5

5 out of 5 stars* for plan year 2024

Plan ID: H3219-003

What You Need to Know:

  • Allina Health Aetna Medicare Discover Grand (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 $96, 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 $4,000 per year (in-network).
  • Allina Health Aetna Medicare Discover Grand (PPO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is .
  • This plan's Part D Initial Coverage Limit is $10.

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

$96

Monthly Premium

Medicare Plan Features
Monthly Premium: $96.00
Part C Premium: $85.90
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$96.00 $85.90 $10.10 $0 $10.10 $0 0.0
Gap Coverage: Yes
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local PPO
Similar Plan: H3219-004
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): $4,000
Annual Deductible: NULL
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Sibley, Minnesota: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
less than 10 members New plan - No summary rating as of yet. 5 out of 5 Stars. 5 out of 5 Stars.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,780 drugs
Number of Members Enrolled in this Plan in Sibley, Minnesota: 2,740 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
$85.90 $10.10 $0.00 $96.00
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
$85.90 $7.60 $93.50 $5.00 $90.90 $2.50 $88.40
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)
337 $0.00 571 $5.00 915 $47.00 1247 $100.00 710 33%

Other Medicare Advantage Plans in Sibley, Minnesota

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Insufficient data to rate this plan.
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Insufficient data to rate this plan.
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Allina Health Aetna Medicare Discover Plus (PPO) (2023)Local PPO$5,900$250
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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 Elite (PPO) (2023)Local PPO$3,500$0
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Allina Health Aetna Medicare Discover Value (PPO) (2023)Local PPO *$5,900$-
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Humana Honor (PPO) (2023)Local PPO *$6,700$-
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Humana Value Plus H5216-176 (PPO) (2023)Local PPO$6,700$230
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5
UCare Value (HMO-POS) (2023)Local HMO *$3,400$-
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Platinum Blue Choice Plan (Cost) (2023)Cost *$3,500$-
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UCare Complete (HMO-POS) (2023)Local HMO$3,000$235
5
UCare Prime (HMO-POS) (2023)Local HMO$7,000$445
5
Platinum Blue Complete Plan (Cost) (2023)Cost *$2,700$-
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Medica Prime Solution Thrift (Cost) (2023)Cost *$6,700$-
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Platinum Blue Core Plan with Rx (Cost) (2023)Cost$6,000$445
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Medica Prime Solution Value (Cost) (2023)Cost *$4,000$-
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Platinum Blue Choice Plan with Rx (Cost) (2023)Cost$3,500$445
5
Medica Prime Solution Basic (Cost) (2023)Cost *$3,400$-
5
Platinum Blue Complete Plan with Rx (Cost) (2023)Cost$2,700$445
5
Medica Prime Solution Enhanced (Cost) (2023)Cost *$3,000$-
5
HealthPartners Freedom Basic (Cost) (2023)Cost *$-$-
Insufficient data to rate this plan.
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
UCare Value Plus (HMO-POS) (2023)Local HMO *$5,500$-
5
Medica Prime Solution Standard (Cost) (2023)Cost *$4,500$-
5
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4
Medicare Advantage Plans by Allina Health Aetna Medicare
Allina Health Aetna Medicare Discover Plus (PPO) (2023)Local PPO$5,900$250
5
Allina Health Aetna Medicare Discover Premier (PPO) (2023)Local PPO$5,000$150
5
Allina Health Aetna Medicare Discover Elite (PPO) (2023)Local PPO$3,500$0
5
Allina Health Aetna Medicare Discover Value (PPO) (2023)Local PPO *$5,900$-
5

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