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Joel Ohman is the CEO of a private equity-backed digital media company. He is a CERTIFIED FINANCIAL PLANNER™, author, angel investor, and serial entrepreneur who loves creating new things, whether books or businesses. He has also previously served as the founder and resident CFP® of a national insurance agency, Real Time Health Quotes. He has an MBA from the University of South Florida. Joel...

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Reviewed by Joel Ohman
Founder, CFP®

UPDATED: Oct 29, 2021

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The Highlights

  • There are 26 plans that cost the same as your original Medicare in ME
  • Standalone Medicare Part D Plans in Maine are meant to help cover prescription drug costs
  • You can choose from Maine HMO and PPO Medicare Advantage plans

There are several options in Maine for Medicare Advantage plans. Medicare Advantage (Medicare Part C) is offered by 10 companies in Maine; 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 ME 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 Maine, enter your ZIP code for fast, free ME Medicare quotes today.

The Complete List of Maine Medicare Advantage Companies

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

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Medicare Advantage Companies in Maine

Company Number of Plans Counties
AMH Health 4 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset
Aetna 1 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset
Aetna Medicare 2 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset
Anthem 1 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset
Harvard Pilgrim Health Care, Inc 3 Cumberland, Franklin, York, Kennebec
Humana 7 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset
Martin’s Point Generations 1 Cumberland
Martin’s Point Generations Advantage 5 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset
UnitedHealthcare 6 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset
WellCare 6 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset

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Maine Medicare Advantage Plans by Company

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

Medicare Plans in Maine Offered by Humana

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

Plan Name Base Plan ID Counties Plan Type Monthly Premium
HumanaChoice H5216-177 (PPO) H5216-177 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset Local PPO $39.00
Humana Gold Plus SNP-DE H5619-003 (HMO D-SNP) H5619-003 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset Local HMO $0.00 for people who qualify for both Medicare and Medicaid.
Humana Gold Plus H5619-066 (HMO) H5619-066 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset Local HMO $0.00
HumanaChoice H5216-175 (PPO) H5216-175 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset Local PPO $0.00
Humana Gold Plus H5619-001 (HMO) H5619-001 Cumberland, York, Sagadahoc, Androscoggin Local HMO $0.00
Humana Honor (PPO) H5216-059 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset Local PPO* $0.00
Humana Gold Plus H5619-137 (HMO) H5619-137 Penobscot, Knox, Oxford, Waldo, Kennebec, Lincoln Local HMO $29.00

Medicare Plans in Maine Offered by AMH Health

Though plans can vary from county to county, AMH Health offers these Medicare plans in Maine.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Anthem l MaineHealth Advantage Choice (HMO-POS) H9065-002 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset Local HMO $0.00
Anthem l MaineHealth Advantage Access (PPO) H9219-001 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset Local PPO $21.00
Anthem l MaineHealth Advantage Extra (HMO) H9065-005 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset Local HMO $21.60
Anthem l MaineHealth Advantage Plus (HMO) H9065-008 Franklin, Knox, Oxford, Waldo, Kennebec, Lincoln, Sagadahoc, Androscoggin, Somerset Local HMO $0.00

Medicare Plans in Maine Offered by WellCare

Though plans can vary from county to county, WellCare offers these Medicare plans in Maine.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
WellCare Liberty (HMO D-SNP) H9364-003 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset Local HMO $0.00 for people who qualify for both Medicare and Medicaid.
WellCare Today’s Options Premier 300 (PFFS) H2816-040 Cumberland, Franklin, Penobscot, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Lincoln, Sagadahoc, Androscoggin, Somerset PFFS* $0.00
WellCare Access (HMO D-SNP) H9364-002 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset Local HMO $0.00 for people who qualify for both Medicare and Medicaid.
WellCare Value (HMO) H9364-001 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset Local HMO $0.00
WellCare Today’s Options Advantage Plus 550B (PPO) H2775-109 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset Local PPO $0.00
WellCare Today’s Options Premier 200 (PFFS) H2816-039 Cumberland, Franklin, Penobscot, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Lincoln, Sagadahoc, Androscoggin, Somerset PFFS* $0.00

