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Reviewed by Joel Ohman
Founder, CFP®

UPDATED: Oct 29, 2021

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The Highlights

  • You can choose from Idaho HMO and PPO Medicare Advantage plans
  • Standalone Medicare Part D Plans in Idaho are meant to help cover prescription drug costs
  • There are 28 plans that cost the same as your original Medicare in ID

There are several options in Idaho for Medicare Advantage plans. Medicare Advantage (Medicare Part C) is offered by 13 companies in Idaho; and options such as HMO, PPO, and POS may be available depending on which county you live in.

To make sure you’re getting the best ID Medicare provider and plan for your needs, compare rates and out-of-pocket costs to find the ideal coverage and cost combination for you.

If you’re ready to compare Medicare plans from the top companies in your county or across Idaho, enter your ZIP code for fast, free ID Medicare quotes today.

The Complete List of Idaho Medicare Advantage Companies

There are many companies offering Part C Medicare Advantage in ID. Below, you’ll find a complete listing of health insurance companies that offer Medicare Advantage plans in Idaho, the counties those plans are offered in, and the number of plans each company offers.

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Medicare Advantage Companies in Idaho

Company Number of Plans Counties
Aetna Medicare 4 Gem, Elmore, Ada, Payette, Owyhee, Washington, Kootenai, Canyon
Blue Cross of Idaho 7 Bonner, Bannock, Bonneville, Shoshone, Gooding, Gem, Jefferson, Elmore, Ada, Payette, Latah, Valley, Madison, Power, Clark, Fremont, Nez Perce, Cassia, Minidoka, Boundary, Owyhee, Twin Falls, Washington, Bingham, Jerome, Kootenai, Adams, Boise, Canyon
BlueCross BlueShield Minnesota 1 Bonner, Bannock, Bonneville, Shoshone, Gooding, Gem, Jefferson, Elmore, Ada, Payette, Latah, Valley, Madison, Power, Clark, Fremont, Nez Perce, Cassia, Minidoka, Boundary, Owyhee, Twin Falls, Washington, Bingham, Jerome, Kootenai, Adams, Boise, Canyon
BlueCross of Idaho 1 Bonner, Bannock, Bonneville, Shoshone, Gooding, Gem, Jefferson, Elmore, Ada, Payette, Latah, Valley, Benewah, Madison, Power, Clark, Fremont, Nez Perce, Cassia, Minidoka, Boundary, Owyhee, Twin Falls, Washington, Bingham, Jerome, Kootenai, Adams, Boise, Canyon
Humana 8 Bonner, Kootenai, Bannock, Bonneville, Gem, Elmore, Ada, Payette, Owyhee, Washington, Bingham, Boise, Canyon, Gooding, Blaine, Twin Falls, Jerome, Lincoln, Camas
MediGold 4 Gem, Elmore, Ada, Payette, Owyhee, Washington, Canyon
Molina Healthcare 1 Bonner, Bannock, Bonneville, Gem, Jefferson, Elmore, Ada, Payette, Madison, Power, Fremont, Nez Perce, Cassia, Minidoka, Boundary, Owyhee, Twin Falls, Bingham, Kootenai, Boise, Canyon
Molina Healthcare of Utah & Idaho 1 Ada, Twin Falls, Canyon
PacificSource Medicare 7 Bonner, Bannock, Bonneville, Jefferson, Madison, Boundary, Bingham, Kootenai, Gooding, Gem, Elmore, Ada, Payette, Valley, Blaine, Owyhee, Twin Falls, Jerome, Lincoln, Camas, Boise, Canyon
Regence BlueShield Of Idaho 4 Bonner, Gem, Ada, Latah, Nez Perce, Owyhee, Kootenai, Boise, Canyon
Regence BlueShield of Idaho 2 Ada, Canyon
SelectHealth 3 Gooding, Gem, Elmore, Payette, Valley, Cassia, Minidoka, Owyhee, Twin Falls, Washington, Jerome, Adams, Boise, Franklin, Ada, Canyon
UnitedHealthcare 10 Bonner, Bannock, Bonneville, Shoshone, Latah, Nez Perce, Boundary, Twin Falls, Bingham, Kootenai, Gem, Ada, Payette, Canyon, Valley

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Idaho Medicare Advantage Plans by Company

We’ve put together a list of all of plans available from each ID Medicare company to help you compare Medicare Advantage plans by company in Idaho. Take a look at the plans here.

