Dobbins, California Medicare Companies and Plans (2021)

Dobbins, California 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, Dobbins, CA supplemental plans are also available. Medicare plans in Dobbins, California are sold by both large national companies and local insurers.

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UPDATED: Oct 12, 2021

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The Highlights

  • Dobbins, CA Medicare options include Advantage, standalone Part D, and Medicare supplement
  • You can buy Medicare supplement coverage in Dobbins, California if you have original Medicare and want coverage for out-of-pocket costs
  • Medicare Advantage plans in Dobbins, California may include prescription drug coverage, or you may need to buy Part D coverage separately

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

Dobbins, California 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 Dobbins original Medicare plans don’t cover, like coinsurance and deductibles.

Ready to buy Dobbins, California Medicare coverage? Enter your ZIP code to compare Dobbins, CA Medicare options available to you right now.

Medicare Advantage Companies in Dobbins, California

Medicare Advantage in Dobbins, California 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 Dobbins, CA 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 Dobbins, 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
Anthem MediBlue Access (PPO) – H8552-029-0 $30.00 $370 . Tier 1 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $4.00, Generic: $12.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 26%, Select Care Drugs: $0.00 $6,700
Anthem MediBlue Dual Access (PPO D-SNP) – H8552-030-0 $0.00 for people who qualify for both Medicare and Medicaid. $0 for people who qualify for both Medicare and Medicaid. Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $4.00, Preferred Brand: $36.00, Non-Preferred Drug: $95.00, Specialty Tier: 25%, Select Care Drugs: $0.00 n/a
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

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Medicare Supplement Companies in Dobbins, California

Original Medicare leaves you with some out-of-pocket costs such as deductibles and coinsurance. With a Dobbins, California Medicare supplement plan, you can get coverage for some or all of those costs. Medicare supplement plans in California 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 Dobbins, 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

Dobbins, California Standard Medicare Plan Coverage

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

Dobbins, California Standard Medicare Plan Coverage

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 Dobbins, California

Prescription drug coverage for Medicare in Dobbins, California is covered by a Part D plan. You can purchase Part D coverage in Dobbins, California 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 Dobbins, 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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