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Founder, CFP®

UPDATED: Oct 29, 2021

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The Highlights

  • There are 14 Medicare Avantage companies in Utah
  • There are 22 plans that cost the same as your original Medicare in UT
  • If you choose Medicare Advantage, you’ll still need to pay your Utah original Medicare premium

There are several options in Utah for Medicare Advantage plans. Medicare Advantage (Medicare Part C) is offered by 14 companies in Utah; 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 UT 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 Utah, enter your ZIP code for fast, free UT Medicare quotes today.

The Complete List of Utah Medicare Advantage Companies

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

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Medicare Advantage Companies in Utah

Company Number of Plans Counties
Advantage U 1 Davis, Utah, Tooele, Weber, Salt Lake
Aetna Medicare 5 Davis, Iron, Utah, Box Elder, Rich, Cache, Morgan, Daggett, Summit, Tooele, Washington, Weber, Salt Lake, Wasatch, Duchesne, Juab, Uintah, Carbon
American Health Plans 1 Utah, Box Elder, Weber, Salt Lake
Cigna 1 Davis, Utah, Weber, Salt Lake
Humana 5 Davis, Utah, Weber, Salt Lake, Iron, Washington
Imperial Insurance Companies 1 Salt Lake
Imperial Insurance Companies, Inc 2 Salt Lake
Lasso Healthcare 2 Davis, Iron, Utah, Wayne, Garfield, Grand, Sevier, Box Elder, Rich, Duchesne, Sanpete, Millard, Cache, Kane, Morgan, Piute, Daggett, San Juan, Beaver, Summit, Tooele, Washington, Juab, Weber, Uintah, Salt Lake, Emery, Wasatch, Carbon
Molina Healthcare 1 Davis, Iron, Utah, Box Elder, Cache, Tooele, Washington, Weber, Salt Lake
Molina Healthcare of Utah & Idaho 1 Davis, Utah, Box Elder, Cache, Summit, Tooele, Weber, Salt Lake
Regence BlueCross BlueShield of Utah 4 Davis, Iron, Utah, Box Elder, Cache, Morgan, Summit, Tooele, Washington, Weber, Salt Lake, Wasatch
SelectHealth 3 Davis, Utah, Box Elder, Rich, Cache, Morgan, Summit, Tooele, Weber, Salt Lake, Wasatch, Iron, Wayne, Garfield, Sevier, Sanpete, Millard, Piute, Washington, Juab
Steward Health Choice Generations 1 Davis, Utah, Tooele, Weber, Salt Lake
UnitedHealthcare 10 Davis, Utah, Box Elder, Cache, Morgan, Summit, Tooele, Weber, Salt Lake, Wasatch, Iron, Washington

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Utah Medicare Advantage Plans by Company

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

Medicare Plans in Utah Offered by UnitedHealthcare

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

Plan Name Base Plan ID Counties Plan Type Monthly Premium
AARP Medicare Advantage Plan 1 (HMO) H4604-003 Davis, Utah, Box Elder, Cache, Morgan, Summit, Tooele, Weber, Salt Lake, Wasatch Local HMO $39.00
AARP Medicare Advantage Plan 2 (HMO) H4604-011 Davis, Utah, Box Elder, Cache, Morgan, Summit, Tooele, Weber, Salt Lake, Wasatch Local HMO $0.00
AARP Medicare Advantage Choice (PPO) H7404-021 Davis, Utah, Box Elder, Cache, Morgan, Summit, Tooele, Weber, Salt Lake, Wasatch Local PPO $0.00
AARP Medicare Advantage Patriot (HMO) H4604-005 Davis, Iron, Utah, Box Elder, Cache, Morgan, Summit, Tooele, Washington, Weber, Salt Lake, Wasatch Local HMO * $0.00
AARP Medicare Advantage Walgreens (HMO) H4604-018 Davis, Utah, Box Elder, Cache, Morgan, Summit, Tooele, Weber, Salt Lake, Wasatch Local HMO $0.00
UnitedHealthcare Medicare Advantage Assure (PPO) H0271-003 Davis, Utah, Box Elder, Cache, Morgan, Summit, Tooele, Weber, Salt Lake, Wasatch Local PPO $32.60
UnitedHealthcare Medicare Advantage Assist (HMO C-SNP) H4604-017 Davis, Utah, Box Elder, Cache, Morgan, Summit, Tooele, Weber, Salt Lake, Wasatch Local HMO $39.00
UnitedHealthcare Nursing Home Plan (PPO I-SNP) H0710-051 Davis, Utah, Box Elder, Cache, Tooele, Washington, Weber, Salt Lake, Wasatch Local PPO $35.40
AARP Medicare Advantage (HMO) H4604-016 Iron, Washington Local HMO $25.00
UnitedHealthcare Medicare Advantage Choice (PPO) H2001-017 Washington Local PPO $38.00