Medicare Plans in Maine Offered by Harvard Pilgrim Health Care, Inc

Though plans can vary from county to county, Harvard Pilgrim Health Care, Inc offers these Medicare plans in Maine.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Harvard Pilgrim Stride Choice Rx (HMO-POS) H1660-018 Cumberland, Franklin, York, Kennebec Local HMO $34.00
Harvard Pilgrim Stride Basic Rx (HMO) H1660-015 Cumberland, Franklin, York, Kennebec Local HMO $0.00
Harvard Pilgrim Stride Value Rx (HMO) H1660-013 Cumberland, Franklin, York, Kennebec Local HMO $30.00

Medicare Plans in Maine Offered by Aetna

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

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Aetna Medicare Assure Plan (HMO-POS D-SNP) H3597-011 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset Local HMO $0.00 for people who qualify for both Medicare and Medicaid.

Medicare Plans in Maine Offered by Aetna Medicare

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

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Aetna Medicare Value Plan (HMO) H3597-001 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset Local HMO $0.00
Aetna Medicare Explorer Plan (PPO) H5521-142 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset Local PPO $59.00

Medicare Plans in Maine Offered by UnitedHealthcare

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

Plan Name Base Plan ID Counties Plan Type Monthly Premium
AARP Medicare Advantage Choice (Regional PPO) R5329-001 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset Regional PPO $64.00
UnitedHealthcare Dual Complete (PPO D-SNP) H0271-006 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset Local PPO $0.00 for people who qualify for both Medicare and Medicaid.
AARP Medicare Advantage Choice Plan 1 (PPO) H2001-001 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset Local PPO $0.00
AARP Medicare Advantage Choice Plan 3 (PPO) H2001-019 Cumberland, Franklin, York, Knox, Oxford, Waldo, Kennebec, Lincoln, Sagadahoc, Androscoggin Local PPO $0.00
UnitedHealthcare Nursing Home Plan (PPO I-SNP) H0710-015 Cumberland, Franklin, Penobscot, York, Oxford, Kennebec Local PPO $29.10
AARP Medicare Advantage Choice Plan 2 (PPO) H2001-010 Cumberland, Franklin, York, Knox, Oxford, Waldo, Kennebec, Lincoln, Sagadahoc, Androscoggin Local PPO $59.00

Medicare Plans in Maine Offered by Martin’s Point Generations Advantage

Though plans can vary from county to county, Martin’s Point Generations Advantage offers these Medicare plans in Maine.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Martin’s Point Generations Advantage Flex (Regional PPO) R0802-001 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset Regional PPO $53.00
Martin’s Point Generations Advantage Prime (HMO-POS) H5591-006 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset Local HMO $0.00
Martin’s Point Generations Advantage Select (PPO) H1365-001 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset Local PPO $99.00
Martin’s Point Generations Advantage Alliance (HMO) H5591-003 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset Local HMO * $0.00
Martin’s Point Generations Advantage Value Plus (HMO) H5591-009 Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset Local HMO $29.00

Medicare Plans in Maine Offered by Martin’s Point Generations

Though plans can vary from county to county, Martin’s Point Generations offers these Medicare plans in Maine.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Martin’s Point Generations Advantage Focus DC (HMO C-SNP) H5591-007 Cumberland Local HMO $0.00

Medicare Plans in Maine Offered by Anthem

Though plans can vary from county to county, Anthem offers these Medicare plans in Maine.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Anthem l MaineHealth Advantage Dual Plus (HMO D-SNP) H9065-001 Cumberland, Franklin, Penobscot, York, Knox, Hancock, Oxford, Aroostook, Piscataquis, Waldo, Kennebec, Washington, Lincoln, Sagadahoc, Androscoggin, Somerset Local HMO $0.00 for people who qualify for both Medicare and Medicaid.

