McCook County, South Dakota Medicare Companies and Plans (2022)

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

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The Highlights

  • Medicare Advantage plans in McCook County, South Dakota may include dental, vision, and hearing coverage
  • Medicare supplement plans in McCook County are designed to cover out-of-pocket costs not paid for by original Medicare
  • McCook County residents can buy Medicare Advantage or choose original Medicare

McCook County, South Dakota 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 McCook 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 McCook County, SD Medicare coverage that suits your needs.

Ready to find cheap Medicare rates in McCook County, SD? Enter your ZIP code to compare McCook County, South Dakota Medicare plans today.

Medicare Advantage Companies in McCook County, South Dakota

A Medicare Advantage plan in McCook County, SD 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 McCook County, South Dakota.

Medicare Advantage Companies in McCook County, 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
Aetna Medicare Elite (PPO) – H1608-043-0 $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% $4,900
Aetna Medicare Premier (PPO) – H1608-001-0 $0.00 $0 Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $5,100
Aetna Medicare Prime (PPO) – H1608-004-0 $0.00 $0 Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $5,400
Great Plain Medicare Advantage Gold (HMO I-SNP) – H1787-002-0 $175.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $4.00, Generic: $15.00, Preferred Brand: $45.00, Non-Preferred Brand: $95.00, Specialty Tier: 33% n/a
Great Plains Medicare Advantage (HMO I-SNP) – H1787-001-0 $38.00 $445 No additional gap coverage, only the Donut Hole Discount Tier 1: 25% n/a
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 McCook County, South Dakota

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

Medicare Supplement Companies in McCook County, 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

McCook County, South Dakota Medicare Supplement Coverage by Plan

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

McCook County, South Dakota Medicare Supplement Coverage by Plan

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 McCook County, South Dakota

If you’re looking to buy a standalone McCook County, SD 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 McCook County, South Dakota.

Standalone Medicare Part D plans in McCook County, 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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