Medicare Plans in Utah Offered by Aetna Medicare

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

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Aetna Advantra (HMO) H8649-003 Davis, Iron, Utah, Box Elder, Rich, Cache, Morgan, Daggett, Summit, Tooele, Washington, Weber, Salt Lake, Wasatch Local HMO $0.00
Aetna Medicare Choice Plan (PPO) H5521-101 Davis, Iron, Utah, Washington, Weber, Salt Lake Local PPO $39.00
Aetna Medicare Elite Plan (PPO) H5521-246 Davis, Utah, Weber, Salt Lake Local PPO $0.00
Aetna Medicare Value Plan (PPO) H5521-197 Box Elder, Rich, Duchesne, Cache, Morgan, Daggett, Summit, Tooele, Juab, Uintah, Wasatch, Carbon Local PPO $59.00
Aetna Advantra Select (HMO) H8649-008 Duchesne, Juab, Uintah, Carbon Local HMO $49.00

Medicare Plans in Utah Offered by Regence BlueCross BlueShield of Utah

Though plans can vary from county to county, Regence BlueCross BlueShield of Utah offers these Medicare plans in Utah.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Regence Valiance (PPO) H4605-001 Davis, Iron, Utah, Box Elder, Cache, Morgan, Summit, Tooele, Washington, Weber, Salt Lake, Wasatch Local PPO* $0.00
Regence MedAdvantage + Rx Primary (PPO) H4605-007 Davis, Iron, Utah, Box Elder, Cache, Morgan, Summit, Tooele, Washington, Weber, Salt Lake, Wasatch Local PPO $0.00
Regence MedAdvantage + Rx Enhanced (PPO) H4605-004 Davis, Utah, Weber, Salt Lake Local PPO $178.00
Regence MedAdvantage + Rx Classic (PPO) H4605-002 Davis, Iron, Utah, Box Elder, Cache, Morgan, Summit, Tooele, Washington, Weber, Salt Lake, Wasatch Local PPO $31.00

Medicare Plans in Utah Offered by Lasso Healthcare

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

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Lasso Healthcare Growth (MSA) H1924-001 Davis, Iron, Utah, Wayne, Garfield, Grand, Sevier, Box Elder, Rich, Duchesne, Sanpete, Millard, Cache, Kane, Morgan, Piute, Daggett, San Juan, Beaver, Summit, Tooele, Washington, Juab, Weber, Uintah, Salt Lake, Emery, Wasatch, Carbon MSA* MSAs do not have a monthly premium.
Lasso Healthcare Growth Plus (MSA) H1924-004 Davis, Iron, Utah, Wayne, Garfield, Grand, Sevier, Box Elder, Rich, Duchesne, Sanpete, Millard, Cache, Kane, Morgan, Piute, Daggett, San Juan, Beaver, Summit, Tooele, Washington, Juab, Weber, Uintah, Salt Lake, Emery, Wasatch, Carbon MSA* MSAs do not have a monthly premium.

Medicare Plans in Utah Offered by Molina Healthcare of Utah & Idaho

Though plans can vary from county to county, Molina Healthcare of Utah & Idaho offers these Medicare plans in Utah.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Molina Medicare Choice Care (HMO) H5628-007 Davis, Utah, Box Elder, Cache, Summit, Tooele, Weber, Salt Lake Local HMO $0.00

Medicare Plans in Utah Offered by Humana

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

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Humana Gold Plus H2486-003 (HMO) H2486-003 Davis, Utah, Weber, Salt Lake Local HMO $0.00
Humana Honor (PPO) H5216-046 Davis, Iron, Utah, Washington, Weber, Salt Lake Local PPO* $0.00
HumanaChoice H5216-131 (PPO) H5216-131 Davis, Utah, Weber, Salt Lake Local PPO $0.00
HumanaChoice H5216-247 (PPO) H5216-247 Iron, Washington Local PPO $0.00
HumanaChoice H5216-189 (PPO) H5216-189 Iron, Washington Local PPO $38.00

Medicare Plans in Utah Offered by Molina Healthcare

Though plans can vary from county to county, Molina Healthcare offers these Medicare plans in Utah.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Molina Medicare Complete Care (HMO D-SNP) H5628-001 Davis, Iron, Utah, Box Elder, Cache, Tooele, Washington, Weber, Salt Lake Local HMO $0.00 for people who qualify for both Medicare and Medicaid.

