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The Highlights

  • Medicare Supplement plans in Chisago County, MN include Medigap Basic Plan and Medigap High Deductible Plan
  • Medicare Supplement plans in Chisago County are designed to cover out-of-pocket costs not paid for by original Medicare
  • Chisago County residents can buy Medicare Advantage or choose original Medicare

Chisago County, Minnesota 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 Chisago 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 Chisago County, MN Medicare coverage that suits your needs.

Ready to find cheap Medicare rates in Chisago County, MN? Enter your ZIP code to compare Chisago County, Minnesota Medicare plans today.

Medicare Advantage Companies in Chisago County, Minnesota

A Medicare Advantage plan in Chisago County, MN 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 Chisago County, Minnesota

Medicare Advantage Companies in Chisago County, Minnesota

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 Headwaters (PPO) – H7404-001-0 $0.00 $395. Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 25% $5,900
AARP Medicare Advantage Lakeshore (PPO) – H7404-002-0 $49.00 $295. Tier 1, 2 and 3 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 27% $4,000
AARP Medicare Advantage Patriot (PPO) – H7404-015-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include prescription drug coverage. $6,700
AARP Medicare Advantage Premier (PPO) – H7404-004-0 $35.90 $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% $4,900
AARP Medicare Advantage Riverbank (PPO) – H7404-014-0 $99.00 $250. Tier 1, 2 and 3 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 28% $3,000
Allina Health Aetna Medicare Discover Elite (PPO) – H3219-004-0 $146.00 $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% $3,500
Allina Health Aetna Medicare Discover Grand (PPO) – H3219-003-0 $96.00 $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% $4,000
Allina Health Aetna Medicare Discover Plus (PPO) – H3219-001-0 $0.00 $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% $5,900
Allina Health Aetna Medicare Discover Premier (PPO) – H3219-002-0 $46.00 $150. Tier 1, 2 and 3 exempt Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 30% $5,000
Allina Health Aetna Medicare Discover Value (PPO) – H3219-005-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include prescription drug coverage. $5,900
Blue Cross Medicare Advantage Choice (PPO) – H5959-014-1 $79.20 $300. Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $37.00, Non-Preferred Drug: 45%, Specialty Tier: 27% $3,100
Blue Cross Medicare Advantage Choice MA Only (PPO) – H5959-007-1 $14.00 No Rx Coverage No Rx Coverage This Plan does NOT include prescription drug coverage. $4,900
Blue Cross Medicare Advantage Complete (PPO) – H5959-010-1 $157.20 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $9.00, Preferred Brand: $37.00, Non-Preferred Drug: 45%, Specialty Tier: 33% $2,700
Blue Cross Medicare Advantage Core (PPO) – H5959-013-1 $0.00 $445. Tier 1 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $13.00, Preferred Brand: 21%, Non-Preferred Drug: 45%, Specialty Tier: 25% $5,900
Care Advantage: M Health Fairview & North Memorial (HMO-POS) – H0422-002-0 $139.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: 45%, Specialty Tier: 33% $3,000
Care Core: M Health Fairview & North Memorial (HMO-POS) – H0422-001-0 $44.00 $400. Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: 45%, Specialty Tier: 25% $5,000
HealthPartners Journey Dash (PPO) – H4882-006-0 $91.00 $300. Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $5.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: 40%, Specialty Tier: 27% $3,600
HealthPartners Journey Pace (PPO) – H4882-002-0 $0.00 $300. Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $8.00, Generic: $14.00, Preferred Brand: $47.00, Non-Preferred Drug: 35%, Specialty Tier: 27% $6,100
HealthPartners Journey Steady (PPO) – H4882-003-0 $136.00 $300. Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $4.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: 40%, Specialty Tier: 27% $3,300
