Honolulu County, Hawaii Medicare Companies and Plans (2022)

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

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The Highlights

  • Honolulu County residents can buy Medicare Advantage or choose original Medicare
  • Medicare supplement plans in Honolulu County, HI include Medigap Plan F-high deductible and Medigap Plan G-high deductible
  • Standalone Medicare Part D plans in Honolulu County can help cover the cost of prescriptions

Honolulu County, Hawaii 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 Honolulu 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 Honolulu County, HI Medicare coverage that suits your needs.

Ready to find cheap Medicare rates in Honolulu County, HI? Enter your ZIP code to compare Honolulu County, Hawaii Medicare plans today.

Medicare Advantage Companies in Honolulu County, Hawaii

A Medicare Advantage plan in Honolulu County, HI 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 Honolulu County, Hawaii.

Medicare Advantage Companies in Honolulu County, Hawaii

Plan Name Monthly Prem. (Parts C & D) Deductible Additional Gap Coverage Preferred Pharmacy Copay/ Coinsurance 30-Day Supply MOOP for Part A & B Benefits
‘Ohana Liberty (HMO D-SNP) – H2491-004-0 $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: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: 43%, Specialty Tier: 25% n/a
‘Ohana Plus (HMO) – H2491-013-0 $18.80 $445 . Tier 1 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $20.00, Preferred Brand: $47.00, Non-Preferred Drug: 48%, Specialty Tier: 25% $3,400
‘Ohana Value (HMO) – H2491-009-0 $0.00 $100 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $15.00, Preferred Brand: $45.00, Non-Preferred Drug: $100.00, Specialty Tier: 31% $6,700
AARP Medicare Advantage Choice Plan 1 (PPO) – H2228-024-0 $0.00 $300 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $12.00, Preferred Brand: $45.00, Non-Preferred Drug: $95.00, Specialty Tier: 27% $6,700
AARP Medicare Advantage Choice Plan 2 (PPO) – H2228-067-0 $55.00 $150 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $12.00, Preferred Brand: $45.00, Non-Preferred Drug: $95.00, Specialty Tier: 30% $5,100
AARP Medicare Advantage Patriot (PPO) – H2228-025-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $6,700
AlohaCare Advantage Plus (HMO D-SNP) – H5969-002-0 $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% n/a
HMSA Akamai Advantage Complete (PPO) – H3832-009-0 $0.00 $380 . Tier 1 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $4.50, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 25% $6,700
HMSA Akamai Advantage Complete Plus (PPO) – H3832-010-0 $125.00 $0 Yes, some additional gap coverage. Preferred Generic: $4.00, Generic: $11.00, Preferred Brand: $45.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $3,400
HMSA Akamai Advantage Dual Care (PPO D-SNP) – H3832-011-0 $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 n/a
Humana Gold Plus H0028-048 (HMO) – H0028-048-1 $0.00 $250 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $5.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 28% $5,850
Humana Honor (PPO) – H5216-234-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $7,550
HumanaChoice H5216-232 (PPO) – H5216-232-1 $55.00 $150 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $12.00, Preferred Brand: $45.00, Non-Preferred Drug: $100.00, Specialty Tier: 30% $5,350
HumanaChoice H5216-233 (PPO) – H5216-233-1 $0.00 $275 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $5.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 28% $6,700
Kaiser Permanente Senior Advantage Basic (HMO) – H1230-003-0 $78.00 $0 Yes, some additional gap coverage. Preferred Generic: $3.00, Generic: $12.00, Preferred Brand: $45.00, Non-Preferred Brand: $100.00, Specialty Tier: 33%, Vaccines: $0.00 $7,550
Kaiser Permanente Senior Advantage Enhanced (HMO) – H1230-001-0 $176.00 $0 Yes, some additional gap coverage. Preferred Generic: $3.00, Generic: $12.00, Preferred Brand: $45.00, Non-Preferred Brand: $100.00, Specialty Tier: 33%, Vaccines: $0.00 $5,100
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
Senior Advantage Medicare Medicaid (HMO D-SNP) – H1230-008-0 $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, Tier 6: $0.00 n/a
UnitedHealthcare Dual Complete (PPO D-SNP) – H2228-043-0 $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 Dual Complete RP (Regional PPO D-SNP) – R3175-003-0 $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 Tier 1: $0.00, Tier 2: $0.00, Tier 3: $0.00, Tier 4: $0.00, Tier 5: $0.00 n/a

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Medicare Supplement Companies in Honolulu County, Hawaii

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

Medicare Supplement Companies in Honolulu County, Hawaii

Company Plans
AARP – UnitedHealthcare Insurance Company (Level 1) Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L
AARP – UnitedHealthcare Insurance Company (Level 1/Household) Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L
AARP – UnitedHealthcare Insurance Company (Level 2) Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L
AARP – UnitedHealthcare Insurance Company (Level 2/Household) Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L
AARP – UnitedHealthcare Insurance Company (Standard) Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L
AARP – UnitedHealthcare Insurance Company (Standard/Household) Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L
Colonial Penn Life Insurance Company 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
Colonial Penn Life Insurance Company (Substandard) 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
Globe Life and Accident Insurance Company (Direct to Consumer) Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible
Humana (Humana Insurance Company) Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L
Humana (Humana Insurance Company) (Household) Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L
Sentinel Security Life Insurance Company Medigap Plan B,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F
Transamerica Life Insurance Company (Direct) Medigap Plan B,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan M
United American Insurance Company Medigap Plan B,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible
Mutual of Omaha Insurance Company Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible
State Farm Mutual Automobile Insurance Company Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan G
Loyal American Life Insurance Company (CIGNA) Medigap Plan F,
Medigap Plan G
USAA Life Insurance Company Medigap Plan F,
Medigap Plan G