Medicare Plans in Utah Offered by Advantage U

Though plans can vary from county to county, Advantage U offers these Medicare plans in Utah.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Advantage U Signature (PPO) H4304-001 Davis, Utah, Tooele, Weber, Salt Lake Local PPO $0.00

Medicare Plans in Utah Offered by Steward Health Choice Generations

Though plans can vary from county to county, Steward Health Choice Generations offers these Medicare plans in Utah.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Steward Health Choice Generations (HMO D-SNP) H9455-001 Davis, Utah, Tooele, Weber, Salt Lake Local HMO $0.00 for people who qualify for both Medicare and Medicaid.

Medicare Plans in Utah Offered by Cigna

Though plans can vary from county to county, Cigna offers these Medicare plans in Utah.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Cigna True Choice Medicare (PPO) H7849-029 Davis, Utah, Weber, Salt Lake Local PPO $0.00

Medicare Plans in Utah Offered by SelectHealth

Though plans can vary from county to county, SelectHealth offers these Medicare plans in Utah.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
SelectHealth Advantage Essential (HMO) H1994-001 Davis, Utah, Box Elder, Rich, Cache, Morgan, Summit, Tooele, Weber, Salt Lake, Wasatch Local HMO $0.00
SelectHealth Advantage Enhanced (HMO) H1994-007 Davis, Utah, Box Elder, Rich, Cache, Morgan, Summit, Tooele, Weber, Salt Lake, Wasatch Local HMO $61.00
SelectHealth Advantage (HMO) H1994-002 Iron, Wayne, Garfield, Sevier, Sanpete, Millard, Piute, Washington, Juab Local HMO $34.00

Medicare Plans in Utah Offered by American Health Plans

Though plans can vary from county to county, American Health Plans offers these Medicare plans in Utah.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
American Health Advantage of Utah (HMO I-SNP) H4232-001 Utah, Box Elder, Weber, Salt Lake Local HMO $38.80

Medicare Plans in Utah Offered by Imperial Insurance Companies, Inc

Though plans can vary from county to county, Imperial Insurance Companies, Inc offers these Medicare plans in Utah.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Imperial Insurance Traditional Plus (HMO) H2793-007 Salt Lake Local HMO $32.40
Imperial Insurance Company Traditional (HMO) H2793-003 Salt Lake Local HMO $0.00

Medicare Plans in Utah Offered by Imperial Insurance Companies

Though plans can vary from county to county, Imperial Insurance Companies offers these Medicare plans in Utah.

Plan Name Base Plan ID Counties Plan Type Monthly Premium
Imperial Insurance Value (HMO C-SNP) H2793-005 Salt Lake Local HMO $0.00

