4

4 out of 5 stars* for plan year 2024

Plan ID: H3916-022

What You Need to Know:

  • Freedom Blue PPO Select (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 $170, 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).
  • Freedom Blue PPO Select (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 $52.

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

$170

Monthly Premium

Medicare Plan Features
Monthly Premium: $170.00
Part C Premium: $81.00
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$170.00 $81.00 $52.20 $36.80 $89.00 $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: H3916-024
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 Allegheny, Pennsylvania: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
1,568 members 4.5 out of 5 Stars. 4 out of 5 Stars. 4 out of 5 Stars.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 4,266 drugs
Number of Members Enrolled in this Plan in Allegheny, Pennsylvania: 4,028 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
$81.00 $52.20 $36.80 $170.00
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
$132.50 $79.60 $160.60 $70.30 $151.30 $60.90 $141.90
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)
534 $0.00 1410 $13.00 600 $45.00 791 $95.00 931 33%

Other Medicare Advantage Plans in Allegheny, Pennsylvania

Plan Name Type Premium MOOP Rx Deduct. Rating
UPMC for Life PPO Rx Enhanced (PPO) (2023)Local PPO$7,550$0
3
Aetna Medicare Advantra Credit Value (PPO) (2023)Local PPO$7,550$250
5
Aetna Medicare Advantra Premier (PPO) (2023)Local PPO$6,800$0
5
Aetna Medicare Advantra Premier Plus (PPO) (2023)Local PPO$4,900$0
5
HumanaChoice H5525-017 (PPO) (2023)Local PPO$5,900$0
4
HumanaChoice R0923-001 (Regional PPO) (2023)Regional PPO *$4,900$-
3
HumanaChoice H5525-038 (PPO) (2023)Local PPO$6,700$0
4
HumanaChoice H5216-120 (PPO) (2023)Local PPO$6,700$0
4
HumanaChoice R0923-002 (Regional PPO) (2023)Regional PPO$6,700$0
3
UPMC for Life PPO High Deductible with Rx (PPO) (2023)Local PPO$7,550$0
3
Humana Honor (PPO) (2023)Local PPO *$6,700$-
4
Aetna Medicare Advantra Eagle (HMO) (2023)Local HMO *$4,000$-
5
Aetna Medicare Gold Plan (PPO) (2023)Local PPO$7,550$0
5
Aetna Medicare Value (PPO) (2023)Local PPO$7,550$0
5
Security Blue HMO-POS Deluxe (HMO-POS) (2023)Local HMO$4,500$0
4
Community Blue Medicare HMO Signature (HMO) (2023)Local HMO$7,550$0
4
Aetna Medicare Advantra Gold (HMO) (2023)Local HMO$5,900$0
5
Aetna Medicare Advantra Silver (HMO) (2023)Local HMO$7,550$0
5
Security Blue HMO-POS ValueRx (HMO-POS) (2023)Local HMO$5,500$0
4
HumanaChoice H5216-116 (PPO) (2023)Local PPO *$3,900$-
4
Community Blue Medicare HMO Prestige (HMO) (2023)Local HMO$6,700$0
4
Humana Value Plus H5216-117 (PPO) (2023)Local PPO$6,700$420
4
Security Blue HMO-POS Basic (HMO-POS) (2023)Local HMO *$5,900$-
4
Freedom Blue PPO ValueRx (PPO) (2023)Local PPO$5,500$0
4
Freedom Blue PPO Classic (PPO) (2023)Local PPO$4,500$0
4
UPMC for Life HMO Rx Enhanced (HMO) (2023)Local HMO$7,550$0
4
UPMC for Life HMO Rx (HMO) (2023)Local HMO$7,550$0
4
Security Blue HMO-POS Standard (HMO-POS) (2023)Local HMO$5,000$0
4
AARP Medicare Advantage Patriot (HMO) (2023)Local HMO *$5,500$-
5
Allwell Medicare Boost (HMO) (2023)Local HMO$7,550$0
4
Complete Blue PPO Distinct (PPO) (2023)Local PPO$6,500$0
4
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
AARP Medicare Advantage Choice (PPO) (2023)Local PPO$4,900$0
New plan - not yet rated.
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
Allwell Medicare (HMO) (2023)Local HMO$6,700$0
4
UPMC for Life HMO No Rx (HMO) (2023)Local HMO *$7,550$-
4
UPMC for Life HMO Deductible with Rx (HMO) (2023)Local HMO$7,550$0
4
UPMC for Life HMO Premier Rx (HMO) (2023)Local HMO$7,550$0
4
UPMC for Life HMO Rx Choice (HMO) (2023)Local HMO$7,550$0
4
Allwell Medicare Simple (HMO) (2023)Local HMO *$3,450$-
4
Aetna Medicare Silver (HMO) (2023)Local HMO$7,550$0
5
AARP Medicare Advantage Plan 1 (HMO) (2023)Local HMO$6,700$0
5
Allwell Medicare Complement (HMO) (2023)Local HMO$7,550$445
4
AARP Medicare Advantage Plan 2 (HMO) (2023)Local HMO$5,500$0
5
Medicare Advantage Plans by Highmark Inc
Security Blue HMO-POS Deluxe (HMO-POS) (2023)Local HMO$4,500$0
4
Community Blue Medicare HMO Signature (HMO) (2023)Local HMO$7,550$0
4
Security Blue HMO-POS ValueRx (HMO-POS) (2023)Local HMO$5,500$0
4
Community Blue Medicare HMO Prestige (HMO) (2023)Local HMO$6,700$0
4
Security Blue HMO-POS Basic (HMO-POS) (2023)Local HMO *$5,900$-
4
Freedom Blue PPO ValueRx (PPO) (2023)Local PPO$5,500$0
4
Freedom Blue PPO Classic (PPO) (2023)Local PPO$4,500$0
4
Security Blue HMO-POS Standard (HMO-POS) (2023)Local HMO$5,000$0
4
Complete Blue PPO Distinct (PPO) (2023)Local PPO$6,500$0
4

Find Medicare Advantage Plans in Pennsylvania