Shuman Roy is an entrepreneur, business owner, and musician. He started RoysNoys, LLC in 2013 as a music production and education service company. He also offers small business consulting and advisory services to help businesses get from start-up mode to turn-key operations. Shuman earned his M.B.A from the Stern School of Business in 2001 and has an undergraduate degree from Manhattan College in ...

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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 7 Medicare Avantage companies in South Dakota
  • Standalone Medicare Part D Plans in South Dakota are meant to help cover prescription drug costs
  • You can choose from South Dakota HMO and PPO Medicare Advantage plans

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

The Complete List of South Dakota Medicare Advantage Companies

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

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Medicare Advantage Companies in South Dakota

Company Number of Plans Counties
Aetna Medicare 3 Union, Sanborn, Hutchinson, Bon Homme, Minnehaha, Turner, Yankton, Clay, Brookings, Aurora, McCook, Moody, Lincoln, Lake
Great Plains Medicare Advantage 2 Deuel, Pennington, Union, Douglas, Tripp, Hand, Miner, Bon Homme, Minnehaha, Turner, Day, Kingsbury, Charles Mix, McCook, Custer, Lincoln
HealthPartners 4 Deuel, Union, Codington, Brown, Minnehaha, Turner, Clay, Day, Brookings, Lincoln, Lake
Humana 7 Grant, Deuel, Pennington, Union, Sanborn, Hanson, Hutchinson, Codington, Hamlin, Marshall, Lawrence, Meade, Miner, Bon Homme, Minnehaha, Turner, Spink, Yankton, Roberts, Clay, Day, Clark, Brookings, Kingsbury, Davison, McCook, Moody, Fall River, Custer, Lincoln, Butte, Lake
Lasso Healthcare 2 Grant, Walworth, Deuel, Pennington, Union, Sanborn, Hanson, Hutchinson, Douglas, Codington, Tripp, Jackson, Sully, Jones, Haakon, Hamlin, Marshall, Brule, Bennett, Lawrence, Corson, Meade, Hand, Jerauld, Miner, Bon Homme, Brown, Minnehaha, Turner, Spink, Yankton, Faulk, Todd, Roberts, Clay, Hyde, Day, Clark, Brookings, Kingsbury, Charles Mix, Ziebach, Campbell, Dewey, Aurora, Davison, McCook, McPherson, Buffalo, Beadle, Gregory, Moody, Fall River, Custer, Lincoln, Butte, Stanley, Mellette, Perkins, Edmunds, Lyman, Harding, Lake, Potter, Hughes
Medica 4 Grant, Walworth, Deuel, Pennington, Union, Sanborn, Hanson, Hutchinson, Douglas, Codington, Tripp, Jackson, Sully, Jones, Haakon, Hamlin, Marshall, Brule, Bennett, Lawrence, Corson, Meade, Hand, Jerauld, Miner, Bon Homme, Brown, Minnehaha, Turner, Spink, Yankton, Faulk, Todd, Roberts, Clay, Hyde, Day, Clark, Brookings, Kingsbury, Charles Mix, Ziebach, Campbell, Dewey, Aurora, Davison, McCook, McPherson, Buffalo, Beadle, Gregory, Moody, Fall River, Custer, Lincoln, Butte, Stanley, Mellette, Perkins, Edmunds, Lyman, Harding, Lake, Potter, Hughes
UnitedHealthcare 3 Deuel, Pennington, Union, Lawrence, Meade, Minnehaha, Turner, Yankton, Clay, Brookings, Moody, Lincoln, Lake

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South Dakota Medicare Advantage Plans by Company