HealthPartners Journey Stride (PPO) – H4882-001-0 $51.00 $300. Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $6.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: 40%, Specialty Tier: 27% $4,100
HealthPartners Minnesota Senior Health Options (HMO D-SNP) – H2422-002-0 $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: $0.00, Tier 2: $0.00, Tier 3: $0.00, Tier 4: $0.00, Tier 5: $0.00 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 H5216-176 (PPO) – H5216-176-0 $28.60 $230. Tier 1 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $7.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 29% $6,700
HumanaChoice H5216-063 (PPO) – H5216-063-0 $106.00 $250. Tier 1, 2 and 3 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $6.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 28% $3,200
HumanaChoice H5216-080 (PPO) – H5216-080-1 $59.00 $350. 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: 26% $5,900
HumanaChoice H5216-092 (PPO) – H5216-092-0 $38.00 $350. 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: 50%, Specialty Tier: 26% $6,700
HumanaChoice H5216-167 (PPO) – H5216-167-0 $89.00 $350. Tier 1, 2 and 3 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $6.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 26% $4,500
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 Advantage Solution H6154-002 (HMO-POS) – H6154-002-0 $59.00 $445. Tier 1 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $6.00, Generic: $11.00, Preferred Brand: $47.00, Non-Preferred Drug: 50%, Specialty Tier: 25% $7,550
Medica Advantage Solution H8889-002 (PPO) – H8889-002-0 $99.00 $275. Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $8.00, Preferred Brand: $47.00, Non-Preferred Drug: 50%, Specialty Tier: 28% $3,450
Medica Advantage Solution PartnerCare Focus (HMO I-SNP) – H6154-004-0 $16.00 $140. Tier 1 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $5.00, Generic: $12.00, Preferred Brand: $42.00, Non-Preferred Drug: 50%, Specialty Tier: 30% N/A
Medica Advantage Solution PartnerCare Premier (HMO I-SNP) – H6154-003-0 $66.00 $140. Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $5.00, Generic: $12.00, Preferred Brand: $42.00, Non-Preferred Drug: 50%, Specialty Tier: 30% N/A
Medica DUAL Solution (HMO D-SNP) – H2458-002-0 $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: $0.00 N/A
SecureBlue (HMO D-SNP) – H2425-001-0 $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 N/A
UCare Advocate Choice (HMO I-SNP) – H2459-031-0 $10.00 $435. 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: 25%, Specialty Tier: 25% N/A
UCare Advocate Plus (HMO I-SNP) – H2459-032-0 $38.00 $435. Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $4.00, Generic: $12.00, Preferred Brand: $45.00, Non-Preferred Drug: 25%, Specialty Tier: 25% N/A
UCare Aware (HMO-POS) – H2459-029-0 $26.00 $395. Tier 1 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $2.00, Generic: $10.00, Preferred Brand: 17%, Non-Preferred Drug: 45%, Specialty Tier: 25% $5,000
UCare Classic (HMO-POS) – H2459-021-1 $185.00 $225. Tier 1 and 2 exempt Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $7.00, Preferred Brand: $35.00, Non-Preferred Drug: 45%, Specialty Tier: 29% $3,000
UCare Complete (HMO-POS) – H2459-026-1 $99.00 $235. Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: 45%, Specialty Tier: 28% $3,000
UCare Connect + Medicare (HMO D-SNP) – H5937-001-0 $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 N/A
UCare Essentials Rx (HMO-POS) – H2459-023-1 $56.00 $395. Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $2.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: 45%, Specialty Tier: 25% $3,800
UCare Prime (HMO-POS) – H2459-020-0 $0.00 $445. Tier 1 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $10.00, Preferred Brand: 17%, Non-Preferred Drug: 45%, Specialty Tier: 25% $5,500
UCare Value (HMO-POS) – H2459-001-0 $29.00 No Rx Coverage No Rx Coverage This Plan does NOT include prescription drug coverage. $3,400
UCare Value Plus (HMO-POS) – H2459-030-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include prescription drug coverage. $5,500
UCare’s Minnesota Senior Health Options (HMO D-SNP) – H2456-002-0 $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: $0.00 N/A