Medicare Plans in Idaho Offered by BlueCross BlueShield Minnesota

Though plans can vary from county to county, BlueCross BlueShield Minnesota offers these Medicare plans in Idaho.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Secure Blue no Rx (PPO) H1302-004 Bonner, Bannock, Bonneville, Shoshone, Gooding, Gem, Jefferson, Elmore, Ada, Payette, Latah, Valley, Madison, Power, Clark, Fremont, Nez Perce, Cassia, Minidoka, Boundary, Owyhee, Twin Falls, Washington, Bingham, Jerome, Kootenai, Adams, Boise, Canyon Local PPO* $0.00

Medicare Plans in Idaho Offered by UnitedHealthcare

Though plans can vary from county to county, UnitedHealthcare offers these Medicare plans in Idaho.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
AARP Medicare Advantage Plan 1 (HMO) H4604-013 Bonner, Bannock, Bonneville, Shoshone, Latah, Nez Perce, Boundary, Twin Falls, Bingham, Kootenai Local HMO $49.00
AARP Medicare Advantage Plan 2 (HMO) H4604-020 Bonner, Shoshone, Latah, Nez Perce, Boundary, Kootenai Local HMO $15.00
AARP Medicare Advantage Patriot (HMO) H4604-019 Bonner, Bannock, Bonneville, Shoshone, Gem, Ada, Payette, Latah, Nez Perce, Boundary, Twin Falls, Bingham, Kootenai, Canyon Local HMO * $0.00
AARP Medicare Advantage Focus (HMO) H4604-015 Gem, Ada, Payette, Valley, Twin Falls, Canyon Local HMO $0.00
UnitedHealthcare Medicare Advantage Assure (PPO) H0271-002 Gem, Ada, Payette, Canyon Local PPO $35.50
AARP Medicare Advantage (HMO) H4604-012 Gem, Ada, Payette, Canyon Local HMO $16.00
AARP Medicare Advantage Choice Plan 1 (PPO) H2228-031 Ada, Canyon Local PPO $19.00
AARP Medicare Advantage Walgreens (PPO) H2228-079 Ada, Canyon Local PPO $0.00
AARP Medicare Advantage Choice Plan 2 (PPO) H2228-032 Ada, Canyon Local PPO $76.00
UnitedHealthcare Nursing Home Plan (PPO I-SNP) H0710-031 Kootenai Local PPO $36.00

Medicare Plans in Idaho Offered by Humana

Though plans can vary from county to county, Humana offers these Medicare plans in Idaho.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Humana Gold Plus H5619-078 (HMO) H5619-078 Bonner, Kootenai Local HMO $59.00
Humana Honor (PPO) H5216-046 Bonner, Bannock, Bonneville, Gem, Elmore, Ada, Payette, Owyhee, Washington, Bingham, Kootenai, Boise, Canyon Local PPO* $0.00
HumanaChoice H5216-044 (PPO) H5216-044 Bonner, Gem, Ada, Payette, Kootenai, Boise, Canyon Local PPO $29.00
HumanaChoice H5216-222 (PPO) H5216-222 Bannock, Bonneville, Bingham Local PPO $70.00
Humana Gold Plus H2486-008 (HMO) H2486-008 Gooding, Blaine, Twin Falls, Jerome, Lincoln, Camas Local HMO $20.00
HumanaChoice H5216-132 (PPO) H5216-132 Gem, Elmore, Ada, Payette, Owyhee, Washington, Boise, Canyon Local PPO $0.00
Humana Gold Plus H5619-077 (HMO) H5619-077 Ada, Payette, Canyon Local HMO $26.00
Humana Community (HMO) H2486-005 Ada, Payette, Canyon Local HMO $0.00

