Plan ID: H3442-004

What You Need to Know:

  • AARP Medicare Advantage Walgreens (PPO) is a Medicare Advantage Health Maintenance Organization Local PPO 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 $195 (Tier 1 and 2 excluded from the Deductible.).
  • The plan includes an out-of-pocket maximum of $6,700 per year (in-network).
  • AARP Medicare Advantage Walgreens (PPO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $195 (Tier 1 and 2 excluded from the Deductible.).
  • This plan's Part D Initial Coverage Limit is $0.

$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 $195.0 1.0
Gap Coverage: No
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local PPO
Similar Plan: H3442-005
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): $6,700
Annual Deductible: $195 (Tier 1 and 2 excluded from the Deductible.)
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Hampshire, Massachusetts: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
382 members22,042 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: 3,668 drugs
Number of Members Enrolled in this Plan in Hampshire, Massachusetts: 22,042 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)
303 $0.00 679 $5.00 870 $47.00 1015 $100.00 801 29%

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4
Aetna Medicare Eagle Plan (PPO) (2023)Local PPO *$6,700$-
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4
Health New England Medicare Premium No Rx (HMO) (2023)Local HMO *$4,400$-
4
Health New England Medicare Plus (HMO) (2023)Local HMO$4,900$250
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Health New England Medicare Value (HMO) (2023)Local HMO$6,700$380
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Health New England Medicare Basic No Rx (HMO) (2023)Local HMO *$4,900$-
4
Health New England Medicare Select (HMO-POS) (2023)Local HMO$4,900$250
4
Fallon Medicare Plus Saver No Rx HMO (HMO) (2023)Local HMO *$7,550$-
4
Health New England Medicare Choice (HMO) (2023)Local HMO$5,900$350
4
Medicare PPO Blue PlusRx (PPO) (2023)Local PPO$3,400$200
4
Aetna Medicare Explorer Plan (PPO) (2023)Local PPO$6,700$0
5
Aetna Medicare Explorer Premier Plan (PPO) (2023)Local PPO$6,700$0
5
Medicare PPO Blue SaverRx (PPO) (2023)Local PPO$7,550$405
4
Aetna Medicare Value Plan (HMO) (2023)Local HMO$6,700$250
5
Medicare PPO Blue ValueRx (PPO) (2023)Local PPO$4,900$320
4
Medicare HMO Blue PlusRx (HMO) (2023)Local HMO$3,400$200
4
Medicare HMO Blue ValueRx (HMO) (2023)Local HMO$4,900$320
4
AARP Medicare Advantage Plan 1 (HMO) (2023)Local HMO$5,700$250
5
AARP Medicare Advantage Plan 2 (HMO) (2023)Local HMO$4,900$225
5
Medicare HMO Blue FlexRx (HMO-POS) (2023)Local HMO$3,900$260
4
Medicare HMO Blue SaverRx (HMO) (2023)Local HMO$7,550$320
4
AARP Medicare Advantage Choice (Regional PPO) (2023)Regional PPO$6,700$295
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4
Tufts Medicare Preferred HMO Prime Rx (HMO) (2023)Local HMO$3,450$0
4
Medicare Advantage Plans by UnitedHealthcare
AARP Medicare Advantage Patriot (PPO) (2023)Local PPO *$6,700$-
New plan - not yet rated.
AARP Medicare Advantage Plan 1 (HMO) (2023)Local HMO$5,700$250
5
AARP Medicare Advantage Plan 2 (HMO) (2023)Local HMO$4,900$225
5
AARP Medicare Advantage Choice (Regional PPO) (2023)Regional PPO$6,700$295
5

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