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

Medicare Plans in South Dakota Offered by Humana

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

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Humana Value Plus H5216-171 (PPO) H5216-171 Grant, Deuel, Pennington, Union, Sanborn, Hanson, Hutchinson, Codington, Hamlin, Marshall, Lawrence, Meade, Miner, Bon Homme, Minnehaha, Turner, Spink, Yankton, Roberts, Clay, Day, Clark, Brookings, Kingsbury, Davison, McCook, Moody, Fall River, Custer, Lincoln, Butte, Lake Local PPO $27.80
HumanaChoice H5216-103 (PPO) H5216-103 Grant, Deuel, Pennington, Union, Sanborn, Hanson, Hutchinson, Codington, Hamlin, Marshall, Lawrence, Meade, Miner, Bon Homme, Minnehaha, Turner, Spink, Yankton, Roberts, Clay, Day, Clark, Brookings, Kingsbury, Davison, McCook, Moody, Fall River, Custer, Lincoln, Butte, Lake Local PPO $115.00
HumanaChoice H5216-088 (PPO) H5216-088 Grant, Deuel, Pennington, Union, Sanborn, Hanson, Hutchinson, Codington, Hamlin, Marshall, Lawrence, Meade, Miner, Bon Homme, Minnehaha, Turner, Spink, Yankton, Roberts, Clay, Day, Clark, Brookings, Kingsbury, Davison, McCook, Moody, Fall River, Custer, Lincoln, Butte, Lake Local PPO $67.00
Humana Honor (PPO) H5216-086 Grant, Deuel, Pennington, Union, Sanborn, Hanson, Hutchinson, Codington, Hamlin, Marshall, Lawrence, Meade, Miner, Bon Homme, Minnehaha, Turner, Spink, Yankton, Roberts, Clay, Day, Clark, Brookings, Kingsbury, Davison, McCook, Moody, Fall River, Custer, Lincoln, Butte, Lake Local PPO* $0.00
Humana Gold Choice H8145-089 (PFFS) H8145-089 Deuel, Pennington, Union, Hanson, Bon Homme, Turner, Yankton, Davison PFFS $95.00
HumanaChoice H5216-092 (PPO) H5216-092 Pennington, Minnehaha Local PPO $38.00
Humana Gold Plus H0028-011 (HMO) H0028-011 Pennington, Union, Lawrence, Meade, Minnehaha Local HMO $0.00

Medicare Plans in South Dakota Offered by Lasso Healthcare

Though plans can vary from county to county, Lasso Healthcare offers these Medicare plans in South Dakota.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Lasso Healthcare Growth (MSA) H1924-001 Grant, Walworth, Deuel, Pennington, Union, Sanborn, Hanson, Hutchinson, Douglas, Codington, Tripp, Jackson, Sully, Jones, Haakon, Hamlin, Marshall, Brule, Bennett, Lawrence, Corson, Meade, Hand, Jerauld, Miner, Bon Homme, Brown, Minnehaha, Turner, Spink, Yankton, Faulk, Todd, Roberts, Clay, Hyde, Day, Clark, Brookings, Kingsbury, Charles Mix, Ziebach, Campbell, Dewey, Aurora, Davison, McCook, McPherson, Buffalo, Beadle, Gregory, Moody, Fall River, Custer, Lincoln, Butte, Stanley, Mellette, Perkins, Edmunds, Lyman, Harding, Lake, Potter, Hughes MSA* MSAs do not have a monthly premium.
Lasso Healthcare Growth Plus (MSA) H1924-004 Grant, Walworth, Deuel, Pennington, Union, Sanborn, Hanson, Hutchinson, Douglas, Codington, Tripp, Jackson, Sully, Jones, Haakon, Hamlin, Marshall, Brule, Bennett, Lawrence, Corson, Meade, Hand, Jerauld, Miner, Bon Homme, Brown, Minnehaha, Turner, Spink, Yankton, Faulk, Todd, Roberts, Clay, Hyde, Day, Clark, Brookings, Kingsbury, Charles Mix, Ziebach, Campbell, Dewey, Aurora, Davison, McCook, McPherson, Buffalo, Beadle, Gregory, Moody, Fall River, Custer, Lincoln, Butte, Stanley, Mellette, Perkins, Edmunds, Lyman, Harding, Lake, Potter, Hughes MSA* MSAs do not have a monthly premium.