Medicare Plans in Idaho Offered by PacificSource Medicare

Though plans can vary from county to county, PacificSource Medicare offers these Medicare plans in Idaho.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
PacificSource Medicare Explorer 12 (PPO) H4754-012 Bonner, Bannock, Bonneville, Jefferson, Madison, Boundary, Bingham, Kootenai Local PPO* $0.00
PacificSource Medicare Explorer Rx 11 (PPO) H4754-011 Bonner, Boundary, Kootenai Local PPO $45.00
PacificSource Medicare Explorer Rx 9 (PPO) H4754-009 Bannock, Bonneville, Jefferson, Madison, Bingham Local PPO $99.00
PacificSource Medicare Essentials Rx 21 (HMO) H3864-021 Bannock, Bonneville, Jefferson, Madison, Bingham Local HMO $79.00
PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) H3864-024 Gooding, Gem, Elmore, Ada, Payette, Valley, Blaine, Owyhee, Twin Falls, Jerome, Lincoln, Camas, Boise, Canyon Local HMO $35.00
PacificSource Medicare Explorer 6 (PPO) H4754-006 Gooding, Gem, Elmore, Ada, Payette, Valley, Blaine, Owyhee, Twin Falls, Jerome, Lincoln, Camas, Boise, Canyon Local PPO* $0.00
PacificSource Medicare MyCare Rx 32 (HMO) H3864-032 Ada, Canyon Local HMO $0.00

Medicare Plans in Idaho Offered by Regence BlueShield Of Idaho

Though plans can vary from county to county, Regence BlueShield Of Idaho offers these Medicare plans in Idaho.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Regence Valiance (PPO) H1304-001 Bonner, Gem, Ada, Latah, Nez Perce, Owyhee, Kootenai, Boise, Canyon Local PPO* $0.00
Regence MedAdvantage + Rx Primary (PPO) H1304-011 Bonner, Gem, Ada, Latah, Nez Perce, Owyhee, Kootenai, Boise, Canyon Local PPO $48.00
Regence MedAdvantage + Rx Enhanced (PPO) H1304-004 Bonner, Latah, Nez Perce, Kootenai Local PPO $148.00
Regence MedAdvantage + Rx Classic (PPO) H1304-012 Bonner, Gem, Ada, Latah, Nez Perce, Owyhee, Kootenai, Boise, Canyon Local PPO $87.00

Medicare Plans in Idaho Offered by Molina Healthcare

Though plans can vary from county to county, Molina Healthcare offers these Medicare plans in Idaho.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Molina Medicare Complete Care (HMO D-SNP) H5628-008 Bonner, Bannock, Bonneville, Gem, Jefferson, Elmore, Ada, Payette, Madison, Power, Fremont, Nez Perce, Cassia, Minidoka, Boundary, Owyhee, Twin Falls, Bingham, Kootenai, Boise, Canyon Local HMO $0.00 for people who qualify for both Medicare and Medicaid.

