4

4 out of 5 stars* for plan year 2024

Plan ID: H9615-007

What You Need to Know:

  • MVP Medicare WellSelect Plus with Part D (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 $116, 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 $6,500 per year (in-network).
  • MVP Medicare WellSelect Plus with Part D (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 $40.

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

$116

Monthly Premium

Medicare Plan Features
Monthly Premium: $116.00
Part C Premium: $75.70
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$116.00 $75.70 $40.30 $0 $40.30 $0 0.0
Gap Coverage: Yes
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local PPO
Similar Plan: H9615-008
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: Yes, some additional gap coverage.
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $6,500
Annual Deductible: NULL
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Addison, Vermont: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
21 members 4 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: 3,594 drugs
Number of Members Enrolled in this Plan in Addison, Vermont: 119 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
$75.70 $40.30 $0.00 $116.00
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
$75.70 $30.20 $105.90 $20.10 $95.80 $10.10 $85.80
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)
202 $0.00 1486 $10.00 762 $35.00 388 27% 756 33%

Other Medicare Advantage Plans in Addison, Vermont

Plan Name Type Premium MOOP Rx Deduct. Rating
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Vermont Blue Advantage Unity HMO (HMO) (2023)Local HMO$6,700$200
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Vermont Blue Advantage Freedom PPO (PPO) (2023)Local PPO$6,900$250
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Vermont Blue Advantage Freedom Plus PPO (PPO) (2023)Local PPO$5,000$150
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MVP Medicare Secure with Part D (HMO-POS) (2023)Local HMO$7,550$150
4
MVP Medicare WellSelect with Part D (PPO) (2023)Local PPO$7,550$325
4
MVP Medicare Secure Plus with Part D (HMO-POS) (2023)Local HMO$7,550$0
4
MVP Medicare Preferred Gold with Part D (HMO-POS) (2023)Local HMO$5,800$0
4
AARP Medicare Advantage Plan 1 (HMO) (2023)Local HMO$6,700$250
5
AARP Medicare Advantage Plan 2 (HMO) (2023)Local HMO$5,900$150
5
MVP SmartFund (MSA) (2023)MSA *$-$-
4
AARP Medicare Advantage Plan 3 (HMO) (2023)Local HMO$6,700$0
5
MVP Medicare Preferred Gold without Part D (HMO-POS) (2023)Local HMO *$7,550$-
4
AARP Medicare Advantage Choice (Regional PPO) (2023)Regional PPO$6,700$295
5
WellCare Plus (PPO) (2023)Local PPO$3,450$445
New plan - not yet rated.
WellCare Value (HMO) (2023)Local HMO$6,000$0
New plan - not yet rated.
UnitedHealthcare Medicare Advantage Assure (PPO) (2023)Local PPO$7,550$445
5
Medicare Advantage Plans by MVP HEALTH CARE
MVP Medicare Secure with Part D (HMO-POS) (2023)Local HMO$7,550$150
4
MVP Medicare WellSelect with Part D (PPO) (2023)Local PPO$7,550$325
4
MVP Medicare Secure Plus with Part D (HMO-POS) (2023)Local HMO$7,550$0
4
MVP Medicare Preferred Gold with Part D (HMO-POS) (2023)Local HMO$5,800$0
4
MVP SmartFund (MSA) (2023)MSA *$-$-
4
MVP Medicare Preferred Gold without Part D (HMO-POS) (2023)Local HMO *$7,550$-
4

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