Medicare Plans in South Dakota Offered by Medica

Though plans can vary from county to county, Medica offers these Medicare plans in South Dakota.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Medica Prime Solution Thrift (Cost) H2450-030 Grant, Walworth, Deuel, Pennington, Union, Sanborn, Hanson, Hutchinson, Douglas, Codington, Tripp, Jackson, Sully, Jones, Haakon, Hamlin, Marshall, Brule, Bennett, Lawrence, Corson, Meade, Hand, Jerauld, Miner, Bon Homme, Brown, Minnehaha, Turner, Spink, Yankton, Faulk, Todd, Roberts, Clay, Hyde, Day, Clark, Brookings, Kingsbury, Charles Mix, Ziebach, Campbell, Dewey, Aurora, Davison, McCook, McPherson, Buffalo, Beadle, Gregory, Moody, Fall River, Custer, Lincoln, Butte, Stanley, Mellette, Perkins, Edmunds, Lyman, Harding, Lake, Potter, Hughes Cost * $0.00
Medica Prime Solution Standard (Cost) H2450-044 Grant, Walworth, Deuel, Pennington, Union, Sanborn, Hanson, Hutchinson, Douglas, Codington, Tripp, Jackson, Sully, Jones, Haakon, Hamlin, Marshall, Brule, Bennett, Lawrence, Corson, Meade, Hand, Jerauld, Miner, Bon Homme, Brown, Minnehaha, Turner, Spink, Yankton, Faulk, Todd, Roberts, Clay, Hyde, Day, Clark, Brookings, Kingsbury, Charles Mix, Ziebach, Campbell, Dewey, Aurora, Davison, McCook, McPherson, Buffalo, Beadle, Gregory, Moody, Fall River, Custer, Lincoln, Butte, Stanley, Mellette, Perkins, Edmunds, Lyman, Harding, Lake, Potter, Hughes Cost * $0.00
Medica Prime Solution Premier (Cost) H2450-036 Grant, Walworth, Deuel, Pennington, Union, Sanborn, Hanson, Hutchinson, Douglas, Codington, Tripp, Jackson, Sully, Jones, Haakon, Hamlin, Marshall, Brule, Bennett, Lawrence, Corson, Meade, Hand, Jerauld, Miner, Bon Homme, Brown, Minnehaha, Turner, Spink, Yankton, Faulk, Todd, Roberts, Clay, Hyde, Day, Clark, Brookings, Kingsbury, Charles Mix, Ziebach, Campbell, Dewey, Aurora, Davison, McCook, McPherson, Buffalo, Beadle, Gregory, Moody, Fall River, Custer, Lincoln, Butte, Stanley, Mellette, Perkins, Edmunds, Lyman, Harding, Lake, Potter, Hughes Cost * $0.00
Medica Prime Solution Core (Cost) H2450-034 Grant, Walworth, Deuel, Pennington, Union, Sanborn, Hanson, Hutchinson, Douglas, Codington, Tripp, Jackson, Sully, Jones, Haakon, Hamlin, Marshall, Brule, Bennett, Lawrence, Corson, Meade, Hand, Jerauld, Miner, Bon Homme, Brown, Minnehaha, Turner, Spink, Yankton, Faulk, Todd, Roberts, Clay, Hyde, Day, Clark, Brookings, Kingsbury, Charles Mix, Ziebach, Campbell, Dewey, Aurora, Davison, McCook, McPherson, Buffalo, Beadle, Gregory, Moody, Fall River, Custer, Lincoln, Butte, Stanley, Mellette, Perkins, Edmunds, Lyman, Harding, Lake, Potter, Hughes Cost * $0.00

