San Benito County, California Medicare Companies and Plans (2021)

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

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Leslie Kasperowicz holds a BA in Social Sciences from the University of Winnipeg. She spent several years as a Farmers Insurance CSR, gaining a solid understanding of insurance products including home, life, auto, and commercial and working directly with insurance customers to understand their needs. She has since used that knowledge in her more than ten years as a writer, largely in the insuranc...

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Reviewed by Leslie Kasperowicz
Farmers CSR for 4 Years

UPDATED: Oct 12, 2021

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The Highlights

  • San Benito County residents can buy Medicare Advantage or choose original Medicare
  • Medicare Advantage plans in San Benito County, California may include dental, vision, and hearing coverage
  • Standalone Medicare Part D plans in San Benito County can help cover the cost of prescriptions

San Benito County, California 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 San Benito 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 San Benito County, CA Medicare coverage that suits your needs.

Ready to find cheap Medicare rates in San Benito County, CA? Enter your ZIP code to compare San Benito County, California Medicare plans today.

Medicare Advantage Companies in San Benito County, California

A Medicare Advantage plan in San Benito County, CA 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 San Benito County, California.

Medicare Advantage Companies in San Benito County, California

Plan Name Monthly Prem. (Parts C & D) Deductible Additional Gap Coverage Preferred Pharmacy Copay/ Coinsurance 30-Day Supply MOOP for Part A & B Benefits
Anthem MediBlue Connect Plus (HMO) – H0544-122-2 $23.50 $445 . Tier 1 exempt Yes, some additional gap coverage. Preferred Generic: 25%, Generic: 25%, Preferred Brand: 25%, Non-Preferred Drug: 25%, Specialty Tier: 25%, Select Care Drugs: $0.00 $7,550
Anthem MediBlue Diabetes (HMO C-SNP) – H0544-118-1 $55.00 $0 Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $7.50, Preferred Brand: $40.00, Non-Preferred Drug: $85.00, Specialty Tier: 33%, Select Care Drugs: $0.00 n/a
Anthem MediBlue Heart (HMO C-SNP) – H0544-119-1 $55.00 $0 Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $7.50, Preferred Brand: $40.00, Non-Preferred Drug: $85.00, Specialty Tier: 33%, Select Care Drugs: $0.00 n/a
Anthem MediBlue Lung (HMO C-SNP) – H0544-117-2 $55.00 $0 Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $7.50, Preferred Brand: $40.00, Non-Preferred Drug: $85.00, Specialty Tier: 33%, Select Care Drugs: $0.00 n/a
Anthem MediBlue StartSmart Plus (HMO) – H0544-121-1 $0.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $5.00, Generic: $12.50, Preferred Brand: $40.00, Non-Preferred Drug: $90.00, Specialty Tier: 33%, Select Care Drugs: $10.00 $3,450
Anthem MediBlue Value Plus (HMO) – H0544-120-1 $60.00 $0 Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $9.50, Preferred Brand: $40.00, Non-Preferred Drug: $85.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $3,000

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Medicare Supplement Companies in San Benito County, California

