Plan ID: H2853-001

What You Need to Know:

  • Ascension Complete Saint Thomas Reward (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 $0, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is $390 (Tier 1 and 2 excluded from the Deductible.).
  • The plan includes an out-of-pocket maximum of $7,550 per year (in-network).
  • Ascension Complete Saint Thomas Reward (HMO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $390 (Tier 1 and 2 excluded from the Deductible.).
  • This plan's Part D Initial Coverage Limit is $0.

$0

Monthly Premium

Medicare Plan Features
Monthly Premium: $0
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:
$0 $0 $0 $0 $0 $390.0 1.0
Gap Coverage: No
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local HMO
Similar Plan: H2853-002
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): $7,550
Annual Deductible: $390 (Tier 1 and 2 excluded from the Deductible.)
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Cannon, Tennessee: 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: 3,411 drugs
Number of Members Enrolled in this Plan in Cannon, Tennessee: 8 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 $0.00 $0.00 $0.00
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
$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
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)
217 $2.00 410 $20.00 1011 $47.00 902 $100.00 680 26%

Other Medicare Advantage Plans in Cannon, Tennessee

Plan Name Type Premium MOOP Rx Deduct. Rating
HumanaChoice R7315-001 (Regional PPO) (2023)Regional PPO *$3,400$-
4
Amerivantage Balance Plus (HMO) (2023)Local HMO$6,700$445
New plan - not yet rated.
HumanaChoice R7315-002 (Regional PPO) (2023)Regional PPO$6,700$400
4
Humana Honor (PPO) (2023)Local PPO *$3,400$-
4
Cigna Premier Medicare (HMO-POS) (2023)Local HMO$6,700$200
4
BlueAdvantage Diamond (PPO) (2023)Local PPO$3,700$0
2
AARP Medicare Advantage Patriot (HMO) (2023)Local HMO *$3,200$-
5
WellCare Dividend (HMO) (2023)Local HMO$6,700$0
4
Ascension Complete Saint Thomas Secure (HMO) (2023)Local HMO$4,900$0
New plan - not yet rated.
HumanaChoice H5216-097 (PPO) (2023)Local PPO$6,700$150
4
Aetna Medicare Premier Plan (PPO) (2023)Local PPO$7,500$0
5
WellCare Patriot (HMO-POS) (2023)Local HMO *$4,500$-
4
WellCare Value (HMO-POS) (2023)Local HMO$5,500$0
4
HumanaChoice H5216-180 (PPO) (2023)Local PPO$6,700$225
4
AARP Medicare Advantage Walgreens (PPO) (2023)Local PPO$5,900$0
New plan - not yet rated.
Aetna Medicare Premier Plus Plan (PPO) (2023)Local PPO$6,700$0
5
Aetna Medicare Value Plus Plan (HMO) (2023)Local HMO$6,700$250
New plan - not yet rated.
BlueAdvantage Emerald (PPO) (2023)Local PPO$4,900$0
2
Cigna True Choice Medicare (PPO) (2023)Local PPO$5,900$0
New plan - not yet rated.
BlueAdvantage Ruby (PPO) (2023)Local PPO$4,300$0
2
Amerivantage Classic Plus (HMO-POS) (2023)Local HMO$4,900$0
New plan - not yet rated.
WellCare Premier (PPO) (2023)Local PPO$5,500$75
New plan - not yet rated.
BlueAdvantage Sapphire (PPO) (2023)Local PPO$5,700$0
2
WellCare Absolute (PPO) (2023)Local PPO$6,700$90
New plan - not yet rated.
Amerivantage Classic (HMO) (2023)Local HMO$6,500$0
5
Cigna Preferred Medicare (HMO) (2023)Local HMO$6,700$0
4
AARP Medicare Advantage Plan 1 (HMO) (2023)Local HMO$5,900$0
5
AARP Medicare Advantage Plan 2 (HMO) (2023)Local HMO$4,900$0
5
Cigna Fundamental Medicare (HMO) (2023)Local HMO *$6,700$-
4
WellCare Compass (HMO) (2023)Local HMO$4,900$445
4
Humana Gold Plus H4461-029 (HMO-POS) (2023)Local HMO$5,900$0
4
Amerivantage Balance (HMO) (2023)Local HMO$6,700$445
5
Medicare Advantage Plans by Ascension Complete
Ascension Complete Saint Thomas Secure (HMO) (2023)Local HMO$4,900$0
New plan - not yet rated.

Find Medicare Advantage Plans in Tennessee