Wright City, Missouri Medicare Companies and Plans (2021)

Wright City, Missouri 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, Wright City, MO supplemental plans are also available. Medicare plans in Wright City, Missouri are sold by both large national companies and local insurers.

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D. Gilson is a writer and author of essays, poetry, and scholarship that explore the relationship between popular culture, literature, sexuality, and memoir. His latest book is Jesus Freak, with Will Stockton, part of Bloomsbury’s 33 1/3 Series. His other books include I Will Say This Exactly One Time and Crush. His first chapbook, Catch & Release, won the 2012 Robin Becker Prize from Seve...

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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

  • You can buy Medicare supplement coverage in Wright City, Missouri if you have original Medicare and want coverage for out-of-pocket costs
  • Medicare Advantage plans in Wright City, Missouri may include prescription drug coverage, or you may need to buy Part D coverage separately
  • Medicare Advantage plans are available in Wright City with both PPO and HMO networks

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

Wright City, Missouri 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 Wright City original Medicare plans don’t cover, like coinsurance and deductibles.

Ready to buy Wright City, Missouri Medicare coverage? Enter your ZIP code to compare Wright City, MO Medicare options available to you right now.

Medicare Advantage Companies in Wright City, Missouri

Medicare Advantage in Wright City, Missouri 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 Wright City, MO 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 Wright City, Missouri

