5

5 out of 5 stars* for plan year 2024

Plan ID: H5471-099

What You Need to Know:

  • Simply Select (HMO) is a Medicare Advantage Health Maintenance Organization Local HMO plan.
  • It must provide all of the same hospital and medical benefits as Medicare Part A and Part B, however, costs may be different.
  • It has additional benefits not included in Medicare Part A and Part B, including prescription drug coverage.
  • The plan's monthly premium is $31, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is $445 (Tier 1 and 2 excluded from the Deductible.).
  • The plan includes an out-of-pocket maximum of $3,450 per year (in-network).
  • Simply Select (HMO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $445 (Tier 1 and 2 excluded from the Deductible.).
  • This plan's Part D Initial Coverage Limit is $31.

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.

$31

Monthly Premium

Medicare Plan Features
Monthly Premium: $30.80
Part C Premium: $0
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$30.80 $0 $30.80 $0 $30.80 $445.0 1.0
Gap Coverage: Yes
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local HMO
Similar Plan: H5471-100
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: Yes, some additional gap coverage.
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $3,450
Annual Deductible: $445 (Tier 1 and 2 excluded from the Deductible.)
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Hillsborough, Florida: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
145 members 4 out of 5 Stars. 5 out of 5 Stars. 4 out of 5 Stars.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 4,002 drugs
Number of Members Enrolled in this Plan in Hillsborough, Florida: NULL
Number of Drugs Per Tier: NULL
Preferred Pharmacy Cost Sharing During Initial Coverage Phase: NULL
Special Needs Plan SNP Eligibility Requirement: NULL
Monthly Premium Split as Follows:
Part C Premium Part D Base Premium Part D Supplemental Premium Total Premium
$0.00 $30.80 $0.00 $30.80
Monthly Premium with Extra Help Low Income Subsidy:
LIS100 Subsidy Total Monthly Premium with LIS Parts CD LIS25 Subsidy Monthly PartD Premium with LIS LIS25 Subsidy Total Monthly Premium with LIS Parts CD LIS50 Monthly PartD Premium with LIS LIS50 Subsidy Total Monthly Premium with LIS Parts CD LIS75 Monthly PartD Premium with LIS LIS75 Subsidy Total Monthly Premium with LIS Parts CD
$0.00 $23.10 $23.10 $15.40 $15.40 $7.70 $7.70
Formulary Drug Details:
Tier 1 # of Drugs per Tier Tier 1 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 2 # of Drugs per Tier Tier 2 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 3 # of Drugs per Tier Tier 3 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 4 # of Drugs per Tier Tier 4 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 5 # of Drugs per Tier Tier 6 Preferred Pharmacy Cost Sharing (initial coverage phase)
1313 $0.00 1245 $0.00 296 25% 355 25% 793 25%

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WellCare Prime (PPO) (2023)Local PPO$1,700$0
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AARP Medicare Advantage Choice Plan 2 (Regional PPO) (2023)Regional PPO$6,700$395
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CareFree (HMO) (2023)Local HMO$3,400$0
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Cigna Primary Medicare (HMO) (2023)Local HMO$3,500$445
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CareOne PLATINUM (HMO) (2023)Local HMO$3,400$0
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Humana Gold Plus H1036-265 (HMO) (2023)Local HMO$2,750$0
4
AARP Medicare Advantage Choice (PPO) (2023)Local PPO$5,500$150
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4
Cigna Preferred Medicare (HMO) (2023)Local HMO$3,650$0
5
HumanaChoice R5826-074 (Regional PPO) (2023)Regional PPO$7,550$395
4
Cigna Preferred Savings Medicare (HMO) (2023)Local HMO$3,950$0
5
Aetna Medicare Eagle (PPO) (2023)Local PPO *$5,500$-
5
Humana Honor (HMO) (2023)Local HMO *$4,500$-
4
BlueMedicare Value (PPO) (2023)Local PPO$4,500$150
4
AARP Medicare Advantage (HMO-POS) (2023)Local HMO$4,900$0
5
AARP Medicare Advantage Patriot (Regional PPO) (2023)Regional PPO *$6,700$-
5
Simply More (HMO) (2023)Local HMO$3,450$0
5
WellCare Dividend Prime (HMO) (2023)Local HMO$2,500$0
4
HumanaChoice R5826-005 (Regional PPO) (2023)Regional PPO$6,700$100
4
BayCarePlus Signature (HMO) (2023)Local HMO$2,800$0
4
WellCare Elite (HMO) (2023)Local HMO$1,200$0
4
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
Aetna Medicare Premier (PPO) (2023)Local PPO$6,700$300
5
Devoted Health Prime Greater Tampa Bay (HMO) (2023)Local HMO$3,400$445
4
AARP Medicare Advantage Focus (HMO-POS) (2023)Local HMO$3,400$0
5
Aetna Medicare Premier Plus (PPO) (2023)Local PPO$5,500$150
5
BlueMedicare Choice (Regional PPO) (2023)Regional PPO$6,500$250
4
HumanaChoice R5826-018 (Regional PPO) (2023)Regional PPO *$7,550$-
4
BlueMedicare Select (PPO) (2023)Local PPO$5,900$305
4
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4
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Devoted Health Essentials Greater Tampa Bay (HMO) (2023)Local HMO$3,400$0
4
BlueMedicare Classic (HMO) (2023)Local HMO$4,900$0
4
BlueMedicare Premier (HMO) (2023)Local HMO$2,500$0
4
Medicare Advantage Plans by Simply Healthcare Plans, Inc
Simply More (HMO) (2023)Local HMO$3,450$0
5

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