American 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
Oxford Life Insurance Company 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 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
USAA Life 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 World Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Anthem BlueCross – California (Innovative) Medigap Plan F
Blue Shield of California Life & Health Insurance Company (Plan F Extra) Medigap Plan F
Health Net Life Insurance Company (Innovative F/Not Los Angeles and San Diego) Medigap Plan F
Blue Shield of California Life & Health Insurance Company (Plan G Extra) Medigap Plan G
Blue Shield of California Life & Health Insurance Company (Plan G Inspire) Medigap Plan G
Health Net Life Insurance Company (Innovative G/Not Los Angeles and San Diego) Medigap Plan G

Amador County, California Medicare Supplement Coverage by Plan

Not sure which Amador County Medicare supplement plan is right for you? Take a look at the details of each of the standard California Medicare supplement plans to find out what’s covered.

Amador County, California Medicare Supplement Coverage by Plan

Plan Name Monthly Cost Copays Coinsurance Deductibles Plan Benefits
Medigap Plan A Premiums range from $97-$902 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 $151-$576 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 $178-$735 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 $128-$575 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 $177-$1,104 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 $40-$208 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 $128-$961 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 $37-$207 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 $55-$307 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 $100-$447 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 $177-$514 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 $98-$737 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 Amador County, California

If you’re looking to buy a standalone Amador County, CA Medicare Part D plan for prescription drug coverage, you have several options. Review the companies that offer Part D as a standalone policy and what sort of Medicare prescription coverage is available in Amador County, California.