Medicare Plans in South Dakota Offered by HealthPartners

Though plans can vary from county to county, HealthPartners offers these Medicare plans in South Dakota.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
HealthPartners Sanford Basic (Cost) H2462-022 Deuel, Union, Codington, Brown, Minnehaha, Turner, Clay, Day, Brookings, Lincoln, Lake Cost * $0.00
HealthPartners Sanford Active (Cost) H2462-024 Deuel, Union, Codington, Brown, Minnehaha, Turner, Clay, Day, Brookings, Lincoln, Lake Cost * $0.00
HealthPartners Sanford Vital (Cost) H2462-023 Deuel, Union, Codington, Brown, Minnehaha, Turner, Clay, Day, Brookings, Lincoln, Lake Cost * $0.00
HealthPartners Sanford Ultimate (Cost) H2462-025 Deuel, Union, Codington, Brown, Minnehaha, Turner, Clay, Day, Brookings, Lincoln, Lake Cost * $0.00

Medicare Plans in South Dakota Offered by UnitedHealthcare

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

Plan Name Base Plan ID Counties Plan Type Monthly Premium
AARP Medicare Advantage Choice (PPO) H1278-007 Deuel, Pennington, Union, Lawrence, Meade, Minnehaha, Turner, Yankton, Clay, Brookings, Moody, Lincoln, Lake Local PPO $0.00
UnitedHealthcare Medicare Advantage Assure (PPO) H0271-018 Deuel, Pennington, Union, Lawrence, Meade, Minnehaha, Turner, Yankton, Clay, Brookings, Moody, Lincoln, Lake Local PPO $38.00
AARP Medicare Advantage Patriot (PPO) H1278-019 Deuel, Pennington, Union, Lawrence, Meade, Minnehaha, Turner, Yankton, Clay, Brookings, Moody, Lincoln, Lake Local PPO* $0.00

Medicare Plans in South Dakota Offered by Great Plains Medicare Advantage

Though plans can vary from county to county, Great Plains Medicare Advantage offers these Medicare plans in South Dakota.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Great Plains Medicare Advantage (HMO I-SNP) H1787-001 Deuel, Pennington, Union, Douglas, Tripp, Hand, Miner, Bon Homme, Minnehaha, Turner, Day, Kingsbury, Charles Mix, McCook, Custer, Lincoln Local HMO $38.00
Great Plain Medicare Advantage Gold (HMO I-SNP) H1787-002 Deuel, Pennington, Union, Douglas, Tripp, Hand, Miner, Bon Homme, Minnehaha, Turner, Day, Kingsbury, Charles Mix, McCook, Lincoln Local HMO $175.00

Medicare Plans in South Dakota Offered by Aetna Medicare

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

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Aetna Medicare Elite (PPO) H1608-043 Union, Sanborn, Hutchinson, Bon Homme, Minnehaha, Turner, Yankton, Clay, Brookings, Aurora, McCook, Moody, Lincoln, Lake Local PPO $0.00
Aetna Medicare Premier (PPO) H1608-001 Union, Sanborn, Hutchinson, Bon Homme, Minnehaha, Turner, Yankton, Clay, Brookings, Aurora, McCook, Moody, Lincoln, Lake Local PPO $0.00
Aetna Medicare Prime (PPO) H1608-004 Minnehaha, McCook, Lincoln Local PPO $0.00

