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UPDATED: Oct 29, 2021

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The Highlights

  • Santa Teresa, NM Medicare options include Advantage, standalone Part D, and Medicare Supplement
  • Medicare Advantage plans may include Santa Teresa, New Mexico prescription drug coverage, or you may need to buy Part D coverage separately
  • Options for Medicare Supplement in Santa Teresa, New Mexico include Medigap Plan F-high deductible and Medigap Plan K

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

Santa Teresa, New Mexico 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 Santa Teresa original Medicare plans don’t cover, like coinsurance and deductibles.

Ready to buy Santa Teresa, New Mexico Medicare coverage? Enter your ZIP code to compare Santa Teresa, NM Medicare options available to you right now.

Medicare Advantage Companies in Santa Teresa, New Mexico

Medicare Advantage in Santa Teresa, New Mexico 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 Santa Teresa, NM 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 Santa Teresa, New Mexico

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) – H2228-023-0 $0.00 $195 . Tier 1, 2 and 3 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $2.00, Generic: $14.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 29% $3,900
Allwell Dual Medicare (HMO D-SNP) – H2134-001-0 $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: $9.00, Preferred Brand: $47.00, Non-Preferred Drug: 45%, Specialty Tier: 25% N/A
Allwell Dual Medicare Harmony (HMO D-SNP) – H2134-003-0 $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: $1.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: 48%, Specialty Tier: 25% N/A
Allwell Medicare (HMO) – H2134-005-0 $0.00 $125 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $9.00, Preferred Brand: $37.00, Non-Preferred Drug: $90.00, Specialty Tier: 30%, Select Care Drugs: $0.00 $3,450
Allwell Medicare Boost (HMO) – H2134-002-0 $0.00 $150 . Tier 1, 2 and 3 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $9.00, Preferred Brand: $37.00, Non-Preferred Drug: $90.00, Specialty Tier: 30%, Select Care Drugs: $0.00 $7,550
Allwell Medicare Complement (HMO) – H2134-004-0 $20.80 $445 . Tier 1 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $2.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: 48%, Specialty Tier: 25% $3,450
Allwell Medicare Simple (HMO) – H2134-006-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $4,400
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) – H3251-029-0 $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
Blue Cross Medicare Advantage Select (HMO) – H3251-002-0 $0.00 $150 . Tier 1, 2 and 3 exempt Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $13.00, Preferred Brand: $40.00, Non-Preferred Drug: $93.00, Specialty Tier: 30% $4,500
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 H5216-199 (PPO) – H5216-199-0 $28.20 $435 . Tier 1 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $4.00, Generic: $16.00, 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 H5216-137 (PPO) – H5216-137-0 $0.00 $445 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $7.00, Generic: $17.00, Preferred Brand: $47.00, Non-Preferred Drug: $99.00, Specialty Tier: 25% $6,700
HumanaChoice H5216-196 (PPO) – H5216-196-1 $0.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $5.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $5,500
Lasso Healthcare Growth (MSA) – H1924-001-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. N/A
Lasso Healthcare Growth Plus (MSA) – H1924-004-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. N/A
Molina Medicare Choice Care (HMO) – H9082-009-0 $28.20 $445 . Tier 1 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $44.00, Non-Preferred Drug: 37%, Specialty Tier: 25% $7,550
Molina Medicare Complete Care (HMO D-SNP) – H9082-007-0 $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: tbd N/A
Presbyterian Dual Plus (HMO D-SNP) – H3204-013-4 $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
Presbyterian MediCare PPO Plan 1 (PPO) – H3206-003-0 $56.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $6,700
Presbyterian MediCare PPO Plan 2 with Rx (PPO) – H3206-001-0 $188.00 $335 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $4.00, Generic: $10.00, Preferred Brand: $45.00, Non-Preferred Drug: $95.00, Specialty Tier: 25% $6,700
UnitedHealthcare Medicare Advantage Assure (PPO) – H0271-011-0 $19.70 $445 No additional gap coverage, only the Donut Hole Discount Tier 1: 25%, Tier 2: 25%, Tier 3: 25%, Tier 4: 25%, Tier 5: 25% $7,550

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Medicare Supplement Companies in Santa Teresa, New Mexico