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 (HMO-POS) – H2802-028-0 $0.00 $0 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: 33% $2,900
AARP Medicare Advantage Choice Plan 1 (PPO) – H2228-030-0 $29.00 $150 . Tier 1, 2 and 3 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $2.00, Generic: $8.00, Preferred Brand: $45.00, Non-Preferred Drug: $95.00, Specialty Tier: 30% $4,400
AARP Medicare Advantage Patriot (HMO-POS) – H2802-050-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $3,700
AARP Medicare Advantage Walgreens (PPO) – H2228-083-0 $0.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $3,900
Aetna Medicare Advantra 1 (HMO-POS) – H2663-006-0 $33.00 $0 Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $7,550
Aetna Medicare Advantra 2 (HMO) – H2663-002-0 $70.00 $0 Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $4,900
Aetna Medicare Assure Gold Prime (HMO D-SNP) – H5325-005-0 $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: 25%, Non-Preferred Drug: 35%, Specialty Tier: 29% n/a
Aetna Medicare Elite (PPO) – H1608-050-0 $0.00 $0 Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $4,500
Aetna Medicare Gold Advantage Prime (HMO) – H2663-005-0 $0.00 $0 Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $3,450
Aetna Medicare Premier Advantra (PPO) – H1608-013-0 $51.00 $200 . Tier 1, 2 and 3 exempt Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 29% $7,550
Allwell Dual Medicare (HMO D-SNP) – H1664-005-0 $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: $20.00, Preferred Brand: $47.00, Non-Preferred Drug: 50%, Specialty Tier: 28% n/a
Allwell Medicare (HMO) – H1664-004-0 $0.00 $0 Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $37.00, Non-Preferred Drug: $90.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $3,000
Allwell Medicare Boost (HMO) – H1664-010-0 $0.00 $445 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $9.00, Preferred Brand: $37.00, Non-Preferred Drug: $90.00, Specialty Tier: 25%, Select Care Drugs: $0.00 $7,550
Allwell Medicare Complement (HMO) – H1664-011-0 $23.10 $445 . Tier 1 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $2.00, Generic: $8.00, Preferred Brand: $44.00, Non-Preferred Drug: 50%, Specialty Tier: 25% $3,000
American Health Advantage Plus of Missouri (HMO I-SNP) – H4490-002-0 $115.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $15.00, Preferred Brand: $45.00, Non-Preferred Drug: $98.00, Specialty Tier: 33% n/a
American Health Advantage of Missouri (HMO I-SNP) – H4490-001-0 $30.50 $445 No additional gap coverage, only the Donut Hole Discount Tier 1: 25% n/a
Anthem MediBlue Access (PPO) – H4909-015-0 $39.00 $0 Yes, some additional gap coverage. Preferred Generic: $4.00, Generic: $13.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $5,000
Anthem MediBlue Access Basic (PPO) – H4909-016-0 $0.00 $95 . Tier 1 and 2 exempt Yes, some additional gap coverage. Preferred Generic: $4.00, Generic: $13.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 31%, Select Care Drugs: $0.00 $4,900
Anthem MediBlue Dual Advantage (HMO D-SNP) – H3447-018-0 $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: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $95.00, Specialty Tier: 25%, Select Care Drugs: $0.00 n/a
Anthem MediBlue Plus (HMO) – H3447-019-0 $0.00 $0 Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $15.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $3,400
Humana Gold Plus H0028-014 (HMO) – H0028-014-0 $0.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $5.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: $99.00, Specialty Tier: 33% $2,900
Humana Gold Plus SNP-DE H0028-015 (HMO D-SNP) – H0028-015-0 $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: $9.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 27% n/a
Humana Honor (PPO) – H5216-140-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $4,500
HumanaChoice H5216-032 (PPO) – H5216-032-0 $78.00 $195 . Tier 1, 2 and 3 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $8.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: $99.00, Specialty Tier: 29% $6,700
HumanaChoice H5216-033 (PPO) – H5216-033-2 $0.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $7.00, Generic: $14.00, Preferred Brand: $47.00, Non-Preferred Drug: $99.00, Specialty Tier: 33% $3,600
HumanaChoice R1532-001 (Regional PPO) – R1532-001-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $3,900
HumanaChoice R1532-002 (Regional PPO) – R1532-002-0 $50.00 $400 . Tier 1 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $5.00, Generic: $13.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 25% $6,700
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
Provider Partners Missouri Advantage Plan (HMO I-SNP) – H9191-001-0 $30.50 $445 No additional gap coverage, only the Donut Hole Discount Tier 1: 25% n/a
UnitedHealthcare Dual Complete (HMO D-SNP) – H0169-002-0 $0.00 for people who qualify for both Medicare and Medicaid. $0 for people who qualify for both Medicare and Medicaid. No additional gap coverage, only the Donut Hole Discount Tier 1: 15%, Tier 2: 15%, Tier 3: 15%, Tier 4: 15%, Tier 5: 15% n/a
UnitedHealthcare Dual Complete Choice (Regional PPO D-SNP) – R3444-011-0 $0.00 for people who qualify for both Medicare and Medicaid. $0 for people who qualify for both Medicare and Medicaid. No additional gap coverage, only the Donut Hole Discount Tier 1: $0.00, Tier 2: $0.00, Tier 3: $0.00, Tier 4: $0.00, Tier 5: $0.00 n/a
UnitedHealthcare Medicare Advantage Choice Plan 2 (Regional PPO) – R3444-012-0 $55.00 $295 . Tier 1 and 2 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
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) – R3444-023-0 $19.00 $245 . Tier 1 and 2 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% $6,700
UnitedHealthcare Medicare Gold (Regional PPO C-SNP) – R3444-009-0 $23.00 $295 . 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: 27% n/a
UnitedHealthcare Medicare Silver (Regional PPO C-SNP) – R3444-008-0 $4.00 $445 No additional gap coverage, only the Donut Hole Discount Tier 1: 25%, Tier 2: 25%, Tier 3: 25%, Tier 4: 25%, Tier 5: 25% n/a
UnitedHealthcare Nursing Home Plan (PPO I-SNP) – H0710-016-0 $30.50 $445 No additional gap coverage, only the Donut Hole Discount Tier 1: 25%, Tier 2: 25%, Tier 3: 25%, Tier 4: 25%, Tier 5: 25% n/a

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Medicare Supplement Companies in Wright City, Missouri