Maine Medicare Advantage Plans With No Additional Cost

If you decide to get Medicare Advantage in Maine, you still have to pay your original Medicare Part B premium. Many ME 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 Choice Plan 1 (PPO) – H2001-001-0 York, Lincoln, Cumberland, Sagadahoc, Androscoggin, Kennebec, Knox, Waldo, Oxford, Franklin Preferred Generic: $3.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 28% $5,900
AARP Medicare Advantage Choice Plan 3 (PPO) – H2001-019-0 York, Lincoln, Cumberland, Sagadahoc, Androscoggin, Kennebec, Knox, Waldo, Oxford, Franklin Preferred Generic: $0.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $6,700
Aetna Medicare Value Plan (HMO) – H3597-001-0 Lincoln, Androscoggin, Kennebec, Knox, Waldo, Oxford Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $5,900
Anthem l MaineHealth Advantage Choice (HMO-POS) – H9065-002-0 Lincoln, Somerset, Sagadahoc, Androscoggin, Kennebec, Knox, Waldo, Oxford, Franklin Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $5,500
Harvard Pilgrim Stride Basic Rx (HMO) – H1660-015-0 York, Cumberland, Kennebec, Franklin Preferred Generic: $0.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Brand: $100.00, Specialty Tier: 25% $6,700
Humana Gold Plus H5619-001 (HMO) – H5619-001-0 Piscataquis, Lincoln, Cumberland, Somerset, Aroostook, Sagadahoc, Penobscot, Hancock, Androscoggin, Kennebec, Knox, Waldo, Oxford, Franklin Preferred Generic: $6.00, Generic: $16.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 25% $6,700
Humana Gold Plus H5619-066 (HMO) – H5619-066-0 York, Piscataquis, Lincoln, Cumberland, Somerset, Aroostook, Sagadahoc, Penobscot, Hancock, Androscoggin, Kennebec, Knox, Washington, Waldo, Oxford, Franklin Preferred Generic: $6.00, Generic: $16.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 26% $7,550
Humana Honor (PPO) – H5216-059-0 Piscataquis, Somerset, Aroostook, Penobscot, Hancock, Washington This Plan does NOT include prescription drug coverage. $4,500
HumanaChoice H5216-175 (PPO) – H5216-175-0 Piscataquis, Aroostook, Penobscot, Hancock, Washington Preferred Generic: $2.00, Generic: $9.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 28% $6,500
Martin’s Point Generations Advantage Alliance (HMO) – H5591-003-0 Piscataquis, Somerset, Aroostook, Penobscot, Hancock, Washington This Plan does NOT include prescription drug coverage. $5,000
Martin’s Point Generations Advantage Prime (HMO-POS) – H5591-006-4 Cumberland Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $40.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $7,050
Martin’s Point Generations Advantage Value Plus (HMO) – H5591-013-0 Cumberland Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $40.00, Non-Preferred Drug: $95.00, Specialty Tier: 28% $7,550
WellCare Today’s Options Advantage Plus 550B (PPO) – H2775-109-0 Lincoln, Somerset, Sagadahoc, Androscoggin, Kennebec, Knox, Waldo, Oxford, Franklin Preferred Generic: $0.00, Generic: $4.00, Preferred Brand: $37.00, Non-Preferred Drug: $90.00, Specialty Tier: 33% $4,000
