Plan ID: H5644-002

What You Need to Know:

  • Network Health Medicare Explore (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 $11, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is $260 (Tier 1, 2 and 3 excluded from the Deductible.).
  • The plan includes an out-of-pocket maximum of $4,100 per year (in-network).
  • Network Health Medicare Explore (HMO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $260 (Tier 1, 2 and 3 excluded from the Deductible.).
  • This plan's Part D Initial Coverage Limit is $11.

$11

Monthly Premium

Medicare Plan Features
Monthly Premium: $11.00
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:
$11.00 $0 $11.00 $0 $11.00 $260.0 1.0
Gap Coverage: No
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local HMO
Similar Plan: H5644-002
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): $4,100
Annual Deductible: $260 (Tier 1, 2 and 3 excluded from the Deductible.)
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Racine, Wisconsin: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
41 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: 4,703 drugs
Number of Members Enrolled in this Plan in Racine, Wisconsin: 312 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 $11.00 $0.00 $11.00
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 $8.20 $8.20 $5.50 $5.50 $2.70 $2.70
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)
243 $2.00 1809 $8.00 693 $42.00 935 $90.00 1023 28%

Other Medicare Advantage Plans in Racine, Wisconsin

Plan Name Type Premium MOOP Rx Deduct. Rating
Anthem MediBlue Plus (HMO) (2023)Local HMO$4,900$175
5
Aetna Medicare Premier (PPO) (2023)Local PPO$4,600$200
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Aetna Medicare Value (PPO) (2023)Local PPO$4,975$200
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AARP Medicare Advantage (HMO-POS) (2023)Local HMO$4,500$250
5
Humana Gold Plus H6622-040 (HMO) (2023)Local HMO$6,700$315
4
Humana Gold Choice H8145-006 (PFFS) (2023)PFFS$-$445
4
AARP Medicare Advantage Value (HMO-POS) (2023)Local HMO$4,900$275
5
Aurora Health Quartz Med Advantage Value (HMO) (2023)Local HMO *$4,900$-
3
HumanaChoice R5361-002 (Regional PPO) (2023)Regional PPO$6,700$420
5
Aurora Health Quartz Med Advantage Elite (HMO) (2023)Local HMO *$3,900$-
3
Humana Value Plus H5216-173 (PPO) (2023)Local PPO$6,700$230
4
Aetna Medicare Eagle (PPO) (2023)Local PPO *$5,900$-
5
Anthem MediBlue Access (PPO) (2023)Local PPO$5,500$95
5
Anthem MediBlue Access Core (PPO) (2023)Local PPO *$5,500$-
5
Humana Gold Plus H6622-002 (HMO) (2023)Local HMO$4,000$200
4
Network Health Medicare Go (PPO) (2023)Local PPO$4,900$275
4
Humana Gold Plus H6622-034 (HMO) (2023)Local HMO$4,500$300
4
Network Health Medicare Anywhere (PPO) (2023)Local PPO$4,500$250
4
Anthem MediBlue Access Plus (PPO) (2023)Local PPO$4,500$195
5
HumanaChoice H5216-001 (PPO) (2023)Local PPO$3,900$200
4
Humana Honor (PPO) (2023)Local PPO *$6,700$-
4
Secure Saver (MSA) (2023)MSA *$-$-
4
AARP Medicare Advantage Open Plan 1 (PPO) (2023)Local PPO$5,900$325
5
AARP Medicare Advantage Patriot Plan 2 (HMO-POS) (2023)Local HMO *$4,900$-
5
HumanaChoice R5361-001 (Regional PPO) (2023)Regional PPO *$6,700$-
5
HumanaChoice H5216-252 (PPO) (2023)Local PPO$4,900$300
4
HumanaChoice H5216-253 (PPO) (2023)Local PPO$4,200$275
4
NetworkPrime (MSA) (2023)MSA *$-$-
4
Medicare Advantage Plans by Network Health Medicare Advantage Plans
Network Health Medicare Go (PPO) (2023)Local PPO$4,900$275
4
Network Health Medicare Anywhere (PPO) (2023)Local PPO$4,500$250
4
NetworkPrime (MSA) (2023)MSA *$-$-
4

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