Medicare Plans in Idaho Offered by Blue Cross of Idaho

Though plans can vary from county to county, Blue Cross of Idaho offers these Medicare plans in Idaho.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
True Blue no Rx (HMO) H1350-006 Bonner, Bannock, Bonneville, Shoshone, Gooding, Gem, Jefferson, Elmore, Ada, Payette, Latah, Valley, Madison, Power, Clark, Fremont, Nez Perce, Cassia, Minidoka, Boundary, Owyhee, Twin Falls, Washington, Bingham, Jerome, Kootenai, Adams, Boise, Canyon Local HMO * $0.00
True Blue Rx (HMO) H1350-019 Bonner, Bannock, Bonneville, Shoshone, Gooding, Gem, Jefferson, Elmore, Ada, Payette, Latah, Valley, Madison, Power, Clark, Fremont, Nez Perce, Cassia, Minidoka, Boundary, Owyhee, Twin Falls, Washington, Bingham, Jerome, Kootenai, Adams, Boise, Canyon Local HMO $59.00
True Blue Rx Option II (HMO) H1350-016 Bonner, Bannock, Bonneville, Shoshone, Gooding, Gem, Jefferson, Elmore, Ada, Payette, Latah, Valley, Madison, Power, Clark, Fremont, Nez Perce, Cassia, Minidoka, Boundary, Owyhee, Twin Falls, Washington, Bingham, Jerome, Kootenai, Adams, Boise, Canyon Local HMO $105.00
True Blue Rx Gem (HMO) H1350-024 Bonner, Bannock, Bonneville, Shoshone, Gooding, Gem, Jefferson, Elmore, Ada, Payette, Latah, Valley, Madison, Power, Clark, Fremont, Nez Perce, Cassia, Minidoka, Boundary, Owyhee, Twin Falls, Washington, Bingham, Jerome, Kootenai, Adams, Boise, Canyon Local HMO $23.00
True Blue Rx Option I (HMO) H1350-015 Bonner, Bannock, Bonneville, Shoshone, Gooding, Gem, Jefferson, Elmore, Ada, Payette, Latah, Valley, Madison, Power, Clark, Fremont, Nez Perce, Cassia, Minidoka, Boundary, Owyhee, Twin Falls, Washington, Bingham, Jerome, Kootenai, Adams, Boise, Canyon Local HMO $146.00
True Blue Rx Essentials (HMO) H1350-026 Ada, Canyon Local HMO $0.00
True Blue Rx Preferred (HMO) H1350-021 Ada, Canyon Local HMO $0.00

Medicare Plans in Idaho Offered by BlueCross of Idaho

Though plans can vary from county to county, BlueCross of Idaho offers these Medicare plans in Idaho.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
True Blue Special Needs Plan (HMO D-SNP) H1350-025 Bonner, Bannock, Bonneville, Shoshone, Gooding, Gem, Jefferson, Elmore, Ada, Payette, Latah, Valley, Benewah, Madison, Power, Clark, Fremont, Nez Perce, Cassia, Minidoka, Boundary, Owyhee, Twin Falls, Washington, Bingham, Jerome, Kootenai, Adams, Boise, Canyon Local HMO $0.00 for people who qualify for both Medicare and Medicaid.

Medicare Plans in Idaho Offered by SelectHealth

Though plans can vary from county to county, SelectHealth offers these Medicare plans in Idaho.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
SelectHealth Advantage (HMO) H1994-014 Gooding, Gem, Elmore, Payette, Valley, Cassia, Minidoka, Owyhee, Twin Falls, Washington, Jerome, Adams, Boise Local HMO $96.00
SelectHealth Advantage Essential (HMO) H1994-001 Franklin, Ada, Canyon Local HMO $0.00
SelectHealth Advantage Enhanced (HMO) H1994-007 Franklin, Ada, Canyon Local HMO $61.00

Medicare Plans in Idaho Offered by Aetna Medicare

Though plans can vary from county to county, Aetna Medicare offers these Medicare plans in Idaho.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Aetna Medicare Choice Plan (PPO) H9431-006 Gem, Elmore, Ada, Payette, Owyhee, Washington, Kootenai, Canyon Local PPO $31.00
Aetna Medicare Value Plan (HMO) H2056-002 Gem, Elmore, Ada, Payette, Owyhee, Washington, Canyon Local HMO $0.00
Aetna Medicare Elite Plan (HMO) H2056-001 Gem, Elmore, Ada, Payette, Owyhee, Washington, Canyon Local HMO $0.00
Aetna Medicare Select Plan (PPO) H9431-003 Gem, Elmore, Ada, Payette, Owyhee, Washington, Canyon Local PPO $61.00

Medicare Plans in Idaho Offered by MediGold

Though plans can vary from county to county, MediGold offers these Medicare plans in Idaho.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
MediGold Medical Only (HMO) H6910-004 Gem, Elmore, Ada, Payette, Owyhee, Washington, Canyon Local HMO * $0.00
MediGold Essential Care (HMO) H6910-001 Gem, Elmore, Ada, Payette, Owyhee, Washington, Canyon Local HMO $0.00
MediGold True Advantage (HMO) H6910-002 Gem, Elmore, Ada, Payette, Owyhee, Washington, Canyon Local HMO $29.00
MediGold Classic Preferred (HMO) H6910-003 Gem, Elmore, Ada, Payette, Owyhee, Washington, Canyon Local HMO $45.00

