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Reviewed by Joel Ohman
Founder, CFP® Joel Ohman

UPDATED: Oct 30, 2021

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The Highlights

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

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

Hood River, Oregon 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 Hood River original Medicare plans don’t cover, like coinsurance and deductibles.

Ready to buy Hood River, Oregon Medicare coverage? Enter your ZIP code to compare Hood River, OR Medicare options available to you right now.

Medicare Advantage Companies in Hood River, Oregon

Medicare Advantage in Hood River, Oregon 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 Hood River, OR 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 Hood River, Oregon

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 Honor (PPO) – H5216-046-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $5,000
HumanaChoice H5216-048 (PPO) – H5216-048-0 $201.00 $320 . Tier 1 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $16.00, Generic: $18.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 27% $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
Moda Health Central PPORX (PPO) – H3813-010-0 $100.00 $200 . 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 Brand: $100.00, Specialty Tier: 29%, Vaccines: $0.00 $6,000
Moda Health PPO (PPO) – H3813-001-0 $18.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $3,500
PacificSource Medicare Essentials 2 (HMO) – H3864-002-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $5,500
PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) – H3864-014-0 $99.00 $100 . Tier 1 and 2 exempt Yes, some additional gap coverage. Preferred Generic: $3.00, Generic: $12.00, Preferred Brand: $37.00, Non-Preferred Drug: 31%, Specialty Tier: 31%, Select Care Drugs: $0.00 $5,500
PacificSource Medicare Essentials Rx 27 (HMO) – H3864-027-0 $55.00 $399 . Tier 1 and 2 exempt Yes, some additional gap coverage. Preferred Generic: $3.00, Generic: $12.00, Preferred Brand: $37.00, Non-Preferred Drug: 31%, Specialty Tier: 25%, Select Care Drugs: $0.00 $6,700
PacificSource Medicare Essentials Rx 6 (HMO) – H3864-006-0 $218.00 $150 . Tier 1 and 2 exempt Yes, some additional gap coverage. Preferred Generic: $3.00, Generic: $12.00, Preferred Brand: $37.00, Non-Preferred Drug: 31%, Specialty Tier: 30%, Select Care Drugs: $0.00 $5,000
Providence Medicare Compass + RX (HMO-POS) – H9047-039-0 $55.00 $175 . 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
Providence Medicare Latitude + RX (HMO-POS) – H9047-038-0 $195.00 $120 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $45.00, Non-Preferred Drug: $90.00, Specialty Tier: 30% $5,500

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Medicare Supplement Companies in Hood River, Oregon

Original Medicare leaves you with some out-of-pocket costs such as deductibles and coinsurance. With Hood River, Oregon Medicare Supplement plan, you can get coverage for some or all of those costs. Medicare Supplement plans in Oregon 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 Hood River, Oregon

Company Plans
AARP – UnitedHealthcare Insurance Company (Level 2) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
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 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 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 K,
Medigap Plan L,
Medigap Plan N
Accendo Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan N
Cigna Health & Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan N
Cigna Health & Life Insurance Company (w/ 11% HHD) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan N
Cigna Health & Life Insurance Company (w/ 6% HHD) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
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-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-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan M,
Medigap Plan N
Continental Life Insurance Company of Brentwood, Tennessee (Aetna) Medigap Plan A,
Medigap Plan B,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan N
Everence Association Inc. Medigap Plan A,
Medigap Plan C,
Medigap Plan F,
Medigap Plan L,
Medigap Plan N
GPM Health and Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan N
Garden State Life Insurance Company Medigap Plan A,
Medigap Plan F,
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-high deductible,
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-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-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
Lumico Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan N
Manhattan Life Assurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan N
Moda Health Plan, Inc. Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G-high deductible,
Medigap Plan N
National Health Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan N
National Health Insurance Company (Household) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan N
Omaha Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G-high deductible,
Medigap Plan N
Providence Health Assurance Medigap Plan A,
Medigap Plan N
Puritan Life Insurance Company of America Medigap Plan A,
Medigap Plan F,
Medigap Plan N
Regence Blue Cross BlueShield of Oregon Medigap Plan A,
Medigap Plan C,
Medigap Plan F,
Medigap Plan K,
Medigap Plan N
Sentinel Security Life Insurance Company Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan N
State Farm Mutual Automobile Insurance Company Medigap Plan A,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan N
Transamerica Life Insurance Company (Direct) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan K,
Medigap Plan L,
Medigap Plan M,
Medigap Plan N
USAA Life Insurance Company Medigap Plan A,
Medigap Plan F,
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-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
United Commercial Travelers of America Medigap Plan A,
Medigap Plan F,
Medigap Plan N

Hood River, Oregon Standard Medicare Plan Coverage

Wondering what’s covered by each of the standard Oregon Medicare Supplement plans? Take a look at all of the Hood River, Oregon Medicare Supplement plans with coverage details.

