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UPDATED: Jun 29, 2022

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The Highlights

  • Options for Medicare Supplement in Ordway, Colorado include Medigap Plan B and Medigap Plan F-high deductible
  • Medicare Advantage plans may include Ordway, Colorado prescription drug coverage, or you may need to buy Part D coverage separately
  • Medicare Advantage plans are available in Ordway with both PPO and HMO networks

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

Ordway, Colorado 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 Ordway original Medicare plans don’t cover, like coinsurance and deductibles.

Ready to buy Ordway, Colorado Medicare coverage? Enter your ZIP code to compare Ordway, CO Medicare options available to you right now.

Medicare Advantage Companies in Ordway, Colorado

Medicare Advantage in Ordway, Colorado 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 Ordway, CO 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 Ordway, Colorado

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) – H2577-001-2 $0.00 $195 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $2.00, Generic: $8.00, Preferred Brand: $47.00, Non-Preferred Drug: $95.00, Specialty Tier: 29% $5,500
AARP Medicare Advantage Choice Plan 2 (PPO) – H2577-003-2 $0.00 $435 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $2.00, Generic: $8.00, Preferred Brand: $47.00, Non-Preferred Drug: $95.00, Specialty Tier: 25% $6,700
Friday Health Plans Gold Plan (Cost) – H0657-009-0 $68.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $6,700
Friday Health Plans Silver Plan (Cost) – H0657-008-0 $56.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $6,700
Humana Gold Choice H8145-123 (PFFS) – H8145-123-0 $89.00 $300 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $7.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 27% N/A
Humana Honor (PPO) – H5216-213-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $4,400
Humana Value Plus H5216-195 (PPO) – H5216-195-0 $34.30 $435 . Tier 1 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $2.00, Generic: $11.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 25% $7,550
HumanaChoice H5216-077 (PPO) – H5216-077-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $4,000
HumanaChoice H5216-078 (PPO) – H5216-078-1 $56.00 $195 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $2.00, Generic: $8.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 29% $6,700
HumanaChoice H5216-223 (PPO) – H5216-223-0 $28.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $2.00, Generic: $5.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $5,500

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Medicare Supplement Companies in Ordway, Colorado

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

Company Plans
AARP – UnitedHealthcare Insurance Company (Level 1) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
AARP – UnitedHealthcare Insurance Company (Level 1/Household) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
AARP – UnitedHealthcare Insurance Company (Level 2) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
AARP – UnitedHealthcare Insurance Company (Level 2/Household) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
AARP – UnitedHealthcare Insurance Company (Standard) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
AARP – UnitedHealthcare Insurance Company (Standard/Household) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
Accendo Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Aetna Health Insurance Company Medigap Plan A,
Medigap Plan B,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
Anthem Blue Cross and Blue Shield – Colorado Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Atlantic Coast Life Insurance Company Medigap Plan A,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Atlantic Coast Life Insurance Company (Household) Medigap Plan A,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Bankers Fidelity Assurance Company (Preferred) Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan N
Bankers Fidelity Assurance Company (Standard) Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan N
Capitol Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Cigna National Health Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Cigna National Health Insurance Company (Standard II w/ 15% HHD) Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Cigna National Health Insurance Company (Standard II w/ 6% HHD) Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Cigna National Health Insurance Company (Standard II) Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Cigna National Health Insurance Company (Standard III w/ 15% HHD) Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Cigna National Health Insurance Company (Standard III w/ 6% HHD) Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Cigna National Health Insurance Company (Standard III) Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Cigna National Health Insurance Company (w/ 15% HHD) Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Cigna National Health Insurance Company (w/ 6% HHD) Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Colonial Penn Life Insurance Company Medigap Plan A,
Medigap Plan B,
Medigap Plan D,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan M,
Medigap Plan N
Colonial Penn Life Insurance Company (Substandard) Medigap Plan A,
Medigap Plan B,
Medigap Plan D,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan M,
Medigap Plan N
Everence Association Inc. Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan L
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
Great Southern Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
Great Southern Life Insurance Company (Class 1) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
Guarantee Trust Life Insurance Company Medigap Plan A,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Humana (Humana Insurance Company) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
Humana (Humana Insurance Company) (Household) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
Humana 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
Humana Value (HumanaDental Insurance Company) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan N
Humana Value (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 K,
Medigap Plan N
Independence American Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Lumico Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Medico Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Nassau Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
National Guardian Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
National Health Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
National Health Insurance Company (Household) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
Old Surety Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G
Pan-American Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Physicians Life Insurance Company (Issue Age) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible
Prosperity Life Group Medigap Plan A,
Medigap Plan F,
Medigap Plan G
Resource Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G
Royal Arcanum Medigap Plan A,
Medigap Plan D,
Medigap Plan F,
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 G,
Medigap Plan N
State Farm Mutual Automobile Insurance Company Medigap Plan A,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Transamerica Life Insurance Company (Direct) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan M,
Medigap Plan N
USAA Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Union Security Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
United American Insurance Company Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
United Commercial Travelers of America Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
United Insurance Company of America Medigap Plan A,
Medigap Plan D,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
United States Fire Insurance Company Medigap Plan A,
Medigap Plan B,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
United of Omaha Life Insurance Medigap Plan A,
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
Wisconsin Physicians Service Insurance Corporation Medigap Plan A,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
Physicians Life Insurance Company (Attained Age) Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible
Physicians Life Insurance Company (Innovative/Attained Age) Medigap Plan F,
Medigap Plan G
Physicians Life Insurance Company (Innovative/Issue Age) Medigap Plan F,
Medigap Plan G