Utah Medicare Advantage Plans With No Additional Cost

If you decide to get Medicare Advantage in Utah, you still have to pay your original Medicare Part B premium. Many UT 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 Tooele, Uintah, Kane, Sanpete, Daggett, Beaver, Millard, Iron, Morgan, Grand, Salt Lake, Juab, San Juan, Garfield, Weber, Piute, Box Elder, Sevier, Emery, Cache, Wasatch, Summit, Washington, Davis, Utah, Duchesne, Carbon, Wayne, Rich This Plan does NOT include prescription drug coverage. N/A
Lasso Healthcare Growth Plus (MSA) – H1924-004-0 Tooele, Uintah, Kane, Sanpete, Daggett, Beaver, Millard, Iron, Morgan, Grand, Salt Lake, Juab, San Juan, Garfield, Weber, Piute, Box Elder, Sevier, Emery, Cache, Wasatch, Summit, Washington, Davis, Utah, Duchesne, Carbon, Wayne, Rich This Plan does NOT include prescription drug coverage. N/A
AARP Medicare Advantage Choice (PPO) – H7404-021-0 Sanpete, Millard, Iron, Juab, Garfield, Piute, Sevier, Washington, Wayne Preferred Generic: $3.00, Generic: $10.00, Preferred Brand: $45.00, Non-Preferred Drug: $95.00, Specialty Tier: 28% $6,700
AARP Medicare Advantage Patriot (HMO) – H4604-005-0 Tooele, Iron, Morgan, Salt Lake, Weber, Box Elder, Cache, Wasatch, Summit, Washington, Davis, Utah This Plan does NOT include prescription drug coverage. $5,400
AARP Medicare Advantage Plan 2 (HMO) – H4604-011-0 Iron, Salt Lake, Weber, Washington, Davis, Utah Preferred Generic: $3.00, Generic: $10.00, Preferred Brand: $45.00, Non-Preferred Drug: $95.00, Specialty Tier: 29% $5,000
AARP Medicare Advantage Walgreens (HMO) – H4604-018-0 Iron, Washington Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 29% $6,700
Advantage U Signature (PPO) – H4304-001-0 Tooele, Salt Lake, Weber, Davis, Utah Preferred Generic: $3.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 29% $6,900
Aetna Advantra (HMO) – H8649-003-0 Iron, Washington Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $7,550
Molina Medicare Choice Care (HMO) – H5628-007-0 Salt Lake, Weber, Davis, Utah Preferred Generic: $2.00, Generic: $8.00, Preferred Brand: $45.00, Non-Preferred Drug: $100.00, Specialty Tier: 33%, Select Care Drugs: $0.00 $5,400
Regence MedAdvantage + Rx Primary (PPO) – H4605-007-0 Salt Lake, Weber, Davis, Utah Preferred Generic: $3.00, Generic: $13.00, Preferred Brand: $40.00, Non-Preferred Drug: 40%, Specialty Tier: 29% $5,900
Regence Valiance (PPO) – H4605-001-0 Salt Lake, Weber, Davis, Utah This Plan does NOT include prescription drug coverage. $5,000
SelectHealth Advantage Essential (HMO) – H1994-001-0 Tooele, Morgan, Salt Lake, Weber, Box Elder, Cache, Wasatch, Summit, Davis, Utah, Rich Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $45.00, Non-Preferred Brand: $95.00, Specialty Tier: 29% $5,500
Steward Health Choice Generations (HMO D-SNP) – H9455-001-0 Tooele, Salt Lake, Weber, Davis, Utah Tier 1: 15% N/A
Molina Medicare Complete Care (HMO D-SNP) – H5628-001-0 Tooele, Iron, Salt Lake, Weber, Box Elder, Cache, Washington, Davis, Utah Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $23.00, Non-Preferred Drug: 41%, Specialty Tier: 25% N/A
Humana Honor (PPO) – H5216-046-0 Iron, Salt Lake, Weber, Washington, Davis, Utah This Plan does NOT include prescription drug coverage. $5,000
HumanaChoice H5216-247 (PPO) – H5216-247-0 Iron, Washington Preferred Generic: $4.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 25% $7,550
Aetna Medicare Elite Plan (PPO) – H5521-246-0 Salt Lake, Weber, Davis, Utah Preferred Generic: $0.00, Generic: $0.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $7,550
Cigna True Choice Medicare (PPO) – H7849-029-0 Salt Lake, Weber, Davis, Utah Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $5,500
Humana Gold Plus H2486-003 (HMO) – H2486-003-0 Salt Lake, Weber, Davis, Utah Preferred Generic: $2.00, Generic: $8.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 31% $5,900
HumanaChoice H5216-131 (PPO) – H5216-131-0 Washington Preferred Generic: $2.00, Generic: $8.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 30% $5,900
Imperial Insurance Company Traditional (HMO) – H2793-003-0 Salt Lake Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $45.00, Non-Preferred Drug: $90.00, Specialty Tier: 33% $2,999
Imperial Insurance Value (HMO C-SNP) – H2793-005-0 Salt Lake Preferred Generic: $0.00, Generic: $5.00, Preferred Brand: $45.00, Non-Preferred Drug: $90.00, Specialty Tier: 33%, Select Care Drugs: $3.00 N/A

