Hot Springs, South Dakota Medicare Companies and Plans (2021)

Hot Springs, South Dakota 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, Hot Springs, SD supplemental plans are also available. Medicare plans in Hot Springs, South Dakota are sold by both large national companies and local insurers.

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UPDATED: Oct 13, 2021

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The Highlights

  • Medicare Advantage plans are available in Hot Springs with both PPO and HMO networks
  • Options for Medicare supplement in Hot Springs, South Dakota include Medigap Plan K and Medigap Plan M
  • You can buy Medicare supplement coverage in Hot Springs, South Dakota if you have original Medicare and want coverage for out-of-pocket costs

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

Hot Springs, South Dakota 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 Hot Springs original Medicare plans don’t cover, like coinsurance and deductibles.

Ready to buy Hot Springs, South Dakota Medicare coverage? Enter your ZIP code to compare Hot Springs, SD Medicare options available to you right now.

Medicare Advantage Companies in Hot Springs, South Dakota

Medicare Advantage in Hot Springs, South Dakota 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 Hot Springs, SD 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 Hot Springs, South Dakota

Plan Name Monthly Prem. (Parts C & D) Deductible Additional Gap Coverage Preferred Pharmacy Copay/ Coinsurance 30-Day Supply MOOP for Part A & B Benefits
Humana Honor (PPO) – H5216-086-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $6,700
Humana Value Plus H5216-171 (PPO) – H5216-171-0 $27.80 $305 . Tier 1 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
HumanaChoice H5216-088 (PPO) – H5216-088-0 $67.00 $350 . Tier 1, 2 and 3 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: 26% $6,700
HumanaChoice H5216-103 (PPO) – H5216-103-0 $115.00 $250 . 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: 28% $3,500
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
Medica Prime Solution Core (Cost) – H2450-034-0 $79.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $4,000
Medica Prime Solution Core w/Rx (Cost) – H2450-035-0 $132.00 $445 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $1.00, Generic: $8.00, Preferred Brand: $30.00, Non-Preferred Drug: 50%, Specialty Tier: 25% $4,000
Medica Prime Solution Premier (Cost) – H2450-036-0 $189.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $3,000
Medica Prime Solution Premier w/Rx (Cost) – H2450-037-0 $250.60 $445 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $7.00, Preferred Brand: $28.00, Non-Preferred Drug: 50%, Specialty Tier: 25% $3,000
Medica Prime Solution Standard (Cost) – H2450-044-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $4,500
Medica Prime Solution Standard w/Rx (Cost) – H2450-049-0 $30.90 $445 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: 50%, Specialty Tier: 25% $4,500
Medica Prime Solution Thrift (Cost) – H2450-030-0 $34.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $6,700
Medica Prime Solution Thrift w/Rx (Cost) – H2450-007-0 $73.20 $445 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $38.00, Non-Preferred Drug: 50%, Specialty Tier: 25% $6,700

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Medicare Supplement Companies in Hot Springs, South Dakota

