Douglas County, Missouri Medicare Companies and Plans (2022)

Eligible residents can buy Douglas County Medicare plans from multiple insurance companies. Medicare plans available in Douglas 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 Douglas County, MO is to compare coverage and rates from multiple companies.

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The Highlights

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

Douglas County, Missouri 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 Douglas 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 Douglas County, MO Medicare coverage that suits your needs.

Ready to find cheap Medicare rates in Douglas County, MO? Enter your ZIP code to compare Douglas County, Missouri Medicare plans today.

Medicare Advantage Companies in Douglas County, Missouri

A Medicare Advantage plan in Douglas County, MO 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 Douglas County, Missouri.

Medicare Advantage Companies in Douglas County, Missouri

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 Choice (PPO) – H8768-027-0 $0.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $3,900
AARP Medicare Advantage Patriot (HMO-POS) – H2802-050-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $3,700
AARP Medicare Advantage Plan 1 (HMO-POS) – H2802-031-0 $24.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $4.00, Generic: $14.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $3,400
AARP Medicare Advantage Plan 2 (HMO-POS) – H2802-030-0 $0.00 $100 . Tier 1, 2 and 3 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $4.00, Generic: $14.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 31% $3,700
Aetna Medicare Assure (HMO D-SNP) – H5325-004-0 $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 Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: 25%, Non-Preferred Drug: 35%, Specialty Tier: 29% n/a
Aetna Medicare Eagle (HMO) – H2663-022-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $3,450
Aetna Medicare Elite (PPO) – H1608-047-0 $0.00 $0 Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $5,000
Aetna Medicare Premier (HMO) – H2663-021-0 $25.00 $0 Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $3,450
Aetna Medicare Premier Plus (HMO-POS) – H2663-023-0 $0.00 $0 Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $4,400
Aetna Medicare Premier Plus (PPO) – H1608-018-0 $0.00 $0 Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $5,700
Aetna Medicare Premier Preferred (HMO) – H2663-036-0 $0.00 $0 Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $3,450
Allwell Dual Medicare (HMO D-SNP) – H1664-005-0 $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: $20.00, Preferred Brand: $47.00, Non-Preferred Drug: 50%, Specialty Tier: 28% n/a
Allwell Medicare (HMO) – H1664-001-0 $0.00 $0 Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $37.00, Non-Preferred Drug: $90.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $3,400
Allwell Medicare Boost (HMO) – H1664-006-0 $0.00 $445 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $9.00, Preferred Brand: $37.00, Non-Preferred Drug: $90.00, Specialty Tier: 25%, Select Care Drugs: $0.00 $7,550
Allwell Medicare Complement (HMO) – H1664-007-0 $22.30 $445 . Tier 1 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $2.00, Generic: $8.00, Preferred Brand: $44.00, Non-Preferred Drug: 50%, Specialty Tier: 25% $3,400
Anthem MediBlue Access (PPO) – H4909-015-0 $39.00 $0 Yes, some additional gap coverage. Preferred Generic: $4.00, Generic: $13.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $5,000
Anthem MediBlue Access Basic (PPO) – H4909-016-0 $0.00 $95 . Tier 1 and 2 exempt Yes, some additional gap coverage. Preferred Generic: $4.00, Generic: $13.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 31%, Select Care Drugs: $0.00 $4,900
Anthem MediBlue Dual Advantage (HMO D-SNP) – H3447-018-0 $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: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $95.00, Specialty Tier: 25%, Select Care Drugs: $0.00 n/a
Anthem MediBlue Plus (HMO) – H3447-019-0 $0.00 $0 Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $15.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $3,400
Humana Gold Choice H8145-120 (PFFS) – H8145-120-0 $36.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. n/a
Humana Gold Choice H8145-125 (PFFS) – H8145-125-0 $53.00 $195 . Tier 1 and 2 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% n/a
Humana Gold Plus H0028-016 (HMO) – H0028-016-0 $26.00 $195 . Tier 1, 2 and 3 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $6.00, Generic: $11.00, Preferred Brand: $47.00, Non-Preferred Drug: $99.00, Specialty Tier: 29% $7,550
Humana Gold Plus H4623-001 (HMO) – H4623-001-0 $0.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $6.00, Generic: $11.00, Preferred Brand: $47.00, Non-Preferred Drug: $99.00, Specialty Tier: 33% $3,450
Humana Gold Plus SNP-DE H0028-015 (HMO D-SNP) – H0028-015-0 $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 Preferred Generic: $0.00, Generic: $9.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 27% n/a
Humana Honor (PPO) – H5216-140-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $4,500
HumanaChoice H5216-032 (PPO) – H5216-032-0 $78.00 $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 H5216-033 (PPO) – H5216-033-1 $33.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $7.00, Generic: $14.00, Preferred Brand: $47.00, Non-Preferred Drug: $99.00, Specialty Tier: 33% $5,900
HumanaChoice R1532-001 (Regional PPO) – R1532-001-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $3,900
HumanaChoice R1532-002 (Regional PPO) – R1532-002-0 $50.00 $400 . Tier 1 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $5.00, Generic: $13.00, 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
Provider Partners Missouri Advantage Plan (HMO I-SNP) – H9191-001-0 $30.50 $445 No additional gap coverage, only the Donut Hole Discount Tier 1: 25% n/a
UnitedHealthcare Dual Complete (HMO D-SNP) – H0169-002-0 $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% n/a
UnitedHealthcare Dual Complete Choice (Regional PPO D-SNP) – R3444-011-0 $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: $0.00, Tier 2: $0.00, Tier 3: $0.00, Tier 4: $0.00, Tier 5: $0.00 n/a
UnitedHealthcare Medicare Advantage Choice Plan 2 (Regional PPO) – R3444-012-0 $55.00 $295 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $4.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 27% $6,700
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) – R3444-023-0 $19.00 $245 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $4.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 28% $6,700
UnitedHealthcare Medicare Gold (Regional PPO C-SNP) – R3444-009-0 $23.00 $295 . Tier 1, 2 and 3 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $4.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 27% n/a
UnitedHealthcare Medicare Silver (Regional PPO C-SNP) – R3444-008-0 $4.00 $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% n/a
WellCare Imperial (PPO D-SNP) – H7518-003-0 $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 Preferred Generic: $0.00, Generic: $8.00, Preferred Brand: $45.00, Non-Preferred Drug: 50%, Specialty Tier: 25% n/a
WellCare Patriot (PPO) – H7518-002-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $4,000
WellCare Premier (PPO) – H7518-001-0 $0.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $5,900