Standalone Medicare Part D Plans in Utah

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

Standalone Medicare Part D Plans in Utah

Plan Details Tiers
AARP MedicareRx Preferred (PDP)
S5820 – 030 – 0
by UnitedHealthcare
Monthly Premium: $95.50
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 – 375 – 0
by UnitedHealthcare
Monthly Premium: $36.10
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: $35.00
Tier 4: 40%
Tier 5: 25%
AARP MedicareRx Walgreens (PDP)
S5921 – 412 – 0
by UnitedHealthcare
Monthly Premium: $39.60
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 – 153 – 0
by Cigna
Monthly Premium: $37.70
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: $38.00
Tier 4: 50%
Tier 5: 25%
Cigna Secure-Essential Rx (PDP)
S5617 – 310 – 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: 44%
Tier 5: 25%
Cigna Secure-Extra Rx (PDP)
S5617 – 276 – 0
by Cigna
Monthly Premium: $48.60
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 – 055 – 0
by Clear Spring Health
Monthly Premium: $15.00
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $3.00
Tier 3: $40.00
Tier 4: 45%
Tier 5: 25%
Clear Spring Health Value Rx (PDP)
S6946 – 026 – 0
by Clear Spring Health
Monthly Premium: $30.90
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 – 031 – 0
by Elixir Insurance
Monthly Premium: $35.50
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: 28%
Tier 5: 25%
Express Scripts Medicare – Choice (PDP)
S5660 – 216 – 0
by Express Scripts Medicare
Monthly Premium: $76.70
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: 49%
Tier 5: 31%
Express Scripts Medicare – Saver (PDP)
S5660 – 247 – 0
by Express Scripts Medicare
Monthly Premium: $24.30
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 – 133 – 0
by Express Scripts Medicare
Monthly Premium: $34.70
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: $34.00
Tier 4: 46%
Tier 5: 25%
Humana Basic Rx Plan (PDP)
S5884 – 147 – 0
by Humana
Monthly Premium: $36.70
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 – 177 – 0
by Humana
Monthly Premium: $62.80
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 – 210 – 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 – 030 – 0
by Mutual of Omaha Rx
Monthly Premium: $79.70
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: 35%
Tier 5: 25%
Mutual of Omaha Rx Premier (PDP)
S7126 – 100 – 0
by Mutual of Omaha Rx
Monthly Premium: $24.80
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%
Regence Medicare Script Basic (PDP)
S5916 – 001 – 0
by Regence BlueShield of Idaho
Monthly Premium: $93.50
Annual Deductible: $300
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $3.00
Tier 2: $10.00
Tier 3: $40.00
Tier 4: 30%
Tier 5: 27%
Regence Medicare Script Enhanced (PDP)
S5916 – 002 – 0
by Regence BlueShield of Idaho
Monthly Premium: $123.50
Annual Deductible: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $3.00
Tier 2: $10.00
Tier 3: $47.00
Tier 4: 40%
Tier 5: 33%
SilverScript Choice (PDP)
S5601 – 062 – 0
by Aetna Medicare
Monthly Premium: $34.30
Annual Deductible: $250
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $5.00
Tier 3: $35.00
Tier 4: 43%
Tier 5: 28%
SilverScript Plus (PDP)
S5601 – 063 – 0
by Aetna Medicare
Monthly Premium: $67.50
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 – 206 – 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: 49%
Tier 5: 25%
WellCare Classic (PDP)
S4802 – 021 – 0
by WellCare
Monthly Premium: $33.00
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: 33%
Tier 5: 25%
WellCare Medicare Rx Saver (PDP)
S5810 – 065 – 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: $39.00
Tier 4: 35%
Tier 5: 25%
WellCare Medicare Rx Select (PDP)
S5810 – 307 – 0
by WellCare
Monthly Premium: $22.80
Annual Deductible: $425
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 – 154 – 0
by WellCare
Monthly Premium: $76.00
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: 49%
Tier 5: 33%
WellCare Value Script (PDP)
S4802 – 162 – 0
by WellCare
Monthly Premium: $17.70
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: $43.00
Tier 4: 47%
Tier 5: 25%
WellCare Wellness Rx (PDP)
S4802 – 200 – 0
by WellCare
Monthly Premium: $15.80
Annual Deductible: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $5.00
Tier 3: $40.00
Tier 4: 46%
Tier 5: 25%

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