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Founder, CFP® Joel Ohman

UPDATED: Oct 29, 2021

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The Highlights

  • Medicare Supplement plans in Lewis County, WA include Medigap Plan C and Medigap Plan F
  • Lewis County residents can buy Medicare Advantage or choose original Medicare
  • Standalone Medicare Part D plans in Lewis County can help cover the cost of prescriptions

Lewis County, Washington 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 Lewis 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 Lewis County, WA Medicare coverage that suits your needs.

Ready to find cheap Medicare rates in Lewis County, WA? Enter your ZIP code to compare Lewis County, Washington Medicare plans today.

Medicare Advantage Companies in Lewis County, Washington

A Medicare Advantage plan in Lewis County, WA 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 Lewis County, Washington

Medicare Advantage Companies in Lewis County, Washington

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 Choice (PPO) – H1821-003-0 $19.00 $225. Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $12.00, Preferred Brand: $45.00, Non-Preferred Drug: $95.00, Specialty Tier: 29% $6,500
AARP Medicare Advantage Plan 1 (HMO) – H3805-037-0 $88.00 $185. Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $12.00, Preferred Brand: $45.00, Non-Preferred Drug: $95.00, Specialty Tier: 29% $4,200
AARP Medicare Advantage Plan 2 (HMO) – H3805-025-1 $19.00 $195. 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% $6,700
AARP Medicare Advantage Plan 3 (HMO) – H3805-015-0 $45.00 $225. Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $12.00, Preferred Brand: $45.00, Non-Preferred Drug: $95.00, Specialty Tier: 29% $5,900
Community Health Plan of WA Dual Plan (HMO D-SNP) – H5826-014-0 $0.00 for people who qualify for both Medicare and Medicaid. $0 for people who qualify for both Medicare and Medicaid. No additional gap coverage, only the Donut Hole Discount Tier 1: 15% N/A
Community Health Plan of WA MA Plan 4 (HMO) – H5826-009-0 $94.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $42.00, Non-Preferred Drug: 50%, Specialty Tier: 33% $6,700
Kaiser Permanente Medicare Advantage Basic (HMO) – H5050-001-0 $40.00 No Rx Coverage No Rx Coverage This Plan does NOT include prescription drug coverage. $4,200
Kaiser Permanente Medicare Advantage Essential (HMO) – H5050-009-0 $99.00 $0 Yes, some additional gap coverage. Preferred Generic: $3.00, Generic: $7.00, Preferred Brand: $45.00, Non-Preferred Brand: $99.00, Specialty Tier: 33%, Vaccines: $0.00 $4,800
Kaiser Permanente Medicare Advantage Optimal (HMO) – H5050-004-0 $295.00 $0 Yes, some additional gap coverage. Preferred Generic: $3.00, Generic: $7.00, Preferred Brand: $45.00, Non-Preferred Brand: $99.00, Specialty Tier: 33%, Vaccines: $0.00 $3,450
Kaiser Permanente Medicare Advantage Vital (HMO) – H5050-013-0 $28.00 $0 Yes, some additional gap coverage. Preferred Generic: $3.00, Generic: $7.00, Preferred Brand: $47.00, Non-Preferred Brand: $99.00, Specialty Tier: 33%, Vaccines: $0.00 $5,800
Molina Medicare Complete Care (HMO D-SNP) – H5823-006-0 $0.00 for people who qualify for both Medicare and Medicaid. $0 for people who qualify for both Medicare and Medicaid. No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $29.00, Non-Preferred Drug: 44%, Specialty Tier: 25% N/A
Premera Blue Cross Medicare Advantage (HMO) – H7245-001-0 $0.00 $180. Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $4.00, Generic: $12.00, Preferred Brand: $42.00, Non-Preferred Drug: 33%, Specialty Tier: 29% $6,300
Premera Blue Cross Medicare Advantage Classic (HMO) – H7245-002-0 $55.00 $180. Tier 1, 2 and 3 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $2.00, Generic: $10.00, Preferred Brand: $40.00, Non-Preferred Drug: 33%, Specialty Tier: 29% $5,000
Regence MedAdvantage + Rx Classic (PPO) – H5009-008-0 $78.00 $250. Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $13.00, Preferred Brand: $40.00, Non-Preferred Drug: 40%, Specialty Tier: 28% $6,200
Regence MedAdvantage + Rx Enhanced (PPO) – H5009-002-0 $157.00 $250. Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $8.00, Preferred Brand: $40.00, Non-Preferred Drug: 40%, Specialty Tier: 28% $5,400
Regence MedAdvantage + Rx Primary (PPO) – H5009-009-0 $38.00 $300. Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $13.00, Preferred Brand: $40.00, Non-Preferred Drug: 40%, Specialty Tier: 27% $6,700
Regence Valiance (PPO) – H5009-001-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include prescription drug coverage. $6,200
UnitedHealthcare Dual Complete (HMO D-SNP) – H5008-002-0 $0.00 for people who qualify for both Medicare and Medicaid. $0 for people who qualify for both Medicare and Medicaid. No additional gap coverage, only the Donut Hole Discount Tier 1: 15%, Tier 2: 15%, Tier 3: 15%, Tier 4: 15%, Tier 5: 15% N/A

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Medicare Supplement Companies in Lewis County, Washington

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

Medicare Supplement Companies in Lewis County, Washington

Company Plans
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
Cigna Health & Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
GPM Health and Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
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
Humana (HumanaDental Insurance Company) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Humana (HumanaDental Insurance Company) (Household) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Premera BlueCross BlueShield of Washington Medigap Plan A,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Regence BlueShield Medigap Plan A,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
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
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 N
United World Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
United of Omaha Life Insurance Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Premera Blue Cross (HCA) Medigap Plan G
Premera Blue Cross (HCA) (PEBB Retiree) Medigap Plan G

Lewis County, Washington Medicare Supplement Coverage by Plan

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

Lewis County, Washington Medicare Supplement Coverage by Plan

Plan Name Monthly Cost Copays Coinsurance Deductibles Plan Benefits
Medigap Plan A Premiums range from $121-$307 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 $198-$459 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 $229-$423 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 $160-$365 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 $231-$428 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 $44-$73 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 $100-$321 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 $44-$66 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 $61-$121 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 $137-$147 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 $163-$163 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 $124-$210 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 Lewis County, Washington

If you’re looking to buy a standalone Lewis County, WA 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 Lewis County, Washington.

Standalone Medicare Part D plans in Lewis County, Washington

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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