Medicare Plans in Idaho Offered by Regence BlueShield of Idaho

Though plans can vary from county to county, Regence BlueShield of Idaho offers these Medicare plans in Idaho.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Regence Blue MedAdvantage HMO Plus (HMO) H1969-004 Ada, Canyon Local HMO $38.00
Regence Blue MedAdvantage HMO (HMO) H1969-002 Ada, Canyon Local HMO $0.00

Medicare Plans in Idaho Offered by Molina Healthcare of Utah & Idaho

Though plans can vary from county to county, Molina Healthcare of Utah & Idaho offers these Medicare plans in Idaho.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Molina Medicare Choice Care (HMO) H5628-009 Ada, Twin Falls, Canyon Local HMO $0.00

Idaho Medicare Advantage Plans With No Additional Cost

If you decide to get Medicare Advantage in Idaho, you still have to pay your original Medicare Part B premium. Many ID Medicare companies offer Advantage plans that don’t cost any more than your original Medicare premium. Take a look at your options.

Zero-Cost {?{?state}} Medicare Advantage Plans

Plan Name County Preferred Pharmacy Copay/ Coinsurance 30-Day Supply MOOP for Part A & B Benefits
AARP Medicare Advantage Patriot (HMO) – H4604-019-0 Franklin This Plan does NOT include prescription drug coverage. $5,400
Humana Honor (PPO) – H5216-046-0 Franklin This Plan does NOT include prescription drug coverage. $5,000
PacificSource Medicare Explorer 12 (PPO) – H4754-012-0 Canyon, Ada This Plan does NOT include prescription drug coverage. $3,500
Secure Blue no Rx (PPO) – H1302-004-0 Gooding, Twin Falls, Jerome This Plan does NOT include prescription drug coverage. $3,400
Molina Medicare Complete Care (HMO D-SNP) – H5628-008-0 Minidoka, Twin Falls Preferred Generic: 25%, Generic: 25%, Preferred Brand: 25%, Non-Preferred Drug: 25%, Specialty Tier: 25% N/A
True Blue Special Needs Plan (HMO D-SNP) – H1350-025-0 Twin Falls Tier 1: $0.00, Tier 2: $0.00, Tier 3: $0.00, Tier 4: $0.00, Tier 5: $0.00 N/A
True Blue Special Needs Plan (HMO D-SNP) – H1350-009-0 Valley, Elmore, Boise, Gem, Adams, Payette, Washington, Owyhee Tier 1: $0.00, Tier 2: $0.00, Tier 3: $0.00, Tier 4: $0.00, Tier 5: $0.00 N/A
Regence Valiance (PPO) – H1304-001-0 Franklin This Plan does NOT include prescription drug coverage. $5,900
AARP Medicare Advantage Focus (HMO) – H4604-015-0 Franklin Preferred Generic: $0.00, Generic: $7.00, Preferred Brand: $45.00, Non-Preferred Drug: $95.00, Specialty Tier: 31% $4,900
PacificSource Medicare Explorer 6 (PPO) – H4754-006-0 Franklin This Plan does NOT include prescription drug coverage. $3,500
Regence | St. Luke’s Health Partners Align (HMO) – H1969-007-3 Canyon, Ada Preferred Generic: $3.00, Generic: $12.00, Preferred Brand: $40.00, Non-Preferred Drug: 40%, Specialty Tier: 31% $5,500
Regence | St. Luke’s Health Partners Align No Rx (HMO) – H1969-006-0 Gooding, Twin Falls, Jerome This Plan does NOT include prescription drug coverage. $5,200