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

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,
Medigap Plan N
AARP – UnitedHealthcare Insurance Company (Level 2) 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 B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
American Continental Insurance Company (Aetna) Medigap Plan B,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
Avera Health Plans, Inc. Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
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,
Medigap Plan N
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,
Medigap Plan N
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,
Medigap Plan N
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,
Medigap Plan N
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,
Medigap Plan N
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,
Medigap Plan N
United American Insurance Company Medigap Plan B,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
United Commercial Travelers of America Medigap Plan B,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
United States Fire Insurance Company Medigap Plan B,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
Central States Health and Life Co. of Omaha Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Everence Association Inc. Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan L,
Medigap Plan N
Sanford Health Plan Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
State Farm Mutual Automobile Insurance Company Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
United Insurance Company of America Medigap Plan D,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Wellmark BlueCross BlueShield of South Dakota (Preferred) Medigap Plan D,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Wellmark BlueCross BlueShield of South Dakota (Preferred/Household) Medigap Plan D,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Wellmark BlueCross BlueShield of South Dakota (Standard) Medigap Plan D,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Wellmark BlueCross BlueShield of South Dakota (Standard/Household) Medigap Plan D,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Accendo Insurance Company Medigap Plan F,
Medigap Plan G,
Medigap Plan N
American Financial Security Life Insurance Company Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Assured Life Association Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Bankers Fidelity Life Insurance Company (Preferred) Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan K,
Medigap Plan N
Bankers Fidelity Life Insurance Company (Standard) Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan K,
Medigap Plan N
Capitol Life Insurance Company Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Catholic United Financial Medigap Plan F,
Medigap Plan G
Cigna National Health Insurance Company Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Cigna National Health Insurance Company (Standard II w/ 15% HHD) Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Cigna National Health Insurance Company (Standard II w/ 6% HHD) Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Cigna National Health Insurance Company (Standard II) Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Cigna National Health Insurance Company (Standard III w/ 15% HHD) Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Cigna National Health Insurance Company (Standard III w/ 6% HHD) Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Cigna National Health Insurance Company (Standard III) Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Cigna National Health Insurance Company (w/ 15% HHD) Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Cigna National Health Insurance Company (w/ 6% HHD) Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Combined Insurance Company of America Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Elips Life Insurance Company Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Garden State Life Insurance Company Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan M,
Medigap Plan N
Great Southern Life Insurance Company Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
Great Southern Life Insurance Company (Class 1) Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
Guarantee Trust Life Insurance Company Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Manhattan Life Assurance Company Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Medica Insurance Company Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Nassau Life Insurance Company Medigap Plan F,
Medigap Plan G,
Medigap Plan N
National Guardian Life Insurance Company Medigap Plan F,
Medigap Plan G,
Medigap Plan N
National Health Insurance Company Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
National Health Insurance Company (Household) Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
Omaha Insurance Company Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Oxford Life Insurance Company Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Philadelphia American Life Insurance Company Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Physicians Life Insurance Company (Attained Age) Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible
Physicians Life Insurance Company (Innovative/Attained Age) Medigap Plan F,
Medigap Plan G
Physicians Life Insurance Company (Innovative/Issue Age) Medigap Plan F,
Medigap Plan G
Physicians Life Insurance Company (Issue Age) Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible
Puritan Life Insurance Company of America Medigap Plan F,
Medigap Plan G,
Medigap Plan N
USAA Life Insurance Company Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Union Security Insurance Company Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Heartland National Life Insurance Company Medigap Plan G,
Medigap Plan N

Hot Springs, South Dakota Standard Medicare Plan Coverage

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

Hot Springs, South Dakota Standard Medicare Plan Coverage

Plan Name Monthly Cost Copays Coinsurance Deductibles Plan Benefits
Medigap Plan A Premiums range from $82-$1,012 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 $114-$586 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 $135-$694 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 $109-$640 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 $118-$1,420 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 $29-$185 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 $93-$1,165 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 $28-$169 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 $46-$248 depending on your age, sex, health status, and when you buy. 10% Generally your cost for approved Part B services up to $6,220. Then, you’ll pay $0 for the rest of the year. $742 (50% of Part A deductible) Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: No
Medigap Plan L Premiums range from $63-$492 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 $98-$571 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 $74-$923 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 Hot Springs, South Dakota

Prescription drug coverage for Medicare in Hot Springs, South Dakota is covered by a Part D plan. You can purchase Part D coverage in Hot Springs, South Dakota 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 Hot Springs, South Dakota