WellCare Value (HMO) – H9364-001-0 Lincoln, Somerset, Sagadahoc, Androscoggin, Kennebec, Knox, Waldo, Oxford, Franklin Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: 42%, Specialty Tier: 33% $6,700
WellCare Liberty (HMO D-SNP) – H9364-003-0 York, Piscataquis, Lincoln, Cumberland, Somerset, Aroostook, Sagadahoc, Penobscot, Hancock, Androscoggin, Kennebec, Knox, Washington, Waldo, Oxford, Franklin Preferred Generic: $0.00, Generic: $8.00, Preferred Brand: $45.00, Non-Preferred Drug: 50%, Specialty Tier: 25% N/A
Humana Gold Plus SNP-DE H5619-003 (HMO D-SNP) – H5619-003-0 Piscataquis, Aroostook, Penobscot, Hancock, Washington Preferred Generic: $0.00, Generic: $19.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 25% N/A
UnitedHealthcare Dual Complete (PPO D-SNP) – H0271-006-0 Lincoln, Penobscot, Kennebec, Knox, Waldo, Oxford Tier 1: $0.00, Tier 2: $0.00, Tier 3: $0.00, Tier 4: $0.00, Tier 5: $0.00 N/A
WellCare Access (HMO D-SNP) – H9364-002-0 York, Piscataquis, Lincoln, Cumberland, Somerset, Aroostook, Sagadahoc, Penobscot, Hancock, Androscoggin, Kennebec, Knox, Washington, Waldo, Oxford, Franklin Preferred Generic: $0.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: 47%, Specialty Tier: 25% N/A
Aetna Medicare Assure Plan (HMO-POS D-SNP) – H3597-011-0 Sagadahoc, Androscoggin, Kennebec Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 29% N/A
Anthem l MaineHealth Advantage Dual Plus (HMO D-SNP) – H9065-001-0 Piscataquis, Somerset, Aroostook, Penobscot, Hancock, Washington, Franklin Preferred Generic: $0.00, Generic: $7.00, Preferred Brand: $47.00, Non-Preferred Drug: $95.00, Specialty Tier: 25%, Select Care Drugs: $0.00 N/A
WellCare Today’s Options Premier 300 (PFFS) – H2816-040-0 Piscataquis, Lincoln, Cumberland, Somerset, Aroostook, Sagadahoc, Penobscot, Hancock, Androscoggin, Kennebec, Knox, Waldo, Oxford, Franklin This Plan does NOT include prescription drug coverage. N/A
UnitedHealthcare Dual Complete (PPO D-SNP) – H0271-020-0 Piscataquis, Somerset, Aroostook, Penobscot, Hancock, Washington Tier 1: $0.00, Tier 2: $0.00, Tier 3: $0.00, Tier 4: $0.00, Tier 5: $0.00 N/A
Aetna Medicare Value Plan (HMO) – H3597-007-0 Lincoln, Androscoggin, Kennebec, Knox, Waldo, Oxford Preferred Generic: $2.00, Generic: $5.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $5,900
Anthem l MaineHealth Advantage Plus (HMO) – H9065-008-0 Lincoln, Somerset, Sagadahoc, Androscoggin, Kennebec, Knox, Waldo, Oxford, Franklin Preferred Generic: $4.00, Generic: $10.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $5,500
Martin’s Point Generations Advantage Focus DC (HMO C-SNP) – H5591-007-0 Cumberland Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $40.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% N/A
Martin’s Point Generations Advantage Prime (HMO-POS) – H5591-006-1 Cumberland Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $40.00, Non-Preferred Drug: $95.00, Specialty Tier: 33% $7,050