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

Company Plans
AARP – UnitedHealthcare Insurance Company (Level 2) Medigap Plan B,
Medigap Plan C,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
AARP – UnitedHealthcare Insurance Company (Level 2/Household) Medigap Plan B,
Medigap Plan C,
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 G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
AARP – UnitedHealthcare Insurance Company (Standard/Household) Medigap Plan B,
Medigap Plan C,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
Aetna Health and Life Insurance Company Medigap Plan B,
Medigap Plan G,
Medigap Plan N
Colonial Penn Life Insurance Company Medigap Plan B,
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 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 G,
Medigap Plan G-high deductible,
Medigap Plan N
Humana (Humana Insurance Company) Medigap Plan B,
Medigap Plan C,
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 G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
Transamerica Life Insurance Company (Direct) Medigap Plan B,
Medigap Plan C,
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 G,
Medigap Plan G-high deductible,
Medigap Plan N
United Commercial Travelers of America Medigap Plan B,
Medigap Plan C,
Medigap Plan G,
Medigap Plan N
Americo Financial Life and Annuity Insurance Company Medigap Plan C,
Medigap Plan G,
Medigap Plan N
Americo Financial Life and Annuity Insurance Company (Class 1) Medigap Plan C,
Medigap Plan G,
Medigap Plan N
Prosperity Life Group Medigap Plan C,
Medigap Plan G
State Farm Mutual Automobile Insurance Company Medigap Plan C,
Medigap Plan G,
Medigap Plan N
Accendo Insurance Company Medigap Plan G,
Medigap Plan N
Anthem Blue Cross and Blue Shield – Missouri Medigap Plan G,
Medigap Plan N
Assured Life Association Medigap Plan G,
Medigap Plan N
Cigna Health & Life Insurance Company Medigap Plan G,
Medigap Plan N
Combined Insurance Company of America Medigap Plan G,
Medigap Plan N
GPM Health and Life Insurance Company Medigap Plan G,
Medigap Plan N
Garden State Life Insurance Company Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan M,
Medigap Plan N
Humana Value (HumanaDental Insurance Company) Medigap Plan G,
Medigap Plan N
Humana Value (HumanaDental Insurance Company) (Household) Medigap Plan G,
Medigap Plan N
Lumico Life Insurance Company Medigap Plan G,
Medigap Plan N
Medico Corp Insurance Company Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
National Health Insurance Company Medigap Plan G,
Medigap Plan N
National Health Insurance Company (Household) Medigap Plan G,
Medigap Plan N
Old Surety Life Insurance Company Medigap Plan G
Omaha Insurance Company Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Oxford Life Insurance Company Medigap Plan G,
Medigap Plan N
Pekin Life Insurance Company Medigap Plan G,
Medigap Plan N
Puritan Life Insurance Company of America Medigap Plan G,
Medigap Plan N
USAA Life Insurance Company Medigap Plan G,
Medigap Plan N
United Insurance Company of America Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N

Wright City, Missouri Standard Medicare Plan Coverage

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

Wright City, Missouri Standard Medicare Plan Coverage

Plan Name Monthly Cost Copays Coinsurance Deductibles Plan Benefits
Medigap Plan A Premiums range from $94-$633 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 $144-$501 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 $176-$690 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 $164-$750 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 $178-$848 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 $42-$247 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 $136-$739 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 $42-$235 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 $58-$251 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 $98-$455 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 $133-$526 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 $118-$623 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 Wright City, Missouri

Prescription drug coverage for Medicare in Wright City, Missouri is covered by a Part D plan. You can purchase Part D coverage in Wright City, Missouri 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 Wright City, Missouri

