Plan ID: H5296-002

What You Need to Know:

  • NCPlus (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 $14, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is $445 (Tier 1 excluded from the Deductible.).
  • The plan includes an out-of-pocket maximum of $6,700 per year (in-network).
  • NCPlus (HMO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $445 (Tier 1 excluded from the Deductible.).
  • This plan's Part D Initial Coverage Limit is $14.

$14

Monthly Premium

Medicare Plan Features
Monthly Premium: $13.90
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:
$13.90 $0 $13.90 $0 $13.90 $445.0 1.0
Gap Coverage: No
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local HMO
Similar Plan: H5296-003
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: $445 (Tier 1 excluded from the Deductible.)
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Johnston, North Carolina: 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: 3,466 drugs
Number of Members Enrolled in this Plan in Johnston, North Carolina: 41 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 $13.90 $0.00 $13.90
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 $10.40 $10.40 $6.90 $6.90 $3.50 $3.50
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)
330 $0.00 932 $14.00 776 23% 481 23% 749 25%

Other Medicare Advantage Plans in Johnston, North Carolina

Plan Name Type Premium MOOP Rx Deduct. Rating
Aetna Medicare Value Plan (PPO) (2023)Local PPO$6,500$150
5
AARP Medicare Advantage Plan 2 (HMO-POS) (2023)Local HMO$4,500$95
5
Blue Medicare Enhanced (HMO) (2023)Local HMO$3,900$0
5
Humana Gold Plus H6622-060 (HMO) (2023)Local HMO$4,200$0
4
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
Aetna Medicare Eagle Plan (PPO) (2023)Local PPO *$6,500$-
5
AARP Medicare Advantage Patriot (HMO-POS) (2023)Local HMO *$3,600$-
5
HumanaChoice R1390-002 (Regional PPO) (2023)Regional PPO$7,550$360
4
Blue Medicare Essential (HMO) (2023)Local HMO$6,700$375
5
Humana Honor R1390-003 (Regional PPO) (2023)Regional PPO *$6,700$-
4
HumanaChoice H5525-026 (PPO) (2023)Local PPO$6,700$265
4
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
Aetna Medicare Value Plan (HMO) (2023)Local HMO$5,500$0
New plan - not yet rated.
HumanaChoice H5525-035 (PPO) (2023)Local PPO$6,700$265
4
Blue Medicare Essential Plus (HMO) (2023)Local HMO$4,200$195
5
NC Premier (HMO) (2023)Local HMO$3,400$0
New plan - not yet rated.
Platinum (HMO-POS) (2023)Local HMO$3,400$0
New plan - not yet rated.
Blue Medicare PPO Enhanced (PPO) (2023)Local PPO$5,900$0
4
HumanaChoice R1390-001 (Regional PPO) (2023)Regional PPO *$5,400$-
4
AARP Medicare Advantage Plan 1 (HMO-POS) (2023)Local HMO$3,600$50
5
Aetna Medicare Premier Plan (PPO) (2023)Local PPO$7,000$150
5
Blue Medicare Medical Only (HMO) (2023)Local HMO *$4,400$-
5
AARP Medicare Advantage Choice (PPO) (2023)Local PPO$6,700$250
New plan - not yet rated.
Medicare Advantage Plans by Alignment Health Plan
NC Premier (HMO) (2023)Local HMO$3,400$0
New plan - not yet rated.
Platinum (HMO-POS) (2023)Local HMO$3,400$0
New plan - not yet rated.

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