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

Medicare Supplement Companies in San Benito County, California

Company Plans
AARP – UnitedHealthcare Insurance Company (Level 2) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
AARP – UnitedHealthcare Insurance Company (Level 2/Household) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
AARP – UnitedHealthcare Insurance Company (Standard) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
AARP – UnitedHealthcare Insurance Company (Standard/Household) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
Accendo Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Anthem BlueCross – California Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Blue Shield of California Life & Health Insurance Company Medigap Plan A,
Medigap Plan G,
Medigap Plan N
Cigna Health & Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
Cigna Health & Life Insurance Company (w/ 11% HHD) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
Cigna Health & Life Insurance Company (w/ 6% HHD) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
Combined Insurance Company of America Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Continental Life Insurance Company of Brentwood, Tennessee (Aetna) Medigap Plan A,
Medigap Plan B,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
Everence Association Inc. Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Garden State Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan M,
Medigap Plan N
Globe Life and Accident Insurance Company (Direct to Consumer) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Health Net Life Insurance Company (Not Los Angeles and San Diego) Medigap Plan A,
Medigap Plan D,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
Humana (Humana Insurance Company) Medigap Plan A,
Medigap Plan A,
Medigap Plan B,
Medigap Plan B,
Medigap Plan C,
Medigap Plan C,
Medigap Plan F,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan K,
Medigap Plan L,
Medigap Plan L,
Medigap Plan N,
Medigap Plan N
Humana Achieve (Humana Benefit Plan of Illinois, Inc. dba Humana Benefit Insurance Plan of Illinois, Inc.) Medigap Plan A,
Medigap Plan A,
Medigap Plan F,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan G-high deductible,
Medigap Plan N,
Medigap Plan N
Humana Achieve (Humana Benefit Plan of Illinois, Inc. dba Humana Benefit Insurance Plan of Illinois, Inc.) (Household) Medigap Plan A,
Medigap Plan A,
Medigap Plan F,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan G-high deductible,
Medigap Plan N,
Medigap Plan N
Independence American Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
National Guardian Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
National Health Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
National Health Insurance Company (Household) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
Oxford Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Sentinel Security Life Insurance Company Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan N
State Farm Mutual Automobile Insurance Company Medigap Plan A,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
USAA Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
United American Insurance Company Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
United World Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Anthem BlueCross – California (Innovative) Medigap Plan F
Blue Shield of California Life & Health Insurance Company (Plan F Extra) Medigap Plan F
Health Net Life Insurance Company (Innovative F/Not Los Angeles and San Diego) Medigap Plan F
Blue Shield of California Life & Health Insurance Company (Plan G Extra) Medigap Plan G
Blue Shield of California Life & Health Insurance Company (Plan G Inspire) Medigap Plan G
Health Net Life Insurance Company (Innovative G/Not Los Angeles and San Diego) Medigap Plan G

San Benito County, California Medicare Supplement Coverage by Plan

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

San Benito County, California Medicare Supplement Coverage by Plan

Plan Name Monthly Cost Copays Coinsurance Deductibles Plan Benefits
Medigap Plan A Premiums range from $97-$902 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services $1,484 Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: No
Part A deductible: No
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: No
Medigap Plan B Premiums range from $151-$576 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services $0 Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: No
Part A deductible: Yes
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: No
Medigap Plan C Premiums range from $178-$735 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services $0 Hospital (Part A) deductible,
$0 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: Yes
Part B excess charges: No
Foreign travel emergency: Yes
Medigap Plan D Premiums range from $128-$575 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services $0 Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: Yes
Medigap Plan F Premiums range from $177-$1,104 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services $0 Hospital (Part A) deductible,
$0 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: Yes
Part B excess charges: Yes
Foreign travel emergency: Yes
Medigap Plan F-high deductible Premiums range from $40-$208 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services after you pay $2,370 deductible $2,370 total plan deductible.
After, you pay: $0 Hospital (Part A) deductible,
$0 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: Yes
Part B excess charges: Yes
Foreign travel emergency: Yes
Medigap Plan G Premiums range from $128-$961 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services $0 Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: No
Part B excess charges: Yes
Foreign travel emergency: Yes
Medigap Plan G-high deductible Premiums range from $37-$207 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services after you pay $2,370 deductible $2,370 total plan deductible.
After, you pay: $0 Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: No
Part B excess charges: Yes
Foreign travel emergency: Yes
Medigap Plan K Premiums range from $55-$307 depending on your age, sex, health status, and when you buy. 10% Generally your cost for approved Part B services up to $6,220. Then, you’ll pay $0 for the rest of the year. $742 (50% of Part A deductible) Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: No
Medigap Plan L Premiums range from $100-$447 depending on your age, sex, health status, and when you buy. 5% Generally your cost for approved Part B services up to $3,110. Then, you’ll pay $0 for the rest of the year. $371 (25% of Part A deductible) Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: No
Medigap Plan M Premiums range from $177-$514 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services $742 (50% of Part A deductible) Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: Yes
Medigap Plan N Premiums range from $98-$737 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services with some $20 and $50 copays $0 Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: Yes

Standalone Medicare Part D Plans in San Benito County, California

If you’re looking to buy a standalone San Benito County, CA 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 San Benito County, California.

