4

4 out of 5 stars* for plan year 2024

Plan ID: H3916-012

What You Need to Know:

  • Freedom Blue PPO Basic (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 $66, 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 $5,900 per year (in-network).
  • Freedom Blue PPO Basic (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.

$66

Monthly Premium

Medicare Plan Features
Monthly Premium: $66.00
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:
$66.00 NULL NULL NULL NULL NULL NULL
Gap Coverage: NULL
Benchmark: NULL
Type of Medicare Health: NULL
Health Plan Type: Local PPO *
Similar Plan: H3916-015
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: NULL
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $5,900
Annual Deductible: no drug coverage
Annual Initial Coverage Limit ICL: NULL
Number of Members enrolled in this plan in Dauphin, Pennsylvania: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
13 members 4.5 out of 5 Stars. 4 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 Dauphin, Pennsylvania: 177 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

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Humana Gold Plus H6622-035 (HMO) (2023)Local HMO$6,700$0
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Humana Gold Choice H8145-052 (PFFS) (2023)PFFS$-$360
4
Aetna Medicare Advantra Premier Plus (PPO) (2023)Local PPO$4,900$0
5
Aetna Medicare Advantra Silver (PPO) (2023)Local PPO$7,550$0
5
HumanaChoice H5525-038 (PPO) (2023)Local PPO$6,700$0
4
HumanaChoice H5216-120 (PPO) (2023)Local PPO$6,700$0
4
Humana Gold Choice H8145-055 (PFFS) (2023)PFFS *$-$-
4
Health Partners Medicare Prime (HMO-POS) (2023)Local HMO$7,550$0
4
HumanaChoice R0923-002 (Regional PPO) (2023)Regional PPO$6,700$0
3
Health Partners Medicare Complete (HMO-POS) (2023)Local HMO$7,550$0
4
Aetna Medicare Advantra Silver Plus (PPO) (2023)Local PPO$7,550$0
5
Humana Honor (PPO) (2023)Local PPO *$6,700$-
4
Aetna Medicare Advantra Eagle (HMO) (2023)Local HMO *$4,000$-
5
BlueJourney Premier (HMO) (2023)Local HMO$3,400$0
3
BlueJourney Value (HMO) (2023)Local HMO$4,500$0
3
Aetna Medicare Gold Plan (PPO) (2023)Local PPO$7,550$0
5
Aetna Medicare PinnacleHealth Prime (HMO) (2023)Local HMO$7,550$0
5
Geisinger Gold Classic Essential Rx (HMO) (2023)Local HMO$7,550$0
4
BlueJourney Essential (HMO) (2023)Local HMO$6,700$0
3
Cigna Preferred Medicare (HMO) (2023)Local HMO$6,900$0
4
HumanaChoice H5216-116 (PPO) (2023)Local PPO *$3,900$-
4
Community Blue Medicare HMO Signature (HMO) (2023)Local HMO$6,700$0
4
Geisinger Gold Classic Advantage (HMO) (2023)Local HMO *$3,450$-
4
Geisinger Gold Classic Advantage Rx (HMO) (2023)Local HMO$3,450$0
4
Aetna Medicare Advantra Premier (HMO) (2023)Local HMO$7,550$0
5
Geisinger Gold Preferred Advantage Rx (PPO) (2023)Local PPO$4,000$0
3
Community Blue Medicare PPO Distinct (PPO) (2023)Local PPO$6,500$0
4
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
AARP Medicare Advantage Patriot (HMO) (2023)Local HMO *$5,500$-
5
Geisinger Gold Classic Complete Rx (HMO) (2023)Local HMO$4,900$0
4
Geisinger Gold Preferred Complete Rx (PPO) (2023)Local PPO$6,700$0
3
AARP Medicare Advantage Choice Plan 1 (PPO) (2023)Local PPO$6,700$95
5
Freedom Blue PPO Deluxe (PPO) (2023)Local PPO$4,500$0
4
Allwell Medicare Boost (HMO) (2023)Local HMO$7,550$0
4
AARP Medicare Advantage Choice Plan 2 (PPO) (2023)Local PPO$5,900$150
5
UPMC for Life HMO Rx (HMO) (2023)Local HMO$7,550$0
4
UPMC for Life HMO Deductible with Rx (HMO) (2023)Local HMO$7,550$0
4
AARP Medicare Advantage Choice Plan 3 (PPO) (2023)Local PPO$6,700$0
5
Community Blue Medicare PPO Signature (PPO) (2023)Local PPO$7,550$0
4
Geisinger Gold Preferred Enhanced Rx (PPO) (2023)Local PPO$6,700$0
3
Allwell Medicare (HMO) (2023)Local HMO$6,700$0
4
Freedom Blue PPO Standard (PPO) (2023)Local PPO$5,000$0
4
UPMC for Life HMO Rx Choice (HMO) (2023)Local HMO$7,550$0
4
BlueJourney Classic (PPO) (2023)Local PPO$6,700$0
5
UPMC for Life HMO No Rx (HMO) (2023)Local HMO *$7,550$-
4
Freedom Blue PPO ValueRx (PPO) (2023)Local PPO$5,500$0
4
BlueJourney Prime (PPO) (2023)Local PPO$4,000$0
5
Aetna Medicare Silver (HMO) (2023)Local HMO$7,550$0
5
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
Allwell Medicare Simple (HMO) (2023)Local HMO *$3,450$-
4
UPMC for Life HMO Rx Enhanced (HMO) (2023)Local HMO$7,550$0
4
BlueJourney Select (PPO) (2023)Local PPO$6,700$0
5
UPMC for Life HMO Premier Rx (HMO) (2023)Local HMO$7,550$0
4
Allwell Medicare Complement (HMO) (2023)Local HMO$7,550$445
4
AARP Medicare Advantage (HMO) (2023)Local HMO$6,700$130
5
Medicare Advantage Plans by Highmark Inc
Community Blue Medicare HMO Signature (HMO) (2023)Local HMO$6,700$0
4
Community Blue Medicare PPO Distinct (PPO) (2023)Local PPO$6,500$0
4
Freedom Blue PPO Deluxe (PPO) (2023)Local PPO$4,500$0
4
Community Blue Medicare PPO Signature (PPO) (2023)Local PPO$7,550$0
4
Freedom Blue PPO Standard (PPO) (2023)Local PPO$5,000$0
4
Freedom Blue PPO ValueRx (PPO) (2023)Local PPO$5,500$0
4

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