Skowhegan, Maine Medicare Companies and Plans (2022)

Skowhegan, Maine 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, Skowhegan, ME supplemental plans are also available. Medicare plans in Skowhegan, Maine are sold by both large national companies and local insurers.

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The Highlights

  • You can buy Medicare supplement coverage in Skowhegan, Maine if you have original Medicare and want coverage for out-of-pocket costs
  • Medicare Advantage plans in Skowhegan, Maine may include prescription drug coverage, or you may need to buy Part D coverage separately
  • Options for Medicare supplement in Skowhegan, Maine include Medigap Plan G and Medigap Plan L

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

Skowhegan, Maine 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 Skowhegan original Medicare plans don’t cover, like coinsurance and deductibles.

Ready to buy Skowhegan, Maine Medicare coverage? Enter your ZIP code to compare Skowhegan, ME Medicare options available to you right now.

Medicare Advantage Companies in Skowhegan, Maine

Medicare Advantage in Skowhegan, Maine 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 Skowhegan, ME 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 Skowhegan, Maine

Plan Name Monthly Prem. (Parts C & D) Deductible Additional Gap Coverage Preferred Pharmacy Copay/ Coinsurance 30-Day Supply MOOP for Part A & B Benefits
AARP Medicare Advantage Choice (Regional PPO) – R5329-001-0 $64.00 $295 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 27% $7,550
AARP Medicare Advantage Choice Plan 1 (PPO) – H2001-018-0 $19.00 $195 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 29% $5,900
Aetna Medicare Assure Plan (HMO-POS D-SNP) – H3597-011-0 $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 Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 29% n/a
Aetna Medicare Explorer Plan (PPO) – H5521-144-0 $59.00 $250 . Tier 1 and 2 exempt Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 28% $7,550
Aetna Medicare Value Plan (HMO) – H3597-009-0 $49.00 $150 . Tier 1, 2 and 3 exempt Yes, some additional gap coverage. Preferred Generic: $5.00, Generic: $7.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 30% $7,550
Anthem l MaineHealth Advantage Access (PPO) – H9219-001-0 $21.00 $400 . Tier 1 and 2 exempt Yes, some additional gap coverage. Preferred Generic: $3.00, Generic: $10.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 25%, Select Care Drugs: $0.00 $5,800
Anthem l MaineHealth Advantage Choice (HMO-POS) – H9065-003-0 $21.00 $0 Yes, some additional gap coverage. Preferred Generic: $4.00, Generic: $10.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $5,500
Anthem l MaineHealth Advantage Dual Plus (HMO D-SNP) – H9065-001-0 $0.00 for people who qualify for both Medicare and Medicaid. $0 for people who qualify for both Medicare and Medicaid. Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $7.00, Preferred Brand: $47.00, Non-Preferred Drug: $95.00, Specialty Tier: 25%, Select Care Drugs: $0.00 n/a
Anthem l MaineHealth Advantage Extra (HMO) – H9065-006-0 $21.10 $275 . Tier 1 exempt Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $16.00, Preferred Brand: $47.00, Non-Preferred Drug: $95.00, Specialty Tier: 28%, Select Care Drugs: $0.00 $4,900
Anthem l MaineHealth Advantage Plus (HMO) – H9065-008-0 $0.00 $0 Yes, some additional gap coverage. Preferred Generic: $4.00, Generic: $10.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $5,500
Humana Gold Plus H5619-066 (HMO) – H5619-066-0 $0.00 $355 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $6.00, Generic: $16.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 26% $7,550
Humana Gold Plus SNP-DE H5619-003 (HMO D-SNP) – H5619-003-0 $0.00 for people who qualify for both Medicare and Medicaid. $0 for people who qualify for both Medicare and Medicaid. No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $19.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 25% n/a
Humana Honor (PPO) – H5216-059-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $4,500
HumanaChoice H5216-175 (PPO) – H5216-175-0 $0.00 $250 . Tier 1, 2 and 3 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $2.00, Generic: $9.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 28% $6,500
HumanaChoice H5216-177 (PPO) – H5216-177-0 $39.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $2.00, Generic: $8.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $5,500
Martin’s Point Generations Advantage Alliance (HMO) – H5591-003-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $5,000
Martin’s Point Generations Advantage Flex (Regional PPO) – R0802-001-0 $53.00 $275 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $2.00, Generic: $10.00, Preferred Brand: $40.00, Non-Preferred Drug: $95.00, Specialty Tier: 28% $5,500
Martin’s Point Generations Advantage Prime (HMO-POS) – H5591-001-0 $89.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $40.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $6,850
Martin’s Point Generations Advantage Select (PPO) – H1365-002-0 $99.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $40.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $7,300
Martin’s Point Generations Advantage Value Plus (HMO) – H5591-009-0 $29.00 $275 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $40.00, Non-Preferred Drug: $95.00, Specialty Tier: 28% $7,550
UnitedHealthcare Dual Complete (PPO D-SNP) – H0271-020-0 $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
WellCare Access (HMO D-SNP) – H9364-002-0 $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 Preferred Generic: $0.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: 47%, Specialty Tier: 25% n/a
WellCare Liberty (HMO D-SNP) – H9364-003-0 $0.00 for people who qualify for both Medicare and Medicaid. $0 for people who qualify for both Medicare and Medicaid. No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $8.00, Preferred Brand: $45.00, Non-Preferred Drug: 50%, Specialty Tier: 25% n/a
WellCare Today’s Options Advantage Plus 550B (PPO) – H2775-109-0 $0.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $4.00, Preferred Brand: $37.00, Non-Preferred Drug: $90.00, Specialty Tier: 33% $4,000
WellCare Today’s Options Premier 200 (PFFS) – H2816-039-0 $55.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. n/a
WellCare Today’s Options Premier 300 (PFFS) – H2816-040-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. n/a
WellCare Value (HMO) – H9364-001-0 $0.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: 42%, Specialty Tier: 33% $6,700