True Blue Rx | St. Luke’s Health Partners (HMO) – H1350-023-1 Canyon, Payette, Ada Preferred Generic: $0.00, Generic: $6.00, Preferred Brand: $37.00, Non-Preferred Brand: $90.00, Specialty Tier: 29% $5,400
Aetna Medicare Elite Plan (HMO) – H2056-001-0 Franklin Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $6,900
Aetna Medicare Value Plan (HMO) – H2056-002-0 Franklin Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $7,550
HumanaChoice H5216-132 (PPO) – H5216-132-0 Gooding, Twin Falls, Jerome Preferred Generic: $4.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 29% $5,500
MediGold Essential Care (HMO) – H6910-001-0 Elmore, Canyon, Gem, Payette, Washington, Owyhee, Ada Preferred Generic: $0.00, Generic: $6.00, Preferred Brand: $31.00, Non-Preferred Drug: $90.00, Specialty Tier: 33% $5,500
MediGold Medical Only (HMO) – H6910-004-0 Canyon, Payette, Ada This Plan does NOT include prescription drug coverage. $3,900
AARP Medicare Advantage Walgreens (PPO) – H2228-079-0 Canyon, Ada Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 29% $6,700
Humana Community (HMO) – H2486-005-0 Canyon, Payette, Ada Preferred Generic: $2.00, Generic: $8.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 31% $5,500
Molina Medicare Choice Care (HMO) – H5628-009-0 Canyon, Ada Preferred Generic: $0.00, Generic: $6.00, Preferred Brand: $45.00, Non-Preferred Drug: $100.00, Specialty Tier: 30%, Select Care Drugs: $0.00 $5,000
PacificSource Medicare MyCare Rx 32 (HMO) – H3864-032-0 Canyon, Ada Preferred Generic: $3.00, Generic: $12.00, Preferred Brand: $37.00, Non-Preferred Drug: 31%, Specialty Tier: 33%, Select Care Drugs: $0.00 $5,500
Regence Blue MedAdvantage HMO (HMO) – H1969-002-0 Canyon, Ada Preferred Generic: $3.00, Generic: $12.00, Preferred Brand: $40.00, Non-Preferred Drug: 40%, Specialty Tier: 29% $5,500
Regence MedAdvantage + Rx Primary (PPO) – H1304-011-1 Canyon, Boise, Gem, Owyhee, Ada Preferred Generic: $3.00, Generic: $13.00, Preferred Brand: $40.00, Non-Preferred Drug: 40%, Specialty Tier: 29% $5,500
SelectHealth Advantage Essential (HMO) – H1994-003-0 Canyon, Ada Preferred Generic: $3.00, Generic: $15.00, Preferred Brand: $45.00, Non-Preferred Brand: $95.00, Specialty Tier: 30% $6,700
True Blue Rx Essentials (HMO) – H1350-026-0 Canyon, Ada Preferred Generic: $10.00, Generic: $15.00, Preferred Brand: $37.00, Non-Preferred Brand: $90.00, Specialty Tier: 27% $5,900
True Blue Rx Preferred (HMO) – H1350-021-0 Canyon, Ada Preferred Generic: $0.00, Generic: $6.00, Preferred Brand: $37.00, Non-Preferred Brand: $90.00, Specialty Tier: 29% $5,900
SelectHealth Advantage Essential (HMO) – H1994-001-0 Franklin Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $45.00, Non-Preferred Brand: $95.00, Specialty Tier: 29% $5,500

Standalone Medicare Part D Plans in Idaho

There is a wide variety of Medicare Part D plans available in every state, and Idaho is no exception. Keep in mind that plans vary by county, and don’t forget to check that your ID Medicare Advantage plan doesn’t already include Part D prescription drug coverage.