Standalone Medicare Part D plans in Amador County, California

Plan Details Tiers
SilverScript SmartRx (PDP)
S5601 – 207 – 0
by Aetna Medicare
Monthly Premium: $7.20
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: 48%
Tier 5: 25%
Clear Spring Health Premier Rx (PDP)
S6946 – 056 – 0
by Clear Spring Health
Monthly Premium: $13.30
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: 45%
Tier 5: 25%
Elixir RxPlus (PDP)
S7694 – 137 – 0
by Elixir Insurance
Monthly Premium: $15.10
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $6.00
Tier 3: $43.00
Tier 4: 45%
Tier 5: 25%
WellCare Wellness Rx (PDP)
S4802 – 201 – 0
by WellCare
Monthly Premium: $15.20
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $5.00
Tier 3: $40.00
Tier 4: 46%
Tier 5: 25%
Humana Walmart Value Rx Plan (PDP)
S5884 – 211 – 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: 17%
Tier 4: 35%
Tier 5: 25%
WellCare Value Script (PDP)
S4802 – 163 – 0
by WellCare
Monthly Premium: $17.20
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $7.00
Tier 3: $43.00
Tier 4: 47%
Tier 5: 25%
Cigna Secure-Essential Rx (PDP)
S5617 – 311 – 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: 43%
Tier 5: 25%
Mutual of Omaha Rx Premier (PDP)
S7126 – 101 – 0
by Mutual of Omaha Rx
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: 23%
Tier 4: 44%
Tier 5: 25%
Anthem Blue Cross MediBlue Rx Enhanced (PDP)
S5596 – 076 – 0
by Anthem Blue Cross MediBlue Rx (PDP)
Monthly Premium: $26.10
Annual Deductable: $300
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $0.00
Tier 2: $2.00
Tier 3: 20%
Tier 4: 39%
Tier 5: 26%
Express Scripts Medicare – Saver (PDP)
S5660 – 248 – 0
by Express Scripts Medicare
Monthly Premium: $26.50
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%
Cigna Secure Rx (PDP)
S5617 – 158 – 0
by Cigna
Monthly Premium: $27.70
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: $30.00
Tier 4: 50%
Tier 5: 25%
WellCare Medicare Rx Select (PDP)
S5810 – 295 – 0
by WellCare
Monthly Premium: $28.30
Annual Deductable: $385
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: 26%
AARP MedicareRx Saver Plus (PDP)
S5921 – 376 – 0
by UnitedHealthcare
Monthly Premium: $29.20
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: $25.00
Tier 4: 40%
Tier 5: 25%
Clear Spring Health Value Rx (PDP)
S6946 – 027 – 0
by Clear Spring Health
Monthly Premium: $29.50
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: 35%
Tier 5: 25%
SilverScript Choice (PDP)
S5601 – 064 – 0
by Aetna Medicare
Monthly Premium: $29.50
Annual Deductable: $250
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: 39%
Tier 5: 28%
WellCare Classic (PDP)
S4802 – 094 – 0
by WellCare
Monthly Premium: $30.10
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $2.00
Tier 3: $30.00
Tier 4: 35%
Tier 5: 25%
Cigna Secure-Extra Rx (PDP)
S5617 – 277 – 0
by Cigna
Monthly Premium: $30.30
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: 49%
Tier 5: 31%
Humana Basic Rx Plan (PDP)
S5884 – 114 – 0
by Humana
Monthly Premium: $30.30
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: 32%
Tier 5: 25%
Elixir RxSecure (PDP)
S7694 – 032 – 0
by Elixir Insurance
Monthly Premium: $30.80
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $7.00
Tier 3: 15%
Tier 4: 29%
Tier 5: 25%
WellCare Medicare Rx Saver (PDP)
S5810 – 066 – 0
by WellCare
Monthly Premium: $37.10
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: $36.00
Tier 4: 39%
Tier 5: 25%
AARP MedicareRx Walgreens (PDP)
S5921 – 413 – 0
by UnitedHealthcare
Monthly Premium: $41.60
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%
Blue Shield Rx Plus (PDP)
S2468 – 003 – 0
by Blue Shield of California
Monthly Premium: $59.00
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $2.00
Tier 2: $6.00
Tier 3: $39.00
Tier 4: 41%
Tier 5: 25%
Express Scripts Medicare – Value (PDP)
S5660 – 134 – 0
by Express Scripts Medicare
Monthly Premium: $61.00
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: $30.00
Tier 4: 50%
Tier 5: 25%
Humana Premier Rx Plan (PDP)
S5884 – 178 – 0
by Humana
Monthly Premium: $72.50
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%
Anthem Blue Cross MediBlue Rx Plus (PDP)
S5596 – 034 – 0
by Anthem Blue Cross MediBlue Rx (PDP)
Monthly Premium: $79.90
Annual Deductable: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $3.00
Tier 3: $43.00
Tier 4: 45%
Tier 5: 33%
WellCare Medicare Rx Value Plus (PDP)
S5768 – 155 – 0
by WellCare
Monthly Premium: $81.00
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: 44%
Tier 5: 33%
SilverScript Plus (PDP)
S5601 – 065 – 0
by Aetna Medicare
Monthly Premium: $81.60
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: 45%
Tier 5: 33%
Anthem Blue Cross MediBlue Rx Standard (PDP)
S5596 – 033 – 0
by Anthem Blue Cross MediBlue Rx (PDP)
Monthly Premium: $84.20
Annual Deductable: $390
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $2.00
Tier 3: $32.00
Tier 4: 27%
Tier 5: 25%
Express Scripts Medicare – Choice (PDP)
S5660 – 202 – 0
by Express Scripts Medicare
Monthly Premium: $84.90
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: 49%
Tier 5: 31%
AARP MedicareRx Preferred (PDP)
S5820 – 031 – 0
by UnitedHealthcare
Monthly Premium: $99.30
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%
Mutual of Omaha Rx Plus (PDP)
S7126 – 031 – 0
by Mutual of Omaha Rx
Monthly Premium: $100.00
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: 20%
Tier 4: 35%
Tier 5: 25%
Blue Shield Rx Enhanced (PDP)
S2468 – 004 – 0
by Blue Shield of California
Monthly Premium: $130.40
Annual Deductable: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $2.00
Tier 2: $7.00
Tier 3: $43.00
Tier 4: 33%
Tier 5: 33%

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