5

5 out of 5 stars* for plan year 2024

Plan ID: H3335-015

What You Need to Know:

  • Medicare BlueEnhanced (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 $138, 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 $5,000 per year (in-network).
  • Medicare BlueEnhanced (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 $44.

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

$138

Monthly Premium

Medicare Plan Features
Monthly Premium: $138.00
Part C Premium: $94.30
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$138.00 $94.30 $43.70 $0 $43.70 $0 0.0
Gap Coverage: No
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local PPO
Similar Plan: H3335-018
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): $5,000
Annual Deductible: NULL
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Tioga, New York: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
132 members 4.5 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: 4,388 drugs
Number of Members Enrolled in this Plan in Tioga, New York: NULL
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
$94.30 $43.70 $0.00 $138.00
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
$95.70 $33.10 $127.40 $22.60 $116.90 $12.00 $106.30
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)
240 $0.00 1633 $6.00 712 $42.00 776 $95.00 1027 33%

Other Medicare Advantage Plans in Tioga, New York

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HumanaChoice H5970-015 (PPO) (2023)Local PPO$6,500$250
4
Humana Honor (PPO) (2023)Local PPO *$4,500$-
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Fidelis Medicare Advantage Flex (HMO-POS) (2023)Local HMO$7,550$445
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Fidelis Medicare $0 Premium (HMO) (2023)Local HMO$7,550$0
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Aetna Medicare Credit Plan (PPO) (2023)Local PPO$7,550$250
5
CDPHP Choice (HMO) (2023)Local HMO *$5,000$-
5
Fidelis Medicare Advantage without Rx (HMO-POS) (2023)Local HMO *$7,550$-
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CDPHP Choice Rx (HMO) (2023)Local HMO$5,000$0
5
CDPHP Vital Rx (PPO) (2023)Local PPO$7,500$350
5
CDPHP Value Rx (HMO) (2023)Local HMO$5,800$0
5
CDPHP Flex Rx (PPO) (2023)Local PPO$5,500$0
5
MVP SmartFund (MSA) (2023)MSA *$-$-
4
CDPHP Basic RX (HMO) (2023)Local HMO$6,700$0
5
Aetna Medicare Eagle Plan (PPO) (2023)Local PPO *$7,550$-
5
WellCare Absolute (PPO) (2023)Local PPO$7,550$150
5
CDPHP $0 Medicare Rx (HMO) (2023)Local HMO$7,500$300
5
CDPHP Flex (PPO) (2023)Local PPO *$5,500$-
5
HumanaChoice H5970-001 (PPO) (2023)Local PPO$5,500$0
4
WellCare Today's Options Premier 300 (PFFS) (2023)PFFS *$-$-
5
Medicare BlueSecure (PPO) (2023)Local PPO$6,700$0
5
MVP Medicare Secure with Part D (HMO-POS) (2023)Local HMO$7,550$150
4
Humana Gold Plus H3533-001 (HMO) (2023)Local HMO$7,200$350
4
Aetna Medicare Premier Plan (PPO) (2023)Local PPO$7,550$200
5
WellCare Summit (PPO) (2023)Local PPO$6,700$445
5
Medicare BlueClassic (PPO) (2023)Local PPO$7,200$0
5
MVP Medicare Preferred Gold without Part D (HMO-POS) (2023)Local HMO *$7,550$-
4
Aetna Medicare Value Plan (HMO) (2023)Local HMO$7,550$0
5
Medicare BlueBasic (PPO) (2023)Local PPO *$4,500$-
5
WellCare Today's Options Advantage Plus 150A (PPO) (2023)Local PPO$3,400$0
5
WellCare Today's Options Premier Plus 250A (PFFS) (2023)PFFS$-$0
5
Medicare BlueEssential (PPO) (2023)Local PPO$7,550$150
5
MVP Medicare Preferred Gold with Part D (HMO-POS) (2023)Local HMO$5,800$0
4
WellCare Today's Options Premier Plus 650B (PFFS) (2023)PFFS$-$0
5
WellCare Today's Options Premier 200 (PFFS) (2023)PFFS *$-$-
5
WellCare Today's Options Advantage Plus 550B (PPO) (2023)Local PPO$6,700$0
5
MVP Medicare Secure Plus with Part D (HMO-POS) (2023)Local HMO$7,550$0
4
Medicare Advantage Plans by Excellus Health Plan, Inc
Medicare BlueSecure (PPO) (2023)Local PPO$6,700$0
5
Medicare BlueClassic (PPO) (2023)Local PPO$7,200$0
5
Medicare BlueBasic (PPO) (2023)Local PPO *$4,500$-
5
Medicare BlueEssential (PPO) (2023)Local PPO$7,550$150
5

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