5

5 out of 5 stars* for plan year 2024

Plan ID: H5959-008

What You Need to Know:

  • Blue Cross Medicare Advantage Choice MA Only (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 $14, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is no drug coverage.
  • The plan includes an out-of-pocket maximum of $4,900 per year (in-network).
  • Blue Cross Medicare Advantage Choice MA Only (PPO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is no drug coverage.
  • This plan's Part D Initial Coverage Limit is .

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

$14

Monthly Premium

Medicare Plan Features
Monthly Premium: $14.00
Part C Premium: NULL
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$14.00 NULL NULL NULL NULL NULL NULL
Gap Coverage: NULL
Benchmark: NULL
Type of Medicare Health: NULL
Health Plan Type: Local PPO *
Similar Plan: H5959-009
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: NULL
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $4,900
Annual Deductible: no drug coverage
Annual Initial Coverage Limit ICL: NULL
Number of Members enrolled in this plan in Nicollet, Minnesota: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
39 members 4.5 out of 5 Stars. 5 out of 5 Stars. 4 out of 5 Stars.
Plan Offers Mail Order: NULL
Plan Health Benefits
Total # of Formulary Drugs: NULL
Number of Members Enrolled in this Plan in Nicollet, Minnesota: 694 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
NULL NULL NULL NULL
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
NULL NULL NULL NULL NULL NULL NULL
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)
NULL NULL NULL NULL NULL NULL NULL NULL NULL NULL

Other Medicare Advantage Plans in Nicollet, Minnesota

Plan Name Type Premium MOOP Rx Deduct. Rating
AARP Medicare Advantage Lakeshore (PPO) (2023)Local PPO$4,900$295
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AARP Medicare Advantage Patriot (PPO) (2023)Local PPO *$6,700$-
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Humana Gold Choice H8145-089 (PFFS) (2023)PFFS$-$415
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AARP Medicare Advantage Premier (PPO) (2023)Local PPO$4,900$445
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Medica Advantage Solution H8889-004 (PPO) (2023)Local PPO$7,550$445
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AARP Medicare Advantage Headwaters (PPO) (2023)Local PPO$5,900$395
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Blue Cross Medicare Advantage Choice (PPO) (2023)Local PPO$3,100$300
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Allina Health Aetna Medicare Discover Plus (PPO) (2023)Local PPO$5,900$250
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HumanaChoice H5216-092 (PPO) (2023)Local PPO$6,700$350
4
Blue Cross Medicare Advantage Complete (PPO) (2023)Local PPO$2,700$0
5
Blue Cross Medicare Advantage Core (PPO) (2023)Local PPO$6,700$445
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Allina Health Aetna Medicare Discover Premier (PPO) (2023)Local PPO$5,000$150
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Allina Health Aetna Medicare Discover Grand (PPO) (2023)Local PPO$4,000$0
5
Allina Health Aetna Medicare Discover Elite (PPO) (2023)Local PPO$3,500$0
5
Humana Honor (PPO) (2023)Local PPO *$6,700$-
4
Allina Health Aetna Medicare Discover Value (PPO) (2023)Local PPO *$5,900$-
5
UCare Complete (HMO-POS) (2023)Local HMO$3,000$235
5
UCare Value Plus (HMO-POS) (2023)Local HMO *$5,500$-
5
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
UCare Prime (HMO-POS) (2023)Local HMO$7,000$445
5
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
UCare Classic (HMO-POS) (2023)Local HMO$3,000$225
5
UCare Value (HMO-POS) (2023)Local HMO *$3,400$-
5
UCare Standard (HMO-POS) (2023)Local HMO$6,000$445
5
Medicare Advantage Plans by Blue Cross Blue Shield of Minnesota
Blue Cross Medicare Advantage Choice (PPO) (2023)Local PPO$3,100$300
5
Blue Cross Medicare Advantage Complete (PPO) (2023)Local PPO$2,700$0
5
Blue Cross Medicare Advantage Core (PPO) (2023)Local PPO$6,700$445
5

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