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Medicare Supplement Companies in Chisago County, Minnesota

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

Medicare Supplement Companies in Chisago County, Minnesota

Company Plans
Americo Financial Life and Annuity Insurance Company Medigap $20 & $50 Copay Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new
BlueCross BlueShield of Minnesota Medigap $20 & $50 Copay Plan,
Medigap 50% Cost Sharing Plan,
Medigap 75% Cost Sharing Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new,
Medigap High Deductible Plan,
Medigap High Deductible Plan-new
BlueCross BlueShield of Minnesota (Eligible Before 1-1-20) Medigap $20 & $50 Copay Plan,
Medigap 50% Cost Sharing Plan,
Medigap 75% Cost Sharing Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new,
Medigap High Deductible Plan,
Medigap High Deductible Plan-new
Catholic United Financial Medigap $20 & $50 Copay Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan
Cigna Health & Life Insurance Company Medigap $20 & $50 Copay Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new,
Medigap High Deductible Plan
Colonial Penn Life Insurance Company Medigap $20 & $50 Copay Plan,
Medigap 75% Cost Sharing Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new,
Medigap High Deductible Plan,
Medigap High Deductible Plan-new
Continental Life Insurance Company of Brentwood, Tennessee (Aetna) Medigap $20 & $50 Copay Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new,
Medigap High Deductible Plan,
Medigap High Deductible Plan-new
Health Partners Plans, Inc. Medigap $20 & $50 Copay Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan
Health Partners Plans, Inc. (Eligible Before 1-1-20) Medigap $20 & $50 Copay Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan
Humana (Humana Insurance Company) Medigap $20 & $50 Copay Plan,
Medigap 50% Cost Sharing Plan,
Medigap 75% Cost Sharing Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap High Deductible Plan
Lumico Life Insurance Company Medigap $20 & $50 Copay Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new,
Medigap High Deductible Plan
Medica Health Plans Medigap $20 & $50 Copay Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new,
Medigap High Deductible Plan
National Guardian Life Insurance Company Medigap $20 & $50 Copay Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new
National Health Insurance Company Medigap $20 & $50 Copay Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new,
Medigap High Deductible Plan
Puritan Life Insurance Company of America Medigap $20 & $50 Copay Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new,
Medigap High Deductible Plan,
Medigap High Deductible Plan-new
Sanford Health Plan of Minnesota Medigap $20 & $50 Copay Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new,
Medigap High Deductible Plan
State Farm Mutual Automobile Insurance Company Medigap $20 & $50 Copay Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new
UCare Health, Inc. Medigap $20 & $50 Copay Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan
AARP – UnitedHealthcare Insurance Company (Standard) Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new
AARP – UnitedHealthcare Insurance Company (Standard/Household) Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new
Omaha Insurance Company Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new
Transamerica Life Insurance Company (Direct) Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new

Chisago County, Minnesota Medicare Supplement Coverage by Plan

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

Chisago County, Minnesota Medicare Supplement Coverage by Plan

Plan Name Monthly Cost Copays Coinsurance Deductibles Plan Benefits
Medigap $20 & $50 Copay Plan Premiums range from $152-$344 depending on your age, sex, health status, and when you buy. $0 is 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
Medigap 50% Cost Sharing Plan Premiums range from $132-$173 depending on your age, sex, health status, and when you buy. 10% is 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 75% Cost Sharing Plan Premiums range from $185-$259 depending on your age, sex, health status, and when you buy. 5% is 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 Basic Plan Premiums range from $142-$342 depending on your age, sex, health status, and when you buy. $0 is generally your cost for approved Part B services. $1,484 Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: No
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: Yes
Medigap Extended Basic Plan Premiums range from $217-$756 depending on your age, sex, health status, and when you buy. $0 is 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 Extended Basic Plan-new Premiums range from $200-$605 depending on your age, sex, health status, and when you buy. $0 is 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 High Deductible Plan Premiums range from $63-$195 depending on your age, sex, health status, and when you buy. $0 is 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: No
Foreign travel emergency: Yes
Medigap High Deductible Plan-new Premiums range from $67-$107 depending on your age, sex, health status, and when you buy. $0 is 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: No
Foreign travel emergency: Yes

Standalone Medicare Part D plans in Chisago County, Minnesota

If you’re looking to buy a standalone Chisago County, MN 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 Chisago County, Minnesota.

Standalone Medicare Part D plans in Chisago County, Minnesota

Plan Details Tiers
SilverScript SmartRx (PDP)
S5601 – 200 – 0
by Aetna Medicare
Monthly Premium: $7.30
Annual Deductible: $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 Deductible: $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 Deductible: $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 Deductible: $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 Deductible: $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 Deductible: $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 Deductible: $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 Deductible: $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 Deductible: $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 Deductible: $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 Deductible: $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 Deductible: $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 Deductible: $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 Deductible: $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 Deductible: $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 Deductible: $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 Deductible: $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 Deductible: $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 Deductible: $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 Deductible: $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 Deductible: $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 Deductible: $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 Deductible: $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 Deductible: $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 Deductible: $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 Deductible: $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 Deductible: $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 Deductible: $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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