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Medicare Supplement Companies in Skowhegan, Maine

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

Company Plans
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
Anthem Blue Cross Blue Shield – Maine Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Colonial Penn Life Insurance Company Medigap Plan A,
Medigap Plan B,
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 A,
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
Harvard Pilgrim Health Care Inc. Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan M,
Medigap Plan N
Humana (Humana Insurance Company) Medigap Plan A,
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 A,
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 Healthy Living (Humana Insurance Company) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan K,
Medigap Plan N
Humana Healthy Living (Humana Insurance Company) (Household) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan K,
Medigap Plan N
Loyal American Life Insurance Company (CIGNA) Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
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
Transamerica Life Insurance Company (Direct) Medigap Plan A,
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
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 of Omaha Life Insurance Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan M

Skowhegan, Maine Standard Medicare Plan Coverage

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

Skowhegan, Maine Standard Medicare Plan Coverage

Plan Name Monthly Cost Copays Coinsurance Deductibles Plan Benefits
Medigap Plan A Premiums range from $150-$363 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 $198-$424 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 $235-$471 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 $199-$272 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 $222-$480 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 $47-$132 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 $199-$473 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 $47-$109 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 $73-$221 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 $133-$283 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 $172-$381 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 $158-$314 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 Skowhegan, Maine

Prescription drug coverage for Medicare in Skowhegan, Maine is covered by a Part D plan. You can purchase Part D coverage in Skowhegan, Maine 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 Skowhegan, Maine