Honolulu County, Hawaii Medicare Supplement Coverage by Plan

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

Honolulu County, Hawaii Medicare Supplement Coverage by Plan

Plan Name Monthly Cost Copays Coinsurance Deductibles Plan Benefits
Medigap Plan A Premiums range from $87-$664 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 $115-$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: No
Part A deductible: Yes
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: No
Medigap Plan C Premiums range from $137-$724 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 $113-$490 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 $137-$813 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 $32-$166 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 $110-$800 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 $32-$158 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 $39-$268 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 $76-$481 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 $94-$576 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 $79-$524 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 Honolulu County, Hawaii

If you’re looking to buy a standalone Honolulu County, HI 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 Honolulu County, Hawaii.

Standalone Medicare Part D plans in Honolulu County, Hawaii

Plan Details Tiers
SilverScript SmartRx (PDP)
S5601 – 208 – 0
by Aetna Medicare
Monthly Premium: $5.70
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 – 057 – 0
by Clear Spring Health
Monthly Premium: $14.90
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 – 202 – 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: $5.00
Tier 3: $40.00
Tier 4: 46%
Tier 5: 25%
Humana Walmart Value Rx Plan (PDP)
S5884 – 212 – 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: 18%
Tier 4: 35%
Tier 5: 25%
WellCare Value Script (PDP)
S4802 – 164 – 0
by WellCare
Monthly Premium: $17.80
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $8.00
Tier 3: $43.00
Tier 4: 49%
Tier 5: 25%
Express Scripts Medicare – Saver (PDP)
S5660 – 249 – 0
by Express Scripts Medicare
Monthly Premium: $21.10
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-Essential Rx (PDP)
S5617 – 312 – 0
by Cigna
Monthly Premium: $22.80
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: 44%
Tier 5: 25%
SilverScript Choice (PDP)
S5601 – 066 – 0
by Aetna Medicare
Monthly Premium: $23.80
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: $35.00
Tier 4: 31%
Tier 5: 25%
Mutual of Omaha Rx Premier (PDP)
S7126 – 102 – 0
by Mutual of Omaha Rx
Monthly Premium: $25.00
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: 21%
Tier 4: 44%
Tier 5: 25%
WellCare Classic (PDP)
S4802 – 095 – 0
by WellCare
Monthly Premium: $25.20
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $8.00
Tier 3: $32.00
Tier 4: 34%
Tier 5: 25%
WellCare Medicare Rx Select (PDP)
S5810 – 308 – 0
by WellCare
Monthly Premium: $25.20
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: $47.00
Tier 4: 42%
Tier 5: 25%
AARP MedicareRx Saver Plus (PDP)
S5921 – 381 – 0
by UnitedHealthcare
Monthly Premium: $26.70
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $8.00
Tier 3: $26.00
Tier 4: 38%
Tier 5: 25%
Clear Spring Health Value Rx (PDP)
S6946 – 028 – 0
by Clear Spring Health
Monthly Premium: $26.70
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: 36%
Tier 5: 25%
WellCare Medicare Rx Saver (PDP)
S5810 – 067 – 0
by WellCare
Monthly Premium: $27.00
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $18.00
Tier 3: $45.00
Tier 4: 33%
Tier 5: 25%
AARP MedicareRx Walgreens (PDP)
S5921 – 414 – 0
by UnitedHealthcare
Monthly Premium: $30.80
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 – 033 – 0
by Elixir Insurance
Monthly Premium: $36.50
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: 30%
Tier 5: 25%
Humana Basic Rx Plan (PDP)
S5884 – 115 – 0
by Humana
Monthly Premium: $40.90
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $1.00
Tier 3: 20%
Tier 4: 35%
Tier 5: 25%
Express Scripts Medicare – Value (PDP)
S5660 – 135 – 0
by Express Scripts Medicare
Monthly Premium: $46.40
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: 50%
Tier 5: 25%
Cigna Secure-Extra Rx (PDP)
S5617 – 278 – 0
by Cigna
Monthly Premium: $50.20
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%
Cigna Secure Rx (PDP)
S5617 – 163 – 0
by Cigna
Monthly Premium: $52.80
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
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%
Express Scripts Medicare – Choice (PDP)
S5660 – 203 – 0
by Express Scripts Medicare
Monthly Premium: $62.30
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: 49%
Tier 5: 31%
Humana Premier Rx Plan (PDP)
S5884 – 179 – 0
by Humana
Monthly Premium: $69.80
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: 47%
Tier 5: 25%
WellCare Medicare Rx Value Plus (PDP)
S5768 – 198 – 0
by WellCare
Monthly Premium: $75.90
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: 47%
Tier 5: 33%
AARP MedicareRx Preferred (PDP)
S5820 – 032 – 0
by UnitedHealthcare
Monthly Premium: $78.20
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 – 032 – 0
by Mutual of Omaha Rx
Monthly Premium: $78.30
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%
SilverScript Plus (PDP)
S5601 – 067 – 0
by Aetna Medicare
Monthly Premium: $84.70
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%

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