Plan ID: H3213-012

What You Need to Know:

  • CareSource Advantage (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 $25, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is $75 (Tier 1 and 2 excluded from the Deductible.).
  • The plan includes an out-of-pocket maximum of $5,600 per year (in-network).
  • CareSource Advantage (HMO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $75 (Tier 1 and 2 excluded from the Deductible.).
  • This plan's Part D Initial Coverage Limit is $25.

$25

Monthly Premium

Medicare Plan Features
Monthly Premium: $24.50
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:
$24.50 $0 $24.50 $0 $24.50 $75.00 1.0
Gap Coverage: No
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local HMO
Similar Plan: H3213-013
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: No additional gap coverage, only the Donut Hole Discount
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $5,600
Annual Deductible: $75 (Tier 1 and 2 excluded from the Deductible.)
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Bullitt, Kentucky: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
less than 10 members New plan - No summary rating as of yet. New plan - not yet rated. New plan - not yet rated.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,710 drugs
Number of Members Enrolled in this Plan in Bullitt, Kentucky: less than 10 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 $24.50 $0.00 $24.50
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 $18.40 $18.40 $12.20 $12.20 $6.10 $6.10
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)
296 $4.00 1744 $10.00 428 $45.00 362 $100.00 788 31%

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Anthem MediBlue Access Basic (Regional PPO) (2023)Regional PPO$6,400$100
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5
Aetna Medicare Value Plan (PPO) (2023)Local PPO$7,000$150
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AARP Medicare Advantage Plan 1 (HMO) (2023)Local HMO$4,900$195
5
Humana Gold Plus H5619-073 (HMO) (2023)Local HMO$5,900$0
4
AARP Medicare Advantage Plan 2 (HMO) (2023)Local HMO$4,500$150
5
AARP Medicare Advantage Patriot (PPO) (2023)Local PPO *$4,500$-
5
HumanaChoice H5216-018 (PPO) (2023)Local PPO$6,700$0
4
WellCare Patriot (HMO-POS) (2023)Local HMO *$5,000$-
5
HumanaChoice H5216-107 (PPO) (2023)Local PPO$6,700$0
4
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
HumanaChoice H5216-188 (PPO) (2023)Local PPO$6,700$0
4
Humana Honor (PPO) (2023)Local PPO *$6,700$-
4
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
Anthem MediBlue Access Core (PPO) (2023)Local PPO *$4,900$-
4
HumanaChoice H5216-105 (PPO) (2023)Local PPO *$4,500$-
4
Medicare Advantage Plans by CareSource
CareSource Advantage Zero Premium (HMO) (2023)Local HMO$7,550$150
New plan - not yet rated.

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