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

Company Plans
AARP – UnitedHealthcare Insurance Company (Level 1) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
AARP – UnitedHealthcare Insurance Company (Level 1/Household) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
AARP – UnitedHealthcare Insurance Company (Level 2) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
AARP – UnitedHealthcare Insurance Company (Level 2/Household) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
AARP – UnitedHealthcare Insurance Company (Standard) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
AARP – UnitedHealthcare Insurance Company (Standard/Household) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
Accendo Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan N
American Benefit Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan N
American Continental Insurance Company (Aetna) Medigap Plan A,
Medigap Plan B,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan N
Bankers Fidelity Assurance Company (Preferred) Medigap Plan A,
Medigap Plan F,
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-high deductible,
Medigap Plan K,
Medigap Plan N
Blue Cross and Blue Shield of New Mexico Medigap Plan A,
Medigap Plan B,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G-high deductible,
Medigap Plan N
Capitol Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan N
Catholic Life Insurance Medigap Plan A,
Medigap Plan F,
Medigap Plan N
Cigna Health & Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan N
Cigna Health & Life Insurance Company (Standard II w/ 15% HHD) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan N
Cigna Health & Life Insurance Company (Standard II w/ 6% HHD) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan N
Cigna Health & Life Insurance Company (Standard II) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan N
Cigna Health & Life Insurance Company (Standard III w/ 15% HHD) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan N
Cigna Health & Life Insurance Company (Standard III w/ 6% HHD) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan N
Cigna Health & Life Insurance Company (Standard III) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan N
Cigna Health & Life Insurance Company (w/ 15% HHD) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan N
Cigna Health & Life Insurance Company (w/ 6% HHD) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan N
Colonial Penn Life Insurance Company Medigap Plan A,
Medigap Plan B,
Medigap Plan D,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan M,
Medigap Plan N
Colonial Penn Life Insurance Company (Substandard) Medigap Plan A,
Medigap Plan B,
Medigap Plan D,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan M,
Medigap Plan N
Garden State Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G-high deductible,
Medigap Plan M,
Medigap Plan N
Globe Life and Accident Insurance Company (Direct to Consumer) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G-high deductible,
Medigap Plan N
Great Southern Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan N
Great Southern Life Insurance Company (Class 1) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan N
Heartland National Life Insurance Company Medigap Plan A,
Medigap Plan N
Humana (Humana Insurance Company) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
Humana (Humana Insurance Company) (Household) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
Humana Healthy Living (Humana Insurance Company) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan K,
Medigap Plan N
Humana Healthy Living (Humana Insurance Company) (Household) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan K,
Medigap Plan N
Humana Value (HumanaDental Insurance Company) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
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-high deductible,
Medigap Plan K,
Medigap Plan N
Lumico Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan N
Manhattan Life Assurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan N
Medico Insurance Company Medigap Plan A,
Medigap Plan D,
Medigap Plan F
Nassau Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan N
National Guardian Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan N
National Health Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan N
National Health Insurance Company (Household) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan N
Old Surety Life Insurance Company Medigap Plan A,
Medigap Plan C,
Medigap Plan F
Omaha Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G-high deductible,
Medigap Plan N
Philadelphia American Life Insurance Company Medigap Plan A,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G-high deductible,
Medigap Plan N
Puritan Life Insurance Company of America Medigap Plan A,
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
Shenandoah Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan N
Southern Guaranty Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan N
State Farm Mutual Automobile Insurance Company Medigap Plan A,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan N
Transamerica Life Insurance Company (Direct) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan K,
Medigap Plan L,
Medigap Plan M,
Medigap Plan N
USAA Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan N
Union Security Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan N
United American Insurance Company Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
United Insurance Company of America Medigap Plan A,
Medigap Plan D,
Medigap Plan F,
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-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
WMI Mutual Insurance Company Medigap Plan A,
Medigap Plan C,
Medigap Plan F,
Medigap Plan N

Santa Teresa, New Mexico Standard Medicare Plan Coverage

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

Santa Teresa, New Mexico Standard Medicare Plan Coverage

Plan Name Monthly Cost Copays Coinsurance Deductibles Plan Benefits
Medigap Plan A Premiums range from $72-$779 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 $103-$619 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 $112-$563 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 $98-$554 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 $117-$921 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 $26-$299 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 $97-$759 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 $26-$153 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 $33-$265 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 $61-$551 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 $93-$640 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 $69-$563 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 Santa Teresa, New Mexico

Prescription drug coverage for Medicare in Santa Teresa, New Mexico is covered by a Part D plan. You can purchase Part D coverage in Santa Teresa, New Mexico 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 Santa Teresa, New Mexico

