5

5 out of 5 stars* for plan year 2024

Plan ID: H8783-003

What You Need to Know:

  • EssentiaCare Access (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 $445 (Tier 1 excluded from the Deductible.).
  • The plan includes an out-of-pocket maximum of $5,500 per year (in-network).
  • EssentiaCare Access (PPO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $445 (Tier 1 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 $445.0 1.0
Gap Coverage: No
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local PPO
Similar Plan: H8783-001
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): $5,500
Annual Deductible: $445 (Tier 1 excluded from the Deductible.)
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Bayfield, Wisconsin: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
less than 10 members New plan - No summary rating as of yet. 5 out of 5 Stars. 5 out of 5 Stars.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,586 drugs
Number of Members Enrolled in this Plan in Bayfield, Wisconsin: 10 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)
388 $3.00 1567 $10.00 288 17% 573 45% 770 25%

Other Medicare Advantage Plans in Bayfield, Wisconsin

Plan Name Type Premium MOOP Rx Deduct. Rating
Anthem MediBlue Plus (HMO) (2023)Local HMO$4,900$175
5
Ascend Rx (HMO-POS) (2023)Local HMO$4,500$330
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Essence Rx (HMO-POS) (2023)Local HMO$3,400$330
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Spirit (HMO-POS) (2023)Local HMO *$1,200$-
4
Medica Prime Solution Thrift (Cost) (2023)Cost *$6,700$-
5
Spirit Rx (HMO-POS) (2023)Local HMO$1,200$0
4
Medica Prime Solution Focus (Cost) (2023)Cost *$4,000$-
5
Essence (HMO-POS) (2023)Local HMO *$3,400$-
4
Medica Prime Solution Total (Cost) (2023)Cost *$3,000$-
5
HumanaChoice R5361-002 (Regional PPO) (2023)Regional PPO$6,700$420
5
Anthem MediBlue Access (PPO) (2023)Local PPO$5,500$95
5
Esteem Rx (HMO-POS) (2023)Local HMO$5,000$250
4
Anthem MediBlue Access Core (PPO) (2023)Local PPO *$5,500$-
5
HumanaChoice R5361-001 (Regional PPO) (2023)Regional PPO *$6,700$-
5
EssentiaCare Secure (PPO) (2023)Local PPO$4,500$400
5
EssentiaCare Grand (PPO) (2023)Local PPO$3,500$250
5
Secure Saver (MSA) (2023)MSA *$-$-
4
NetworkPrime (MSA) (2023)MSA *$-$-
4
Medicare Advantage Plans by UCare
EssentiaCare Secure (PPO) (2023)Local PPO$4,500$400
5
EssentiaCare Grand (PPO) (2023)Local PPO$3,500$250
5

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