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Medicare Supplement Companies in Douglas County, Missouri

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

Medicare Supplement Companies in Douglas County, Missouri

Company Plans
AARP – UnitedHealthcare Insurance Company (Level 2) Medigap Plan B,
Medigap Plan C,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
AARP – UnitedHealthcare Insurance Company (Level 2/Household) Medigap Plan B,
Medigap Plan C,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
AARP – UnitedHealthcare Insurance Company (Standard) Medigap Plan B,
Medigap Plan C,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
AARP – UnitedHealthcare Insurance Company (Standard/Household) Medigap Plan B,
Medigap Plan C,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
Aetna Health and Life Insurance Company Medigap Plan B,
Medigap Plan G,
Medigap Plan N
Colonial Penn Life Insurance Company Medigap Plan B,
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 B,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan M,
Medigap Plan N
Globe Life and Accident Insurance Company (Direct to Consumer) Medigap Plan B,
Medigap Plan C,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Humana (Humana Insurance Company) Medigap Plan B,
Medigap Plan C,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
Humana (Humana Insurance Company) (Household) Medigap Plan B,
Medigap Plan C,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
Transamerica Life Insurance Company (Direct) Medigap Plan B,
Medigap Plan C,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan M,
Medigap Plan N
United American Insurance Company Medigap Plan B,
Medigap Plan C,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
United Commercial Travelers of America Medigap Plan B,
Medigap Plan C,
Medigap Plan G,
Medigap Plan N
Americo Financial Life and Annuity Insurance Company Medigap Plan C,
Medigap Plan G,
Medigap Plan N
Americo Financial Life and Annuity Insurance Company (Class 1) Medigap Plan C,
Medigap Plan G,
Medigap Plan N
Prosperity Life Group Medigap Plan C,
Medigap Plan G
State Farm Mutual Automobile Insurance Company Medigap Plan C,
Medigap Plan G,
Medigap Plan N
Accendo Insurance Company Medigap Plan G,
Medigap Plan N
Anthem Blue Cross and Blue Shield – Missouri Medigap Plan G,
Medigap Plan N
Assured Life Association Medigap Plan G,
Medigap Plan N
Cigna Health & Life Insurance Company Medigap Plan G,
Medigap Plan N
Combined Insurance Company of America Medigap Plan G,
Medigap Plan N
GPM Health and Life Insurance Company Medigap Plan G,
Medigap Plan N
Garden State Life Insurance Company Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan M,
Medigap Plan N
Humana Value (HumanaDental Insurance Company) Medigap Plan G,
Medigap Plan N
Humana Value (HumanaDental Insurance Company) (Household) Medigap Plan G,
Medigap Plan N
Lumico Life Insurance Company Medigap Plan G,
Medigap Plan N
Medico Corp Insurance Company Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
National Health Insurance Company Medigap Plan G,
Medigap Plan N
National Health Insurance Company (Household) Medigap Plan G,
Medigap Plan N
Old Surety Life Insurance Company Medigap Plan G
Omaha Insurance Company Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Oxford Life Insurance Company Medigap Plan G,
Medigap Plan N
Pekin Life Insurance Company Medigap Plan G,
Medigap Plan N
Puritan Life Insurance Company of America Medigap Plan G,
Medigap Plan N
USAA Life Insurance Company Medigap Plan G,
Medigap Plan N
United Insurance Company of America Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N

Douglas County, Missouri Medicare Supplement Coverage by Plan

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

Douglas County, Missouri Medicare Supplement Coverage by Plan

Plan Name Monthly Cost Copays Coinsurance Deductibles Plan Benefits
Medigap Plan A Premiums range from $94-$633 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 $144-$501 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 $176-$690 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 $164-$750 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 $178-$848 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 $42-$247 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 $136-$739 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 $42-$235 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 $58-$251 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 $98-$455 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 $133-$526 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 $118-$623 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 Douglas County, Missouri

If you’re looking to buy a standalone Douglas County, MO 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 Douglas County, Missouri.