Standalone Medicare Part D Plans in Maine

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

Standalone Medicare Part D Plans in Maine

Plan Details Tiers
AARP MedicareRx Preferred (PDP)
S5820 – 001 – 0
by UnitedHealthcare
Monthly Premium: $81.80
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 – 378 – 0
by UnitedHealthcare
Monthly Premium: $27.40
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: $33.00
Tier 4: 40%
Tier 5: 25%
AARP MedicareRx Walgreens (PDP)
S5921 – 384 – 0
by UnitedHealthcare
Monthly Premium: $36.40
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%
Anthem MediBlue Rx Enhanced (PDP)
S5596 – 066 – 0
by Anthem MediBlue Rx (PDP)
Monthly Premium: $19.60
Annual Deductible: $350
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $0.00
Tier 2: $2.00
Tier 3: 20%
Tier 4: 38%
Tier 5: 26%
Anthem MediBlue Rx Plus (PDP)
S5596 – 001 – 0
by Anthem MediBlue Rx (PDP)
Monthly Premium: $60.70
Annual Deductible: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $3.00
Tier 3: $43.00
Tier 4: 45%
Tier 5: 33%
Anthem MediBlue Rx Standard (PDP)
S5596 – 046 – 0
by Anthem MediBlue Rx (PDP)
Monthly Premium: $57.80
Annual Deductible: $395
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $2.00
Tier 3: $36.00
Tier 4: 31%
Tier 5: 25%
Cigna Secure Rx (PDP)
S5617 – 003 – 0
by Cigna
Monthly Premium: $29.30
Annual Deductible: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $2.00
Tier 3: $33.00
Tier 4: 50%
Tier 5: 25%
Cigna Secure-Essential Rx (PDP)
S5617 – 280 – 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: 49%
Tier 5: 25%
Cigna Secure-Extra Rx (PDP)
S5617 – 246 – 0
by Cigna
Monthly Premium: $53.90
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%
Elixir RxPlus (PDP)
S7694 – 124 – 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%
Elixir RxSecure (PDP)
S7694 – 001 – 0
by Elixir Insurance
Monthly Premium: $28.50
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: 32%
Tier 5: 25%
Express Scripts Medicare – Choice (PDP)
S5660 – 172 – 0
by Express Scripts Medicare
Monthly Premium: $65.40
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%
Express Scripts Medicare – Saver (PDP)
S5660 – 218 – 0
by Express Scripts Medicare
Monthly Premium: $25.80
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 – 104 – 0
by Express Scripts Medicare
Monthly Premium: $25.30
Annual Deductible: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $3.00
Tier 3: $24.00
Tier 4: 50%
Tier 5: 25%
Humana Basic Rx Plan (PDP)
S5884 – 101 – 0
by Humana
Monthly Premium: $27.80
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 – 148 – 0
by Humana
Monthly Premium: $68.30
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%
Humana Walmart Value Rx Plan (PDP)
S5884 – 181 – 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 – 001 – 0
by Mutual of Omaha Rx
Monthly Premium: $99.40
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: 36%
Tier 5: 25%
Mutual of Omaha Rx Premier (PDP)
S7126 – 071 – 0
by Mutual of Omaha Rx
Monthly Premium: $23.90
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: 44%
Tier 5: 25%
SilverScript Choice (PDP)
S5601 – 002 – 0
by Aetna Medicare
Monthly Premium: $26.30
Annual Deductible: $305
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: 44%
Tier 5: 27%
SilverScript Plus (PDP)
S5601 – 003 – 0
by Aetna Medicare
Monthly Premium: $66.80
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 – 176 – 0
by Aetna Medicare
Monthly Premium: $7.10
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 – 075 – 0
by WellCare
Monthly Premium: $26.70
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 – 035 – 0
by WellCare
Monthly Premium: $35.50
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: $36.00
Tier 4: 41%
Tier 5: 25%
WellCare Medicare Rx Select (PDP)
S5810 – 296 – 0
by WellCare
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: $3.00
Tier 3: $47.00
Tier 4: 42%
Tier 5: 25%
WellCare Medicare Rx Value Plus (PDP)
S5768 – 125 – 0
by WellCare
Monthly Premium: $75.60
Annual Deductible: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $4.00
Tier 3: $47.00
Tier 4: 50%
Tier 5: 33%
WellCare Value Script (PDP)
S4802 – 136 – 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: $7.00
Tier 3: $43.00
Tier 4: 47%
Tier 5: 25%
WellCare Wellness Rx (PDP)
S4802 – 170 – 0
by WellCare
Monthly Premium: $15.20
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: 46%
Tier 5: 25%

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