3

3 out of 5 stars* for plan year 2024

Plan ID: H4605-007

What You Need to Know:

  • Regence MedAdvantage + Rx Primary (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 $0, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is $200 (Tier 1 and 2 excluded from the Deductible.).
  • The plan includes an out-of-pocket maximum of $5,900 per year (in-network).
  • Regence MedAdvantage + Rx Primary (PPO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $200 (Tier 1 and 2 excluded from the Deductible.).
  • This plan's Part D Initial Coverage Limit is $0.

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

$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 $200.0 1.0
Gap Coverage: No
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local PPO
Similar Plan: H4605-008
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): $5,900
Annual Deductible: $200 (Tier 1 and 2 excluded from the Deductible.)
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Wasatch, Utah: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
18 members 4 out of 5 Stars. 3 out of 5 Stars. 4 out of 5 Stars.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,494 drugs
Number of Members Enrolled in this Plan in Wasatch, Utah: 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
$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)
308 $3.00 927 $13.00 762 $40.00 748 40% 749 29%

Other Medicare Advantage Plans in Wasatch, Utah

Plan Name Type Premium MOOP Rx Deduct. Rating
Regence Valiance (PPO) (2023)Local PPO *$5,000$-
3
Aetna Medicare Value Plan (PPO) (2023)Local PPO$7,550$100
5
Aetna Advantra (HMO) (2023)Local HMO$7,550$0
5
UnitedHealthcare Medicare Advantage Assure (PPO) (2023)Local PPO$7,550$445
5
AARP Medicare Advantage Plan 1 (HMO) (2023)Local HMO$4,500$200
5
AARP Medicare Advantage Plan 2 (HMO) (2023)Local HMO$5,000$200
5
AARP Medicare Advantage Walgreens (HMO) (2023)Local HMO$6,700$225
5
AARP Medicare Advantage Choice (PPO) (2023)Local PPO$6,700$275
5
Regence MedAdvantage + Rx Classic (PPO) (2023)Local PPO$5,500$150
3
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
SelectHealth Advantage Essential (HMO) (2023)Local HMO$5,500$200
2
SelectHealth Advantage Enhanced (HMO) (2023)Local HMO$5,400$200
2
AARP Medicare Advantage Patriot (HMO) (2023)Local HMO *$5,400$-
5
Medicare Advantage Plans by Regence BlueCross BlueShield of Utah
Regence Valiance (PPO) (2023)Local PPO *$5,000$-
3
Regence MedAdvantage + Rx Classic (PPO) (2023)Local PPO$5,500$150
3

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