Standalone Medicare Part D plans in San Benito County, California

Plan Details Tiers
SilverScript SmartRx (PDP)
S5601 – 207 – 0
by Aetna Medicare
Monthly Premium: $7.20
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $19.00
Tier 3: $46.00
Tier 4: 48%
Tier 5: 25%
Clear Spring Health Premier Rx (PDP)
S6946 – 056 – 0
by Clear Spring Health
Monthly Premium: $13.30
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $3.00
Tier 3: $40.00
Tier 4: 45%
Tier 5: 25%
Elixir RxPlus (PDP)
S7694 – 137 – 0
by Elixir Insurance
Monthly Premium: $15.10
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $6.00
Tier 3: $43.00
Tier 4: 45%
Tier 5: 25%
WellCare Wellness Rx (PDP)
S4802 – 201 – 0
by WellCare
Monthly Premium: $15.20
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $5.00
Tier 3: $40.00
Tier 4: 46%
Tier 5: 25%
Humana Walmart Value Rx Plan (PDP)
S5884 – 211 – 0
by Humana
Monthly Premium: $17.20
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $4.00
Tier 3: 17%
Tier 4: 35%
Tier 5: 25%
WellCare Value Script (PDP)
S4802 – 163 – 0
by WellCare
Monthly Premium: $17.20
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $7.00
Tier 3: $43.00
Tier 4: 47%
Tier 5: 25%
Cigna Secure-Essential Rx (PDP)
S5617 – 311 – 0
by Cigna
Monthly Premium: $24.00
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $2.00
Tier 3: 18%
Tier 4: 43%
Tier 5: 25%
Mutual of Omaha Rx Premier (PDP)
S7126 – 101 – 0
by Mutual of Omaha Rx
Monthly Premium: $24.00
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $2.00
Tier 3: 23%
Tier 4: 44%
Tier 5: 25%
Anthem Blue Cross MediBlue Rx Enhanced (PDP)
S5596 – 076 – 0
by Anthem Blue Cross MediBlue Rx (PDP)
Monthly Premium: $26.10
Annual Deductable: $300
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $0.00
Tier 2: $2.00
Tier 3: 20%
Tier 4: 39%
Tier 5: 26%
Express Scripts Medicare – Saver (PDP)
S5660 – 248 – 0
by Express Scripts Medicare
Monthly Premium: $26.50
Annual Deductable: $285
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $2.00
Tier 2: $7.00
Tier 3: $35.00
Tier 4: 50%
Tier 5: 28%
Cigna Secure Rx (PDP)
S5617 – 158 – 0
by Cigna
Monthly Premium: $27.70
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $2.00
Tier 3: $30.00
Tier 4: 50%
Tier 5: 25%
WellCare Medicare Rx Select (PDP)
S5810 – 295 – 0
by WellCare
Monthly Premium: $28.30
Annual Deductable: $385
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $3.00
Tier 3: $47.00
Tier 4: 42%
Tier 5: 26%
AARP MedicareRx Saver Plus (PDP)
S5921 – 376 – 0
by UnitedHealthcare
Monthly Premium: $29.20
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $5.00
Tier 3: $25.00
Tier 4: 40%
Tier 5: 25%
Clear Spring Health Value Rx (PDP)
S6946 – 027 – 0
by Clear Spring Health
Monthly Premium: $29.50
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $3.00
Tier 3: $42.00
Tier 4: 35%
Tier 5: 25%
SilverScript Choice (PDP)
S5601 – 064 – 0
by Aetna Medicare
Monthly Premium: $29.50
Annual Deductable: $250
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $5.00
Tier 3: $35.00
Tier 4: 39%
Tier 5: 28%
WellCare Classic (PDP)
S4802 – 094 – 0
by WellCare
Monthly Premium: $30.10
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $2.00
Tier 3: $30.00
Tier 4: 35%
Tier 5: 25%
Cigna Secure-Extra Rx (PDP)
S5617 – 277 – 0
by Cigna
Monthly Premium: $30.30