Ordway, Colorado Standard Medicare Plan Coverage

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

Ordway, Colorado Standard Medicare Plan Coverage

Plan Name Monthly Cost Copays Coinsurance Deductibles Plan Benefits
Medigap Plan A Premiums range from $80-$1,098 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 $108-$966 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 $149-$1,237 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 $125-$693 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 $121-$1,262 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 $32-$350 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 $110-$1,108 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 $32-$329 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 $36-$540 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 $71-$740 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 $112-$523 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 $77-$792 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 Ordway, Colorado

Prescription drug coverage for Medicare in Ordway, Colorado is covered by a Part D plan. You can purchase Part D coverage in Ordway, Colorado 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 Ordway, Colorado

Plan Details Tiers
SilverScript SmartRx (PDP)
S5601 – 202 – 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: 47%
Tier 5: 25%
WellCare Value Script (PDP)
S4802 – 160 – 0
by WellCare
Monthly Premium: $14.50
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: $43.00
Tier 4: 48%
Tier 5: 25%
WellCare Wellness Rx (PDP)
S4802 – 196 – 0
by WellCare
Monthly Premium: $16.40
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: $38.00
Tier 4: 46%
Tier 5: 25%
Humana Walmart Value Rx Plan (PDP)
S5884 – 206 – 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%
Anthem MediBlue Rx Enhanced (PDP)
S5596 – 082 – 0
by Anthem MediBlue Rx (PDP)
Monthly Premium: $19.50
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: 39%
Tier 5: 26%
Cigna Secure-Essential Rx (PDP)
S5617 – 306 – 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 – 304 – 0
by WellCare
Monthly Premium: $25.40
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 – 096 – 0
by Mutual of Omaha Rx
Monthly Premium: $26.90
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: 40%
Tier 5: 25%
SilverScript Choice (PDP)
S5601 – 054 – 0
by Aetna Medicare
Monthly Premium: $29.70
Annual Deductible: $370
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: 41%
Tier 5: 26%
Express Scripts Medicare – Value (PDP)
S5660 – 129 – 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: $6.00
Tier 3: $43.00
Tier 4: 47%
Tier 5: 25%
AARP MedicareRx Saver Plus (PDP)
S5921 – 372 – 0
by UnitedHealthcare
Monthly Premium: $30.70
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: $36.00
Tier 4: 40%
Tier 5: 25%
WellCare Classic (PDP)
S4802 – 091 – 0
by WellCare
Monthly Premium: $30.90
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: $32.00
Tier 4: 32%
Tier 5: 25%
Elixir RxPlus (PDP)
S7694 – 027 – 0
by Elixir Insurance
Monthly Premium: $31.20
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: 25%
Tier 5: 25%
Express Scripts Medicare – Saver (PDP)
S5660 – 243 – 0
by Express Scripts Medicare
Monthly Premium: $31.50
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%
Humana Basic Rx Plan (PDP)
S5884 – 111 – 0
by Humana
Monthly Premium: $32.30
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%
WellCare Medicare Rx Saver (PDP)
S5810 – 061 – 0
by WellCare
Monthly Premium: $32.30
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: 38%
Tier 5: 25%
Cigna Secure Rx (PDP)
S5617 – 133 – 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: $3.00
Tier 3: $42.00
Tier 4: 50%
Tier 5: 25%
AARP MedicareRx Walgreens (PDP)
S5921 – 408 – 0
by UnitedHealthcare
Monthly Premium: $42.00
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%
Cigna Secure-Extra Rx (PDP)
S5617 – 272 – 0
by Cigna
Monthly Premium: $49.70
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%
Anthem MediBlue Rx Standard (PDP)
S5596 – 059 – 0
by Anthem MediBlue Rx (PDP)
Monthly Premium: $61.80
Annual Deductible: $430
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $2.00
Tier 3: $33.00
Tier 4: 28%
Tier 5: 25%
Humana Premier Rx Plan (PDP)
S5884 – 173 – 0
by Humana
Monthly Premium: $67.60
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%
Anthem MediBlue Rx Plus (PDP)
S5596 – 060 – 0
by Anthem MediBlue Rx (PDP)
Monthly Premium: $80.60
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%
WellCare Medicare Rx Value Plus (PDP)
S5768 – 150 – 0
by WellCare
Monthly Premium: $81.50
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: 45%
Tier 5: 33%
Express Scripts Medicare – Choice (PDP)
S5660 – 197 – 0
by Express Scripts Medicare
Monthly Premium: $84.50
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%
SilverScript Plus (PDP)
S5601 – 055 – 0
by Aetna Medicare
Monthly Premium: $85.20
Annual Deductible: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $0.00
Tier 2: $2.00
Tier 3: $47.00
Tier 4: 50%
Tier 5: 33%
Mutual of Omaha Rx Plus (PDP)
S7126 – 026 – 0
by Mutual of Omaha Rx
Monthly Premium: $100.00
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: 35%
Tier 5: 25%
AARP MedicareRx Preferred (PDP)
S5820 – 026 – 0
by UnitedHealthcare
Monthly Premium: $102.60
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%

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