Standalone Medicare Part D plans in Douglas County, Missouri

Plan Details Tiers
SilverScript SmartRx (PDP)
S5601 – 193 – 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: 46%
Tier 5: 25%
Clear Spring Health Premier Rx (PDP)
S6946 – 044 – 0
by Clear Spring Health
Monthly Premium: $13.60
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%
WellCare Wellness Rx (PDP)
S4802 – 187 – 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: $3.00
Tier 3: $40.00
Tier 4: 46%
Tier 5: 25%
WellCare Value Script (PDP)
S4802 – 152 – 0
by WellCare
Monthly Premium: $15.40
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%
Humana Walmart Value Rx Plan (PDP)
S5884 – 197 – 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: 34%
Tier 5: 25%
Express Scripts Medicare – Saver (PDP)
S5660 – 234 – 0
by Express Scripts Medicare
Monthly Premium: $21.70
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 Medicare Rx Select (PDP)
S5810 – 297 – 0
by WellCare
Monthly Premium: $23.30
Annual Deductable: $330
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: 27%
Cigna Secure-Essential Rx (PDP)
S5617 – 297 – 0
by Cigna
Monthly Premium: $23.90
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: 48%
Tier 5: 25%
Mutual of Omaha Rx Premier (PDP)
S7126 – 087 – 0
by Mutual of Omaha Rx
Monthly Premium: $24.20
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%
Blue MedicareRx Enhanced (PDP)
S5596 – 078 – 0
by Blue MedicareRx (PDP)
Monthly Premium: $25.40
Annual Deductable: $240
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: 38%
Tier 5: 26%
Express Scripts Medicare – Value (PDP)
S5660 – 120 – 0
by Express Scripts Medicare
Monthly Premium: $26.30
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: $32.00
Tier 4: 50%
Tier 5: 25%
SilverScript Choice (PDP)
S5601 – 036 – 0
by Aetna Medicare
Monthly Premium: $26.80
Annual Deductable: $245
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%
Clear Spring Health Value Rx (PDP)
S6946 – 015 – 0
by Clear Spring Health
Monthly Premium: $27.50
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: 32%
Tier 5: 25%
WellCare Classic (PDP)
S4802 – 072 – 0
by WellCare
Monthly Premium: $27.50
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: $30.00
Tier 4: 34%
Tier 5: 25%
Humana Basic Rx Plan (PDP)
S5884 – 140 – 0
by Humana
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: $1.00
Tier 3: 20%
Tier 4: 35%
Tier 5: 25%
Cigna Secure Rx (PDP)
S5617 – 088 – 0
by Cigna
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: $2.00
Tier 3: $41.00
Tier 4: 50%
Tier 5: 25%
AARP MedicareRx Walgreens (PDP)
S5921 – 399 – 0
by UnitedHealthcare
Monthly Premium: $32.00
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%
WellCare Medicare Rx Saver (PDP)
S5810 – 052 – 0
by WellCare
Monthly Premium: $35.50
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: $38.00
Tier 4: 37%
Tier 5: 25%
Elixir RxPlus (PDP)
S7694 – 018 – 0
by Elixir Insurance
Monthly Premium: $48.50
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: 25%
Tier 5: 25%
Cigna Secure-Extra Rx (PDP)
S5617 – 263 – 0
by Cigna
Monthly Premium: $50.00
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%
AARP MedicareRx Saver Plus (PDP)
S5921 – 363 – 0
by UnitedHealthcare
Monthly Premium: $53.70
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $8.00
Tier 3: $40.00
Tier 4: 40%
Tier 5: 25%
SilverScript Plus (PDP)
S5601 – 037 – 0
by Aetna Medicare
Monthly Premium: $57.10
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%
Blue MedicareRx Plus (PDP)
S5596 – 044 – 0
by Blue MedicareRx (PDP)
Monthly Premium: $65.80
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%
Humana Premier Rx Plan (PDP)
S5884 – 164 – 0
by Humana
Monthly Premium: $66.00
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: $45.00
Tier 4: 49%
Tier 5: 25%
Blue MedicareRx Value (PDP)
S5596 – 043 – 0
by Blue MedicareRx (PDP)
Monthly Premium: $69.30
Annual Deductable: $290
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: 34%
Tier 5: 25%
Express Scripts Medicare – Choice (PDP)
S5660 – 211 – 0
by Express Scripts Medicare
Monthly Premium: $73.30
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 – 141 – 0
by WellCare
Monthly Premium: $73.40
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: 50%
Tier 5: 33%
Mutual of Omaha Rx Plus (PDP)
S7126 – 017 – 0
by Mutual of Omaha Rx
Monthly Premium: $75.60
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: 37%
Tier 5: 25%
AARP MedicareRx Preferred (PDP)
S5820 – 017 – 0
by UnitedHealthcare
Monthly Premium: $94.10
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%

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