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UPDATED: Oct 29, 2021

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The Highlights

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

Hempstead County, Arkansas 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 Hempstead 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 Hempstead County, AR Medicare coverage that suits your needs.

Ready to find cheap Medicare rates in Hempstead County, AR? Enter your ZIP code to compare Hempstead County, Arkansas Medicare plans today.

Medicare Advantage Companies in Hempstead County, Arkansas

A Medicare Advantage plan in Hempstead County, AR 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 Hempstead County, Arkansas

Medicare Advantage Companies in Hempstead County, Arkansas

Plan Name Monthly Prem. (Parts C & D) Deductible Additional Gap Coverage Preferred Pharmacy Copay/ Coinsurance 30-Day Supply MOOP for Part A & B Benefits
Humana Gold Plus H5619-069 (HMO) – H5619-069-0 $15.00 $195. Tier 1, 2 and 3 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $6.00, Generic: $11.00, Preferred Brand: $47.00, Non-Preferred Drug: $99.00, Specialty Tier: 29% $6,700
Humana Gold Plus SNP-DE H5619-123 (HMO D-SNP) – H5619-123-0 $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 Value Plus H5619-109 (HMO) – H5619-109-0 $26.80 $445. Tier 1 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $1.00, Generic: $17.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 25% $7,550
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
Tribute Advantage (HMO-POS D-SNP) – H1587-001-0 $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
Tribute Select (HMO-POS I-SNP) – H1587-003-0 $24.90 $445 No additional gap coverage, only the Donut Hole Discount Tier 1: 25% 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

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Medicare Supplement Companies in Hempstead County, Arkansas

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

Medicare Supplement Companies in Hempstead County, Arkansas

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
Aetna Health and Life Insurance Company Medigap Plan A,
Medigap Plan B,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
American Benefit Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
American Retirement Life Insurance Company (CIGNA) Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
American Retirement Life Insurance Company (CIGNA) (Standard II) Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
American Retirement Life Insurance Company (CIGNA) (Standard III) Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Arkansas Blue Cross Blue Shield Medigap Plan A,
Medigap Plan B,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Atlantic Coast Life Insurance Company Medigap Plan A,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Atlantic Coast Life Insurance Company (Household) Medigap Plan A,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Bankers Fidelity Assurance Company (Preferred) Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan N
Bankers Fidelity Assurance Company (Standard) Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan N
Colonial Penn Life Insurance Company Medigap Plan A,
Medigap Plan B,
Medigap Plan D,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan M,
Medigap Plan N
Colonial Penn Life Insurance Company (Substandard) Medigap Plan A,
Medigap Plan B,
Medigap Plan D,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan M,
Medigap Plan N
Elips Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
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 F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Great Southern Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
Great Southern Life Insurance Company (Class 1) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
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 Achieve (CompBenefits Insurance Company) Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Humana Achieve (CompBenefits Insurance Company) (Household) Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
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
Independence American Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Manhattan Life Assurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Mutual of Omaha Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
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
New Era Life Insurance Company Medigap Plan A,
Medigap Plan C,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan M,
Medigap Plan N
Old Surety Life Insurance Company Medigap Plan A,
Medigap Plan C,
Medigap Plan F
Prosperity Life Group Medigap Plan A,
Medigap Plan F,
Medigap Plan G
Qualchoice Life Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan K,
Medigap Plan N
Qualchoice Life (Eligible post 1-1-20) Medigap Plan A,
Medigap Plan G,
Medigap Plan K,
Medigap Plan N
Sentinel Security Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G
Southern Guaranty Insurance Company 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
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 Commercial Travelers of America Medigap Plan A,
Medigap Plan B,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
United Insurance Company of America Medigap Plan A,
Medigap Plan D,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
United States Fire Insurance Company Medigap Plan A,
Medigap Plan B,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
Arkansas Blue Cross Blue Shield (Eligible Before 1-1-2020) Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N

Hempstead County, Arkansas Medicare Supplement Coverage by Plan

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

Hempstead County, Arkansas Medicare Supplement Coverage by Plan

Plan Name Monthly Cost Copays Coinsurance Deductibles Plan Benefits
Medigap Plan A Premiums range from $108-$1,300 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: No
Part A deductible: No
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: No
Medigap Plan B Premiums range from $160-$851 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: No
Part A deductible: Yes
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: No
Medigap Plan C Premiums range from $165-$392 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: No
Foreign travel emergency: Yes
Medigap Plan D Premiums range from $140-$280 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: No
Foreign travel emergency: Yes
Medigap Plan F Premiums range from $148-$451 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 Plan F-high deductible Premiums range from $40-$323 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: Yes
Foreign travel emergency: Yes
Medigap Plan G Premiums range from $119-$416 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 Plan G-high deductible Premiums range from $40-$95 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: Yes
Foreign travel emergency: Yes
Medigap Plan K Premiums range from $65-$168 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 Plan L Premiums range from $82-$233 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 Plan M Premiums range from $99-$253 depending on your age, sex, health status, and when you buy. $0 is 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 $101-$343 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

Standalone Medicare Part D plans in Hempstead County, Arkansas

If you’re looking to buy a standalone Hempstead County, AR 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 Hempstead County, Arkansas.