Plan Details Tiers
SilverScript SmartRx (PDP)
S5601 – 176 – 0
by Aetna Medicare
Monthly Premium: $7.10
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: 49%
Tier 5: 25%
Elixir RxPlus (PDP)
S7694 – 124 – 0
by Elixir Insurance
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: $6.00
Tier 3: $43.00
Tier 4: 45%
Tier 5: 25%
WellCare Wellness Rx (PDP)
S4802 – 170 – 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: $6.00
Tier 3: $40.00
Tier 4: 46%
Tier 5: 25%
Humana Walmart Value Rx Plan (PDP)
S5884 – 181 – 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: 19%
Tier 4: 35%
Tier 5: 25%
WellCare Value Script (PDP)
S4802 – 136 – 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%
Anthem MediBlue Rx Enhanced (PDP)
S5596 – 066 – 0
by Anthem MediBlue Rx (PDP)
Monthly Premium: $19.60
Annual Deductable: $350
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $0.00
Tier 2: $2.00
Tier 3: 20%
Tier 4: 38%
Tier 5: 26%
Mutual of Omaha Rx Premier (PDP)
S7126 – 071 – 0
by Mutual of Omaha Rx
Monthly Premium: $23.90
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $2.00
Tier 3: 23%
Tier 4: 44%
Tier 5: 25%
Cigna Secure-Essential Rx (PDP)
S5617 – 280 – 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: 49%
Tier 5: 25%
WellCare Medicare Rx Select (PDP)
S5810 – 296 – 0
by WellCare
Monthly Premium: $24.70
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 – Value (PDP)
S5660 – 104 – 0
by Express Scripts Medicare
Monthly Premium: $25.30
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: $24.00
Tier 4: 50%
Tier 5: 25%
Express Scripts Medicare – Saver (PDP)
S5660 – 218 – 0
by Express Scripts Medicare
Monthly Premium: $25.80
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%
SilverScript Choice (PDP)
S5601 – 002 – 0
by Aetna Medicare
Monthly Premium: $26.30
Annual Deductable: $305
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: 44%
Tier 5: 27%
WellCare Classic (PDP)
S4802 – 075 – 0
by WellCare
Monthly Premium: $26.70
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: 33%
Tier 5: 25%
AARP MedicareRx Saver Plus (PDP)
S5921 – 378 – 0
by UnitedHealthcare
Monthly Premium: $27.40
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: $33.00
Tier 4: 40%
Tier 5: 25%
Humana Basic Rx Plan (PDP)
S5884 – 101 – 0
by Humana
Monthly Premium: $27.80
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $1.00
Tier 3: 20%
Tier 4: 35%
Tier 5: 25%
Elixir RxSecure (PDP)
S7694 – 001 – 0
by Elixir Insurance
Monthly Premium: $28.50
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: 32%
Tier 5: 25%
Cigna Secure Rx (PDP)
S5617 – 003 – 0
by Cigna
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: $2.00
Tier 3: $33.00
Tier 4: 50%
Tier 5: 25%
WellCare Medicare Rx Saver (PDP)
S5810 – 035 – 0
by WellCare
Monthly Premium: $35.50
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $5.00
Tier 3: $36.00
Tier 4: 41%
Tier 5: 25%
AARP MedicareRx Walgreens (PDP)
S5921 – 384 – 0
by UnitedHealthcare
Monthly Premium: $36.40
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%
Cigna Secure-Extra Rx (PDP)
S5617 – 246 – 0
by Cigna
Monthly Premium: $53.90
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%
Anthem MediBlue Rx Standard (PDP)
S5596 – 046 – 0
by Anthem MediBlue Rx (PDP)
Monthly Premium: $57.80
Annual Deductable: $395
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $2.00
Tier 3: $36.00
Tier 4: 31%
Tier 5: 25%
Anthem MediBlue Rx Plus (PDP)
S5596 – 001 – 0
by Anthem MediBlue Rx (PDP)
Monthly Premium: $60.70
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%
Express Scripts Medicare – Choice (PDP)
S5660 – 172 – 0
by Express Scripts Medicare
Monthly Premium: $65.40
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%
SilverScript Plus (PDP)
S5601 – 003 – 0
by Aetna Medicare
Monthly Premium: $66.80
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%
Humana Premier Rx Plan (PDP)
S5884 – 148 – 0
by Humana
Monthly Premium: $68.30
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%
WellCare Medicare Rx Value Plus (PDP)
S5768 – 125 – 0
by WellCare
Monthly Premium: $75.60
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%
AARP MedicareRx Preferred (PDP)
S5820 – 001 – 0
by UnitedHealthcare
Monthly Premium: $81.80
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 – 001 – 0
by Mutual of Omaha Rx
Monthly Premium: $99.40
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: 36%
Tier 5: 25%

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