Plan Details Tiers
SilverScript SmartRx (PDP)
S5601 – 201 – 0
by Aetna Medicare
Monthly Premium: $6.20
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 Value Script (PDP)
S4802 – 159 – 0
by WellCare
Monthly Premium: $14.30
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $8.00
Tier 3: $43.00
Tier 4: 47%
Tier 5: 25%
WellCare Wellness Rx (PDP)
S4802 – 195 – 0
by WellCare
Monthly Premium: $14.70
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: $39.00
Tier 4: 47%
Tier 5: 25%
Humana Walmart Value Rx Plan (PDP)
S5884 – 205 – 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%
AARP MedicareRx Saver Plus (PDP)
S5921 – 371 – 0
by UnitedHealthcare
Monthly Premium: $22.70
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: $35.00
Tier 4: 40%
Tier 5: 25%
Cigna Secure Rx (PDP)
S5617 – 128 – 0
by Cigna
Monthly Premium: $22.70
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: $47.00
Tier 4: 50%
Tier 5: 25%
WellCare Classic (PDP)
S4802 – 090 – 0
by WellCare
Monthly Premium: $23.00
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: 40%
Tier 5: 25%
WellCare Medicare Rx Select (PDP)
S5810 – 303 – 0
by WellCare
Monthly Premium: $23.10
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%
SilverScript Choice (PDP)
S5601 – 052 – 0
by Aetna Medicare
Monthly Premium: $23.30
Annual Deductible: $320
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: 27%
Elixir RxPlus (PDP)
S7694 – 026 – 0
by Elixir Insurance
Monthly Premium: $23.90
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: 26%
Tier 5: 25%
Cigna Secure-Essential Rx (PDP)
S5617 – 305 – 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: 45%
Tier 5: 25%
Mutual of Omaha Rx Premier (PDP)
S7126 – 095 – 0
by Mutual of Omaha Rx
Monthly Premium: $25.00
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: 23%
Tier 4: 40%
Tier 5: 25%
Humana Basic Rx Plan (PDP)
S5884 – 110 – 0
by Humana
Monthly Premium: $25.10
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 – 060 – 0
by WellCare
Monthly Premium: $25.20
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: 40%
Tier 5: 25%
Express Scripts Medicare – Saver (PDP)
S5660 – 242 – 0
by Express Scripts Medicare
Monthly Premium: $30.40
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%
AARP MedicareRx Walgreens (PDP)
S5921 – 407 – 0
by UnitedHealthcare
Monthly Premium: $33.20
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: 40%
Tier 5: 25%
Cigna Secure-Extra Rx (PDP)
S5617 – 271 – 0
by Cigna
Monthly Premium: $50.50
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%
Express Scripts Medicare – Value (PDP)
S5660 – 128 – 0
by Express Scripts Medicare
Monthly Premium: $50.60
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $8.00
Tier 3: $47.00
Tier 4: 50%
Tier 5: 25%
Humana Premier Rx Plan (PDP)
S5884 – 172 – 0
by Humana
Monthly Premium: $61.40
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%
SilverScript Plus (PDP)
S5601 – 053 – 0
by Aetna Medicare
Monthly Premium: $62.90
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%
Express Scripts Medicare – Choice (PDP)
S5660 – 196 – 0
by Express Scripts Medicare
Monthly Premium: $65.30
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%
Blue Cross MedicareRx Basic (PDP)
S5715 – 013 – 0
by Blue Cross and Blue Shield of New Mexico
Monthly Premium: $70.60
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: 12%
Tier 4: 42%
Tier 5: 25%
WellCare Medicare Rx Value Plus (PDP)
S5768 – 149 – 0
by WellCare
Monthly Premium: $76.90
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: 44%
Tier 5: 33%
Mutual of Omaha Rx Plus (PDP)
S7126 – 025 – 0
by Mutual of Omaha Rx
Monthly Premium: $85.00
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: 36%
Tier 5: 25%
Blue Cross MedicareRx Value (PDP)
S5715 – 003 – 0
by Blue Cross and Blue Shield of New Mexico
Monthly Premium: $88.30
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $0.00
Tier 2: $8.00
Tier 3: $40.00
Tier 4: 38%
Tier 5: 25%
AARP MedicareRx Preferred (PDP)
S5820 – 025 – 0
by UnitedHealthcare
Monthly Premium: $90.20
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%
Blue Cross MedicareRx Plus (PDP)
S5715 – 004 – 0
by Blue Cross and Blue Shield of New Mexico
Monthly Premium: $136.10
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: $30.00
Tier 4: 40%
Tier 5: 33%

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