Standalone Medicare Part D plans in Hempstead County, Arkansas

Plan Details Tiers
SilverScript SmartRx (PDP)
S5601 – 194 – 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 – 045 – 0
by Clear Spring Health
Monthly Premium: $16.70
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: $40.00
Tier 4: 45%
Tier 5: 25%
WellCare Wellness Rx (PDP)
S4802 – 188 – 0
by WellCare
Monthly Premium: $17.00
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: $41.00
Tier 4: 46%
Tier 5: 25%
Humana Walmart Value Rx Plan (PDP)
S5884 – 198 – 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: 18%
Tier 4: 35%
Tier 5: 25%
BlueMedicare Saver Rx (PDP)
S5795 – 008 – 0
by Arkansas Blue Medicare
Monthly Premium: $19.00
Annual Deductible: $325
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $4.00
Tier 2: $10.00
Tier 3: $47.00
Tier 4: 50%
Tier 5: 27%
WellCare Value Script (PDP)
S4802 – 153 – 0
by WellCare
Monthly Premium: $19.10
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: $43.00
Tier 4: 47%
Tier 5: 25%
Cigna Secure Rx (PDP)
S5617 – 225 – 0
by Cigna
Monthly Premium: $21.70
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: $42.00
Tier 4: 50%
Tier 5: 25%
Cigna Secure-Essential Rx (PDP)
S5617 – 298 – 0
by Cigna
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: 18%
Tier 4: 43%
Tier 5: 25%
Clear Spring Health Value Rx (PDP)
S6946 – 016 – 0
by Clear Spring Health
Monthly Premium: $24.00
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%
SilverScript Choice (PDP)
S5601 – 038 – 0
by Aetna Medicare
Monthly Premium: $24.30
Annual Deductible: $265
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%
Mutual of Omaha Rx Premier (PDP)
S7126 – 088 – 0
by Mutual of Omaha Rx
Monthly Premium: $24.70
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: 45%
Tier 5: 25%
WellCare Classic (PDP)
S4802 – 073 – 0
by WellCare
Monthly Premium: $25.00
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: $30.00
Tier 4: 33%
Tier 5: 25%
Indy Health SaverRx (PDP)
S3535 – 012 – 0
by Indy Health Insurance Company
Monthly Premium: $25.30
Annual Deductible: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $10.00
Tier 3: $47.00
Tier 4: 50%
Tier 5: 25%
WellCare Medicare Rx Select (PDP)
S5810 – 298 – 0
by WellCare
Monthly Premium: $26.00
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%
WellCare Medicare Rx Saver (PDP)
S5810 – 053 – 0
by WellCare
Monthly Premium: $26.20
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: $37.00
Tier 4: 37%
Tier 5: 25%
Express Scripts Medicare – Saver (PDP)
S5660 – 235 – 0
by Express Scripts Medicare
Monthly Premium: $26.40
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%
Humana Basic Rx Plan (PDP)
S5884 – 141 – 0
by Humana
Monthly Premium: $26.90
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: 34%
Tier 5: 25%
AARP MedicareRx Walgreens (PDP)
S5921 – 400 – 0
by UnitedHealthcare
Monthly Premium: $36.90
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%
Express Scripts Medicare – Value (PDP)
S5660 – 121 – 0
by Express Scripts Medicare
Monthly Premium: $40.20
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: $42.00
Tier 4: 50%
Tier 5: 25%
Elixir RxPlus (PDP)
S7694 – 019 – 0
by Elixir Insurance
Monthly Premium: $44.40
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: 15%
Tier 4: 28%
Tier 5: 25%
Indy Health EliteRx (PDP)
S3535 – 008 – 0
by Indy Health Insurance Company
Monthly Premium: $44.40
Annual Deductible: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $3.00
Tier 2: $5.00
Tier 3: $47.00
Tier 4: 50%
Tier 5: 33%
AARP MedicareRx Saver Plus (PDP)
S5921 – 364 – 0
by UnitedHealthcare
Monthly Premium: $46.80
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: $41.00
Tier 4: 40%
Tier 5: 25%
Cigna Secure-Extra Rx (PDP)
S5617 – 264 – 0
by Cigna
Monthly Premium: $47.90
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%
SilverScript Plus (PDP)
S5601 – 107 – 0
by Aetna Medicare
Monthly Premium: $53.20
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%
BlueMedicare Value Rx (PDP)
S5795 – 003 – 0
by Arkansas Blue Medicare
Monthly Premium: $58.20
Annual Deductible: $310
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $3.00
Tier 2: $6.00
Tier 3: $40.00
Tier 4: 48%
Tier 5: 27%
Humana Premier Rx Plan (PDP)
S5884 – 165 – 0
by Humana
Monthly Premium: $58.30
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%
WellCare Medicare Rx Value Plus (PDP)
S5768 – 142 – 0
by WellCare
Monthly Premium: $75.90
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: 46%
Tier 5: 33%
Express Scripts Medicare – Choice (PDP)
S5660 – 212 – 0
by Express Scripts Medicare
Monthly Premium: $76.20
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%
Mutual of Omaha Rx Plus (PDP)
S7126 – 018 – 0
by Mutual of Omaha Rx
Monthly Premium: $77.60
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%
AARP MedicareRx Preferred (PDP)
S5820 – 018 – 0
by UnitedHealthcare
Monthly Premium: $86.20
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%
BlueMedicare Premier Rx (PDP)
S5795 – 002 – 0
by Arkansas Blue Medicare
Monthly Premium: $140.10
Annual Deductible: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $2.00
Tier 2: $8.00
Tier 3: $40.00
Tier 4: $90.00
Tier 5: 33%

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