Hood River, Oregon Standard Medicare Plan Coverage

Plan Name Monthly Cost Copays Coinsurance Deductibles Plan Benefits
Medigap Plan A Premiums range from $75-$823 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 $122-$637 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 $141-$681 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 $130-$565 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 $141-$944 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 $27-$202 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 $117-$737 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 $27-$158 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 $39-$295 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 $78-$568 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 $128-$659 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 $93-$533 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 Hood River, Oregon

Prescription drug coverage for Medicare in Hood River, Oregon is covered by a Part D plan. You can purchase Part D coverage in Hood River, Oregon 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 Hood River, Oregon

Plan Details Tiers
SilverScript SmartRx (PDP)
S5601 – 205 – 0
by Aetna Medicare
Monthly Premium: $6.30
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: 49%
Tier 5: 25%
Clear Spring Health Premier Rx (PDP)
S6946 – 054 – 0
by Clear Spring Health
Monthly Premium: $14.00
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%
Elixir RxPlus (PDP)
S7694 – 136 – 0
by Elixir Insurance
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: $6.00
Tier 3: $43.00
Tier 4: 45%
Tier 5: 25%
Humana Walmart Value Rx Plan (PDP)
S5884 – 209 – 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%
WellCare Wellness Rx (PDP)
S4802 – 199 – 0
by WellCare
Monthly Premium: $17.20
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $5.00
Tier 3: $40.00
Tier 4: 46%
Tier 5: 25%
WellCare Value Script (PDP)
S4802 – 135 – 0
by WellCare
Monthly Premium: $18.70
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-Essential Rx (PDP)
S5617 – 309 – 0
by Cigna
Monthly Premium: $24.00
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: 50%
Tier 5: 25%
WellCare Medicare Rx Select (PDP)
S5810 – 306 – 0
by WellCare
Monthly Premium: $24.50
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%
Mutual of Omaha Rx Premier (PDP)
S7126 – 099 – 0
by Mutual of Omaha Rx
Monthly Premium: $24.90
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: 23%
Tier 4: 41%
Tier 5: 25%
Express Scripts Medicare – Saver (PDP)
S5660 – 246 – 0
by Express Scripts Medicare
Monthly Premium: $29.50
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%
Express Scripts Medicare – Value (PDP)
S5660 – 132 – 0
by Express Scripts Medicare
Monthly Premium: $30.30
Annual Deductible: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $5.00
Tier 3: $35.00
Tier 4: 47%
Tier 5: 25%
WellCare Classic (PDP)
S4802 – 020 – 0
by WellCare
Monthly Premium: $30.50
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: $25.00
Tier 4: 33%
Tier 5: 25%
Clear Spring Health Value Rx (PDP)
S6946 – 025 – 0
by Clear Spring Health
Monthly Premium: $31.10
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 – 060 – 0
by Aetna Medicare
Monthly Premium: $31.30
Annual Deductible: $260
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: 43%
Tier 5: 28%
AARP MedicareRx Saver Plus (PDP)
S5921 – 374 – 0
by UnitedHealthcare
Monthly Premium: $32.20
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: $32.00
Tier 4: 40%
Tier 5: 25%
Elixir RxSecure (PDP)
S7694 – 030 – 0
by Elixir Insurance
Monthly Premium: $32.50
Annual Deductible: $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: 35%
Tier 5: 25%
Cigna Secure Rx (PDP)
S5617 – 148 – 0
by Cigna
Monthly Premium: $33.30
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: $36.00
Tier 4: 50%
Tier 5: 25%
WellCare Medicare Rx Saver (PDP)
S5810 – 064 – 0
by WellCare
Monthly Premium: $33.50
Annual Deductible: $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: $35.00
Tier 4: 41%
Tier 5: 25%
AARP MedicareRx Walgreens (PDP)
S5921 – 411 – 0
by UnitedHealthcare
Monthly Premium: $34.00
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: $40.00
Tier 4: 40%
Tier 5: 25%
Humana Basic Rx Plan (PDP)
S5884 – 113 – 0
by Humana
Monthly Premium: $34.00
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: 20%
Tier 4: 34%
Tier 5: 25%
Cigna Secure-Extra Rx (PDP)
S5617 – 275 – 0
by Cigna
Monthly Premium: $40.30
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%
Humana Premier Rx Plan (PDP)
S5884 – 176 – 0
by Humana
Monthly Premium: $65.30
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%
Express Scripts Medicare – Choice (PDP)
S5660 – 215 – 0
by Express Scripts Medicare
Monthly Premium: $71.60
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%
WellCare Medicare Rx Value Plus (PDP)
S5768 – 153 – 0
by WellCare
Monthly Premium: $71.90
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: 48%
Tier 5: 33%
SilverScript Plus (PDP)
S5601 – 061 – 0
by Aetna Medicare
Monthly Premium: $75.00
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 – 029 – 0
by Mutual of Omaha Rx
Monthly Premium: $91.90
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: 36%
Tier 5: 25%
AARP MedicareRx Preferred (PDP)
S5820 – 029 – 0
by UnitedHealthcare
Monthly Premium: $92.10
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%
Asuris Medicare Script Basic (PDP)
S5609 – 001 – 0
by Asuris Northwest Health
Monthly Premium: $93.50
Annual Deductible: $300
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $3.00
Tier 2: $13.00
Tier 3: $40.00
Tier 4: 40%
Tier 5: 27%
Asuris Medicare Script Enhanced (PDP)
S5609 – 002 – 0
by Asuris Northwest Health
Monthly Premium: $124.50
Annual Deductible: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $3.00
Tier 2: $10.00
Tier 3: $47.00
Tier 4: 40%
Tier 5: 33%

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