Plan Details Tiers
SilverScript SmartRx (PDP)
S5601 – 193 – 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: 46%
Tier 5: 25%
Clear Spring Health Premier Rx (PDP)
S6946 – 044 – 0
by Clear Spring Health
Monthly Premium: $13.60
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 – 187 – 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: $3.00
Tier 3: $40.00
Tier 4: 46%
Tier 5: 25%
WellCare Value Script (PDP)
S4802 – 152 – 0
by WellCare
Monthly Premium: $15.40
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 – 197 – 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: 34%
Tier 5: 25%
Express Scripts Medicare – Saver (PDP)
S5660 – 234 – 0
by Express Scripts Medicare
Monthly Premium: $21.70
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 Medicare Rx Select (PDP)
S5810 – 297 – 0
by WellCare
Monthly Premium: $23.30
Annual Deductable: $330
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: 27%
Cigna Secure-Essential Rx (PDP)
S5617 – 297 – 0
by Cigna
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: 18%
Tier 4: 48%
Tier 5: 25%
Mutual of Omaha Rx Premier (PDP)
S7126 – 087 – 0
by Mutual of Omaha Rx
Monthly Premium: $24.20
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%
Blue MedicareRx Enhanced (PDP)
S5596 – 078 – 0
by Blue MedicareRx (PDP)
Monthly Premium: $25.40
Annual Deductable: $240
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%
Express Scripts Medicare – Value (PDP)
S5660 – 120 – 0
by Express Scripts Medicare
Monthly Premium: $26.30
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: $32.00
Tier 4: 50%
Tier 5: 25%
SilverScript Choice (PDP)
S5601 – 036 – 0
by Aetna Medicare
Monthly Premium: $26.80
Annual Deductable: $245
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: 40%
Tier 5: 28%
Clear Spring Health Value Rx (PDP)
S6946 – 015 – 0
by Clear Spring Health
Monthly Premium: $27.50
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: 32%
Tier 5: 25%
WellCare Classic (PDP)
S4802 – 072 – 0
by WellCare
Monthly Premium: $27.50
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: $30.00
Tier 4: 34%
Tier 5: 25%
Humana Basic Rx Plan (PDP)
S5884 – 140 – 0
by Humana
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: $1.00
Tier 3: 20%
Tier 4: 35%
Tier 5: 25%
Cigna Secure Rx (PDP)
S5617 – 088 – 0
by Cigna
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: $2.00
Tier 3: $41.00
Tier 4: 50%
Tier 5: 25%
AARP MedicareRx Walgreens (PDP)
S5921 – 399 – 0
by UnitedHealthcare
Monthly Premium: $32.00
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 – 052 – 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: $38.00
Tier 4: 37%
Tier 5: 25%
Elixir RxPlus (PDP)
S7694 – 018 – 0
by Elixir Insurance
Monthly Premium: $48.50
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $7.00
Tier 3: 15%
Tier 4: 25%
Tier 5: 25%
Cigna Secure-Extra Rx (PDP)
S5617 – 263 – 0
by Cigna
Monthly Premium: $50.00
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%
AARP MedicareRx Saver Plus (PDP)
S5921 – 363 – 0
by UnitedHealthcare
Monthly Premium: $53.70
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $8.00
Tier 3: $40.00
Tier 4: 40%
Tier 5: 25%
SilverScript Plus (PDP)
S5601 – 037 – 0
by Aetna Medicare
Monthly Premium: $57.10
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%
Blue MedicareRx Plus (PDP)
S5596 – 044 – 0
by Blue MedicareRx (PDP)
Monthly Premium: $65.80
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%
Humana Premier Rx Plan (PDP)
S5884 – 164 – 0
by Humana
Monthly Premium: $66.00
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%
Blue MedicareRx Value (PDP)
S5596 – 043 – 0
by Blue MedicareRx (PDP)
Monthly Premium: $69.30
Annual Deductable: $290
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: 34%
Tier 5: 25%
Express Scripts Medicare – Choice (PDP)
S5660 – 211 – 0
by Express Scripts Medicare
Monthly Premium: $73.30
Annual Deductable: $100
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $2.00
Tier 2: $7.00
Tier 3: $42.00
Tier 4: 50%
Tier 5: 31%
WellCare Medicare Rx Value Plus (PDP)
S5768 – 141 – 0
by WellCare
Monthly Premium: $73.40
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%
Mutual of Omaha Rx Plus (PDP)
S7126 – 017 – 0
by Mutual of Omaha Rx
Monthly Premium: $75.60
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%
AARP MedicareRx Preferred (PDP)
S5820 – 017 – 0
by UnitedHealthcare
Monthly Premium: $94.10
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%

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