South Dakota Medicare Advantage Plans With No Additional Cost

If you decide to get Medicare Advantage in South Dakota, you still have to pay your original Medicare Part B premium. Many SD 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
Lasso Healthcare Growth (MSA) – H1924-001-0 Corson, Lyman, Edmunds, Hyde, Spink, Bennett, Mellette, Campbell, Jones, Jackson, Lincoln, Day, Hanson, Charles Mix, Douglas, Pennington, Sully, Codington, Roberts, Fall River, Clark, Bon Homme, Hand, Gregory, Aurora, McCook, Haakon, Brown, Potter, Perkins, Buffalo, Hutchinson, Turner, Davison, Kingsbury, Hughes, Deuel, Miner, Brookings, Hamlin, Clay, Stanley, Lake, McPherson, Union, Custer, Walworth, Yankton, Moody, Beadle, Marshall, Meade, Tripp, Todd, Grant, Minnehaha, Harding, Brule, Faulk, Sanborn, Lawrence, Jerauld, Ziebach, Butte, Dewey This Plan does NOT include prescription drug coverage. N/A
Lasso Healthcare Growth Plus (MSA) – H1924-004-0 Corson, Lyman, Edmunds, Hyde, Spink, Bennett, Mellette, Campbell, Jones, Jackson, Lincoln, Day, Hanson, Charles Mix, Douglas, Pennington, Sully, Codington, Roberts, Fall River, Clark, Bon Homme, Hand, Gregory, Aurora, McCook, Haakon, Brown, Potter, Perkins, Buffalo, Hutchinson, Turner, Davison, Kingsbury, Hughes, Deuel, Miner, Brookings, Hamlin, Clay, Stanley, Lake, McPherson, Union, Custer, Walworth, Yankton, Moody, Beadle, Marshall, Meade, Tripp, Todd, Grant, Minnehaha, Harding, Brule, Faulk, Sanborn, Lawrence, Jerauld, Ziebach, Butte, Dewey This Plan does NOT include prescription drug coverage. N/A
Medica Prime Solution Standard (Cost) – H2450-044-0 Lincoln, Turner, Deuel, Brookings, Clay, Lake, Union, Yankton, Moody, Minnehaha This Plan does NOT include prescription drug coverage. $4,500
Humana Honor (PPO) – H5216-086-0 Lincoln, Turner, Deuel, Brookings, Clay, Lake, Union, Yankton, Moody, Minnehaha This Plan does NOT include prescription drug coverage. $6,700
AARP Medicare Advantage Choice (PPO) – H1278-007-0 Lincoln, Turner, Deuel, Brookings, Clay, Lake, Union, Yankton, Moody, Minnehaha Preferred Generic: $3.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $3,900
AARP Medicare Advantage Patriot (PPO) – H1278-019-0 Pennington, Union, Meade, Minnehaha, Lawrence This Plan does NOT include prescription drug coverage. $6,700
Aetna Medicare Elite (PPO) – H1608-043-0 Lincoln, Bon Homme, Aurora, McCook, Hutchinson, Turner, Brookings, Clay, Lake, Union, Yankton, Moody, Minnehaha, Sanborn Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $4,900
Aetna Medicare Premier (PPO) – H1608-001-0 Lincoln, Bon Homme, Aurora, McCook, Hutchinson, Turner, Brookings, Clay, Lake, Union, Yankton, Moody, Minnehaha, Sanborn Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $5,100
Aetna Medicare Prime (PPO) – H1608-004-0 Pennington, Meade, Lawrence Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $5,400
Humana Gold Plus H0028-011 (HMO) – H0028-011-0 Pennington, Union, Meade, Minnehaha, Lawrence Preferred Generic: $4.00, Generic: $16.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 30% $3,850