Plan Details Tiers
SilverScript SmartRx (PDP)
S5601 – 200 – 0
by Aetna Medicare
Monthly Premium: $7.30
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 – 051 – 0
by Clear Spring Health
Monthly Premium: $14.30
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%
WellCare Wellness Rx (PDP)
S4802 – 194 – 0
by WellCare
Monthly Premium: $15.30
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $4.00
Tier 3: $40.00
Tier 4: 47%
Tier 5: 25%
WellCare Value Script (PDP)
S4802 – 158 – 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: $7.00
Tier 3: $43.00
Tier 4: 47%
Tier 5: 25%
Humana Walmart Value Rx Plan (PDP)
S5884 – 204 – 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: 35%
Tier 5: 25%
Cigna Secure-Essential Rx (PDP)
S5617 – 304 – 0
by Cigna
Monthly Premium: $22.90
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: 50%
Tier 5: 25%
Mutual of Omaha Rx Premier (PDP)
S7126 – 094 – 0
by Mutual of Omaha Rx
Monthly Premium: $23.00
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: 46%
Tier 5: 25%
WellCare Medicare Rx Select (PDP)
S5810 – 302 – 0
by WellCare
Monthly Premium: $23.40
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%
Express Scripts Medicare – Saver (PDP)
S5660 – 241 – 0
by Express Scripts Medicare
Monthly Premium: $25.20
Annual Deductable: $285
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $2.00
Tier 2: $7.00
Tier 3: $35.00
Tier 4: 50%
Tier 5: 28%
WellCare Classic (PDP)
S4802 – 089 – 0
by WellCare
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: $3.00
Tier 3: $31.00
Tier 4: 33%
Tier 5: 25%
Clear Spring Health Value Rx (PDP)
S6946 – 022 – 0
by Clear Spring Health
Monthly Premium: $29.30
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: $42.00
Tier 4: 34%
Tier 5: 25%
AARP MedicareRx Saver Plus (PDP)
S5921 – 370 – 0
by UnitedHealthcare
Monthly Premium: $32.10
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $6.00
Tier 3: $34.00
Tier 4: 40%
Tier 5: 25%
Cigna Secure Rx (PDP)
S5617 – 123 – 0
by Cigna
Monthly Premium: $33.70
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%
SilverScript Choice (PDP)
S5601 – 050 – 0
by Aetna Medicare
Monthly Premium: $33.90
Annual Deductable: $240
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: 46%
Tier 5: 28%
Humana Basic Rx Plan (PDP)
S5884 – 145 – 0
by Humana
Monthly Premium: $34.90
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: 31%
Tier 5: 25%
AARP MedicareRx Walgreens (PDP)
S5921 – 406 – 0
by UnitedHealthcare
Monthly Premium: $35.60
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%
WellCare Medicare Rx Saver (PDP)
S5810 – 059 – 0
by WellCare
Monthly Premium: $36.50
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $3.00
Tier 3: $33.00
Tier 4: 39%
Tier 5: 25%
Cigna Secure-Extra Rx (PDP)
S5617 – 270 – 0
by Cigna
Monthly Premium: $49.20
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%
Express Scripts Medicare – Value (PDP)
S5660 – 127 – 0
by Express Scripts Medicare
Monthly Premium: $49.70
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $3.00
Tier 3: $41.00
Tier 4: 50%
Tier 5: 25%
Elixir RxPlus (PDP)
S7694 – 025 – 0
by Elixir Insurance
Monthly Premium: $54.90
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: 33%
Tier 5: 25%
Humana Premier Rx Plan (PDP)
S5884 – 171 – 0
by Humana
Monthly Premium: $60.80
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: 49%
Tier 5: 25%
MedicareBlue Rx Standard (PDP)
S5743 – 001 – 0
by Wellmark Blue Cross and Blue Shield of Iowa
Monthly Premium: $66.40
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: $29.00
Tier 4: 31%
Tier 5: 25%
SilverScript Plus (PDP)
S5601 – 051 – 0
by Aetna Medicare
Monthly Premium: $70.20
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%
Mutual of Omaha Rx Plus (PDP)
S7126 – 024 – 0
by Mutual of Omaha Rx
Monthly Premium: $75.10
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: 20%
Tier 4: 37%
Tier 5: 25%
WellCare Medicare Rx Value Plus (PDP)
S5768 – 148 – 0
by WellCare
Monthly Premium: $76.70
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%
Express Scripts Medicare – Choice (PDP)
S5660 – 195 – 0
by Express Scripts Medicare
Monthly Premium: $81.00
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%
AARP MedicareRx Preferred (PDP)
S5820 – 024 – 0
by UnitedHealthcare
Monthly Premium: $86.50
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%
MedicareBlue Rx Premier (PDP)
S5743 – 004 – 0
by Wellmark Blue Cross and Blue Shield of Iowa
Monthly Premium: $104.70
Annual Deductable: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $0.00
Tier 2: $0.00
Tier 3: 17%
Tier 4: 40%
Tier 5: 33%

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