Annual Deductable: $100
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $4.00
Tier 2: $10.00
Tier 3: $42.00
Tier 4: 49%
Tier 5: 31%
Humana Basic Rx Plan (PDP)
S5884 – 114 – 0
by Humana
Monthly Premium: $30.30
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $1.00
Tier 3: 20%
Tier 4: 32%
Tier 5: 25%
Elixir RxSecure (PDP)
S7694 – 032 – 0
by Elixir Insurance
Monthly Premium: $30.80
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $7.00
Tier 3: 15%
Tier 4: 29%
Tier 5: 25%
WellCare Medicare Rx Saver (PDP)
S5810 – 066 – 0
by WellCare
Monthly Premium: $37.10
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $2.00
Tier 3: $36.00
Tier 4: 39%
Tier 5: 25%
AARP MedicareRx Walgreens (PDP)
S5921 – 413 – 0
by UnitedHealthcare
Monthly Premium: $41.60
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $6.00
Tier 3: $40.00
Tier 4: 40%
Tier 5: 25%
Blue Shield Rx Plus (PDP)
S2468 – 003 – 0
by Blue Shield of California
Monthly Premium: $59.00
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $2.00
Tier 2: $6.00
Tier 3: $39.00
Tier 4: 41%
Tier 5: 25%
Express Scripts Medicare – Value (PDP)
S5660 – 134 – 0
by Express Scripts Medicare
Monthly Premium: $61.00
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $3.00
Tier 3: $30.00
Tier 4: 50%
Tier 5: 25%
Humana Premier Rx Plan (PDP)
S5884 – 178 – 0
by Humana
Monthly Premium: $72.50
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $4.00
Tier 3: $45.00
Tier 4: 49%
Tier 5: 25%
Anthem Blue Cross MediBlue Rx Plus (PDP)
S5596 – 034 – 0
by Anthem Blue Cross MediBlue Rx (PDP)
Monthly Premium: $79.90
Annual Deductable: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $3.00
Tier 3: $43.00
Tier 4: 45%
Tier 5: 33%
WellCare Medicare Rx Value Plus (PDP)
S5768 – 155 – 0
by WellCare
Monthly Premium: $81.00
Annual Deductable: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $4.00
Tier 3: $47.00
Tier 4: 44%
Tier 5: 33%
SilverScript Plus (PDP)
S5601 – 065 – 0
by Aetna Medicare
Monthly Premium: $81.60
Annual Deductable: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $0.00
Tier 2: $2.00
Tier 3: $47.00
Tier 4: 45%
Tier 5: 33%
Anthem Blue Cross MediBlue Rx Standard (PDP)
S5596 – 033 – 0
by Anthem Blue Cross MediBlue Rx (PDP)
Monthly Premium: $84.20
Annual Deductable: $390
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $2.00
Tier 3: $32.00
Tier 4: 27%
Tier 5: 25%
Express Scripts Medicare – Choice (PDP)
S5660 – 202 – 0
by Express Scripts Medicare
Monthly Premium: $84.90
Annual Deductable: $100
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $2.00
Tier 2: $7.00
Tier 3: $42.00
Tier 4: 49%
Tier 5: 31%
AARP MedicareRx Preferred (PDP)
S5820 – 031 – 0
by UnitedHealthcare
Monthly Premium: $99.30
Annual Deductable: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $5.00
Tier 2: $10.00
Tier 3: $45.00
Tier 4: 40%
Tier 5: 33%
Mutual of Omaha Rx Plus (PDP)
S7126 – 031 – 0
by Mutual of Omaha Rx
Monthly Premium: $100.00
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $2.00
Tier 3: 20%
Tier 4: 35%
Tier 5: 25%
Blue Shield Rx Enhanced (PDP)
S2468 – 004 – 0
by Blue Shield of California
Monthly Premium: $130.40
Annual Deductable: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $2.00
Tier 2: $7.00
Tier 3: $43.00
Tier 4: 33%
Tier 5: 33%

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