Standalone Medicare Part D Plans in South Dakota

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

Standalone Medicare Part D Plans in South Dakota

Plan Details Tiers
AARP MedicareRx Preferred (PDP)
S5820 – 024 – 0
by UnitedHealthcare
Monthly Premium: $86.50
Annual Deductible: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $5.00
Tier 2: $10.00
Tier 3: $45.00
Tier 4: 40%
Tier 5: 33%
AARP MedicareRx Saver Plus (PDP)
S5921 – 370 – 0
by UnitedHealthcare
Monthly Premium: $32.10
Annual Deductible: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $6.00
Tier 3: $34.00
Tier 4: 40%
Tier 5: 25%
AARP MedicareRx Walgreens (PDP)
S5921 – 406 – 0
by UnitedHealthcare
Monthly Premium: $35.60
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $6.00
Tier 3: $40.00
Tier 4: 40%
Tier 5: 25%
Cigna Secure Rx (PDP)
S5617 – 123 – 0
by Cigna
Monthly Premium: $33.70
Annual Deductible: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $2.00
Tier 3: $30.00
Tier 4: 50%
Tier 5: 25%
Cigna Secure-Essential Rx (PDP)
S5617 – 304 – 0
by Cigna
Monthly Premium: $22.90
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: 50%
Tier 5: 25%
Cigna Secure-Extra Rx (PDP)
S5617 – 270 – 0
by Cigna
Monthly Premium: $49.20
Annual Deductible: $100
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $4.00
Tier 2: $10.00
Tier 3: $42.00
Tier 4: 50%
Tier 5: 31%
Clear Spring Health Premier Rx (PDP)
S6946 – 051 – 0
by Clear Spring Health
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: $3.00
Tier 3: $40.00
Tier 4: 45%
Tier 5: 25%
Clear Spring Health Value Rx (PDP)
S6946 – 022 – 0
by Clear Spring Health
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: $3.00
Tier 3: $42.00
Tier 4: 34%
Tier 5: 25%
Elixir RxPlus (PDP)
S7694 – 025 – 0
by Elixir Insurance
Monthly Premium: $54.90
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $7.00
Tier 3: 15%
Tier 4: 33%
Tier 5: 25%
Express Scripts Medicare – Choice (PDP)
S5660 – 195 – 0
by Express Scripts Medicare
Monthly Premium: $81.00
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 – 241 – 0
by Express Scripts Medicare
Monthly Premium: $25.20
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 – 127 – 0
by Express Scripts Medicare
Monthly Premium: $49.70
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: $41.00
Tier 4: 50%
Tier 5: 25%
Humana Basic Rx Plan (PDP)
S5884 – 145 – 0
by Humana
Monthly Premium: $34.90
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: 31%
Tier 5: 25%
Humana Premier Rx Plan (PDP)
S5884 – 171 – 0
by Humana
Monthly Premium: $60.80
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $4.00
Tier 3: $45.00
Tier 4: 49%
Tier 5: 25%
Humana Walmart Value Rx Plan (PDP)
S5884 – 204 – 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: 16%
Tier 4: 35%
Tier 5: 25%
MedicareBlue Rx Premier (PDP)
S5743 – 004 – 0
by Wellmark Blue Cross and Blue Shield of Iowa
Monthly Premium: $104.70
Annual Deductible: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $0.00
Tier 2: $0.00
Tier 3: 17%
Tier 4: 40%
Tier 5: 33%
MedicareBlue Rx Standard (PDP)
S5743 – 001 – 0
by Wellmark Blue Cross and Blue Shield of Iowa
Monthly Premium: $66.40
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $7.00
Tier 3: $29.00
Tier 4: 31%
Tier 5: 25%
Mutual of Omaha Rx Plus (PDP)
S7126 – 024 – 0
by Mutual of Omaha Rx
Monthly Premium: $75.10
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: 37%
Tier 5: 25%
Mutual of Omaha Rx Premier (PDP)
S7126 – 094 – 0
by Mutual of Omaha Rx
Monthly Premium: $23.00
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: 46%
Tier 5: 25%
SilverScript Choice (PDP)
S5601 – 050 – 0
by Aetna Medicare
Monthly Premium: $33.90
Annual Deductible: $240
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: 46%
Tier 5: 28%
SilverScript Plus (PDP)
S5601 – 051 – 0
by Aetna Medicare
Monthly Premium: $70.20
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%
SilverScript SmartRx (PDP)
S5601 – 200 – 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: 46%
Tier 5: 25%
WellCare Classic (PDP)
S4802 – 089 – 0
by WellCare
Monthly Premium: $28.20
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: $31.00
Tier 4: 33%
Tier 5: 25%
WellCare Medicare Rx Saver (PDP)
S5810 – 059 – 0
by WellCare
Monthly Premium: $36.50
Annual Deductible: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $3.00
Tier 3: $33.00
Tier 4: 39%
Tier 5: 25%
WellCare Medicare Rx Select (PDP)
S5810 – 302 – 0
by WellCare
Monthly Premium: $23.40
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%
WellCare Medicare Rx Value Plus (PDP)
S5768 – 148 – 0
by WellCare
Monthly Premium: $76.70
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 – 158 – 0
by WellCare
Monthly Premium: $15.70
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 – 194 – 0
by WellCare
Monthly Premium: $15.30
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: $40.00
Tier 4: 47%
Tier 5: 25%

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