5

5 out of 5 stars* for plan year 2024

Plan ID: H3822-001

What You Need to Know:

  • Blue Cross Medicare Advantage Basic (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 $0, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is .
  • The plan includes an out-of-pocket maximum of $3,400 per year (in-network).
  • Blue Cross Medicare Advantage Basic (HMO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is .
  • This plan's Part D Initial Coverage Limit is $0.

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

$0

Monthly Premium

Medicare Plan Features
Monthly Premium: $0
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:
$0 $0 $0 $0 $0 $0 0.0
Gap Coverage: Yes
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local HMO
Similar Plan: H3822-002
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): $3,400
Annual Deductible: NULL
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in McHenry, Illinois: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
91 members 3.5 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: 3,613 drugs
Number of Members Enrolled in this Plan in McHenry, Illinois: 14,101 members
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 $0.00 $0.00 $0.00
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 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
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)
203 $0.00 944 $8.00 1042 $39.00 710 $93.00 714 33%

Other Medicare Advantage Plans in McHenry, Illinois

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4
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HumanaChoice H5216-251 (PPO) (2023)Local PPO$5,500$200
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Blue Cross Medicare Advantage Basic Plus (HMO-POS) (2023)Local HMO$3,900$0
5
Blue Cross Medicare Advantage Premier Plus (HMO-POS) (2023)Local HMO$4,500$0
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Blue Medicare Advocate Health (HMO) (2023)Local HMO$3,500$0
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Blue Cross Medicare Advantage Choice Plus (PPO) (2023)Local PPO$6,700$445
4
AARP Medicare Advantage Walgreens (PPO) (2023)Local PPO$5,900$250
5
Blue Cross Medicare Advantage Choice Premier (PPO) (2023)Local PPO$5,900$0
4
Humana Gold Choice H8145-008 (PFFS) (2023)PFFS$-$380
4
Blue Cross Medicare Advantage Classic (PPO) (2023)Local PPO$7,550$445
4
Aetna Medicare Premier Plus (PPO) (2023)Local PPO$3,475$0
5
Aetna Medicare Value (PPO) (2023)Local PPO$3,950$0
5
AARP Medicare Advantage Patriot (PPO) (2023)Local PPO *$5,900$-
5
UnitedHealthcare Medicare Advantage Assure (PPO) (2023)Local PPO$7,550$445
5
WellCare Essential (HMO) (2023)Local HMO$3,450$0
5
WellCare Edge (HMO) (2023)Local HMO$3,450$445
5
WellCare Premier (PPO) (2023)Local PPO$3,450$0
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AARP Medicare Advantage Access (HMO) (2023)Local HMO$3,600$100
5
AARP Medicare Advantage Plan 1 (HMO) (2023)Local HMO$3,900$195
5
WellCare Absolute (PPO) (2023)Local PPO$3,450$0
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AARP Medicare Advantage Plan 2 (HMO) (2023)Local HMO$3,900$60
5
HumanaChoice R5361-002 (Regional PPO) (2023)Regional PPO$6,700$420
5
Humana Gold Plus H1468-014 (HMO) (2023)Local HMO$6,700$0
4
Humana Community Select HMO H1468-018 (HMO) (2023)Local HMO$2,650$0
4
Zing Choice IL (HMO) (2023)Local HMO$2,950$0
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Zing Open Access IL (HMO-POS) (2023)Local HMO$3,500$0
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Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
HumanaChoice H5216-013 (PPO) (2023)Local PPO$3,750$0
4
Humana Honor (PPO) (2023)Local PPO *$6,700$-
4
AARP Medicare Advantage Choice (PPO) (2023)Local PPO$3,900$195
5
HumanaChoice R5361-001 (Regional PPO) (2023)Regional PPO *$6,700$-
5
Medicare Advantage Plans by Blue Cross and Blue Shield of IL, NM
Blue Cross Medicare Advantage Basic Plus (HMO-POS) (2023)Local HMO$3,900$0
5
Blue Cross Medicare Advantage Premier Plus (HMO-POS) (2023)Local HMO$4,500$0
5
Blue Cross Medicare Advantage Choice Plus (PPO) (2023)Local PPO$6,700$445
4
Blue Cross Medicare Advantage Choice Premier (PPO) (2023)Local PPO$5,900$0
4
Blue Cross Medicare Advantage Classic (PPO) (2023)Local PPO$7,550$445
4

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