Standalone Medicare Part D Plans in Idaho

Plan Details Tiers
AARP MedicareRx Preferred (PDP)
S5820 – 030 – 0
by UnitedHealthcare
Monthly Premium: $95.50
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%
AARP MedicareRx Saver Plus (PDP)
S5921 – 375 – 0
by UnitedHealthcare
Monthly Premium: $36.10
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: $35.00
Tier 4: 40%
Tier 5: 25%
AARP MedicareRx Walgreens (PDP)
S5921 – 412 – 0
by UnitedHealthcare
Monthly Premium: $39.60
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%
Cigna Secure Rx (PDP)
S5617 – 153 – 0
by Cigna
Monthly Premium: $37.70
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: $38.00
Tier 4: 50%
Tier 5: 25%
Cigna Secure-Essential Rx (PDP)
S5617 – 310 – 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: 44%
Tier 5: 25%
Cigna Secure-Extra Rx (PDP)
S5617 – 276 – 0
by Cigna
Monthly Premium: $48.60
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%
Clear Spring Health Premier Rx (PDP)
S6946 – 055 – 0
by Clear Spring Health
Monthly Premium: $15.00
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%
Clear Spring Health Value Rx (PDP)
S6946 – 026 – 0
by Clear Spring Health
Monthly Premium: $30.90
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%
Elixir RxPlus (PDP)
S7694 – 031 – 0
by Elixir Insurance
Monthly Premium: $35.50
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: 28%
Tier 5: 25%
Express Scripts Medicare – Choice (PDP)
S5660 – 216 – 0
by Express Scripts Medicare
Monthly Premium: $76.70
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: 49%
Tier 5: 31%
Express Scripts Medicare – Saver (PDP)
S5660 – 247 – 0
by Express Scripts Medicare
Monthly Premium: $24.30
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 – 133 – 0
by Express Scripts Medicare
Monthly Premium: $34.70
Annual Deductible: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $8.00
Tier 3: $34.00
Tier 4: 46%
Tier 5: 25%
Humana Basic Rx Plan (PDP)
S5884 – 147 – 0
by Humana
Monthly Premium: $36.70
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: 35%
Tier 5: 25%
Humana Premier Rx Plan (PDP)
S5884 – 177 – 0
by Humana
Monthly Premium: $62.80
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%
Humana Walmart Value Rx Plan (PDP)
S5884 – 210 – 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: 19%
Tier 4: 35%
Tier 5: 25%
Mutual of Omaha Rx Plus (PDP)
S7126 – 030 – 0
by Mutual of Omaha Rx
Monthly Premium: $79.70
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: 20%
Tier 4: 35%
Tier 5: 25%
Mutual of Omaha Rx Premier (PDP)
S7126 – 100 – 0
by Mutual of Omaha Rx
Monthly Premium: $24.80
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: 44%
Tier 5: 25%
Regence Medicare Script Basic (PDP)
S5916 – 001 – 0
by Regence BlueShield of Idaho
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: $10.00
Tier 3: $40.00
Tier 4: 30%
Tier 5: 27%
Regence Medicare Script Enhanced (PDP)
S5916 – 002 – 0
by Regence BlueShield of Idaho
Monthly Premium: $123.50
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%
SilverScript Choice (PDP)
S5601 – 062 – 0
by Aetna Medicare
Monthly Premium: $34.30
Annual Deductible: $250
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%
SilverScript Plus (PDP)
S5601 – 063 – 0
by Aetna Medicare
Monthly Premium: $67.50
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%
SilverScript SmartRx (PDP)
S5601 – 206 – 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: 49%
Tier 5: 25%
WellCare Classic (PDP)
S4802 – 021 – 0
by WellCare
Monthly Premium: $33.00
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: $30.00
Tier 4: 33%
Tier 5: 25%
WellCare Medicare Rx Saver (PDP)
S5810 – 065 – 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: $39.00
Tier 4: 35%
Tier 5: 25%
WellCare Medicare Rx Select (PDP)
S5810 – 307 – 0
by WellCare
Monthly Premium: $22.80
Annual Deductible: $425
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 Value Plus (PDP)
S5768 – 154 – 0
by WellCare
Monthly Premium: $76.00
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: 49%
Tier 5: 33%
WellCare Value Script (PDP)
S4802 – 162 – 0
by WellCare
Monthly Premium: $17.70
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: $43.00
Tier 4: 47%
Tier 5: 25%
WellCare Wellness Rx (PDP)
S4802 – 200 – 0
by WellCare
Monthly Premium: $15.80
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%

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