Adams County, Wisconsin Medicare Companies and Plans (2022)

Eligible residents can buy Adams County Medicare plans from multiple insurance companies. Medicare plans available in Adams County include Medicare Advantage (Part C), Part D prescription drug coverage, and Medicare Supplement (Medigap) plans. The best way to choose the right Medicare coverage in Adams County, WI is to compare coverage and rates from multiple companies.

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The Highlights

  • Adams County residents can buy Medicare Advantage or choose original Medicare
  • Medicare supplement plans in Adams County, WI include Medigap 25% Cost Sharing Plan and Medigap Basic Plan
  • Medicare Advantage plans in Adams County, Wisconsin may include dental, vision, and hearing coverage

Adams County, Wisconsin Medicare plans are widely available, and Medicare-eligible residents can compare options that include Medicare Advantage, standalone Medicare Part D, and Medicare Supplement plans to fill the gaps in original Medicare.

Whether you are just looking for Medigap coverage in Adams County to avoid out-of-pocket costs not covered by your Medicare Part A and B or want to sign up for Medicare Advantage instead, comparing your options is the best way to find affordable Adams County, WI Medicare coverage that suits your needs.

Ready to find cheap Medicare rates in Adams County, WI? Enter your ZIP code to compare Adams County, Wisconsin Medicare plans today.

Medicare Advantage Companies in Adams County, Wisconsin

A Medicare Advantage plan in Adams County, WI can provide additional coverage above and beyond original Medicare and allows you to choose your plan, coverage, and network. Take a look at the companies that offer Medicare Advantage plans in Adams County, Wisconsin.

Medicare Advantage Companies in Adams County, Wisconsin

Plan Name Monthly Prem. (Parts C & D) Deductible Additional Gap Coverage Preferred Pharmacy Copay/ Coinsurance 30-Day Supply MOOP for Part A & B Benefits
AARP Medicare Advantage Open Plan 1 (PPO) – H0294-004-0 $47.00 $325 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $4.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 27% $5,900
AARP Medicare Advantage Patriot Plan 1 (PPO) – H0294-014-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $6,700
Allwell Dual Medicare (HMO D-SNP) – H8189-001-0 $0.00 for people who qualify for both Medicare and Medicaid. $0 for people who qualify for both Medicare and Medicaid. Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $20.00, Preferred Brand: $47.00, Non-Preferred Drug: 50%, Specialty Tier: 29% n/a
Anthem MediBlue Access (PPO) – H4036-009-0 $37.00 $95 . Tier 1 and 2 exempt Yes, some additional gap coverage. Preferred Generic: $4.00, Generic: $15.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 31%, Select Care Drugs: $0.00 $5,500
Anthem MediBlue Access Core (PPO) – H4036-016-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $5,500
Anthem MediBlue Dual Advantage (HMO D-SNP) – H9525-003-0 $0.00 for people who qualify for both Medicare and Medicaid. $0 for people who qualify for both Medicare and Medicaid. Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $4.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 25%, Select Care Drugs: $0.00 n/a
Anthem MediBlue Plus (HMO) – H9525-004-0 $0.00 $175 . Tier 1 and 2 exempt Yes, some additional gap coverage. Preferred Generic: $2.00, Generic: $9.00, Preferred Brand: $42.00, Non-Preferred Drug: $95.00, Specialty Tier: 30%, Select Care Drugs: $0.00 $4,900
Ascend Rx (HMO-POS) – H5211-013-0 $40.00 $330 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $4.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 26%, Vaccines: $0.00 $4,500
Elite (PPO) – H6874-003-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $4,000
Elite Rx (PPO) – H6874-002-0 $79.00 $295 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $2.00, Generic: $10.00, Preferred Brand: $40.00, Non-Preferred Drug: 45%, Specialty Tier: 27% $4,000
Essence (HMO-POS) – H5211-003-0 $16.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $3,400
Essence Rx (HMO-POS) – H5211-002-0 $85.00 $330 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $4.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 26%, Vaccines: $0.00 $3,400
Essential Rx (PPO) – H6874-001-0 $0.00 $295 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $12.00, Preferred Brand: $40.00, Non-Preferred Drug: 45%, Specialty Tier: 27% $5,900
Esteem Rx (HMO-POS) – H5211-012-0 $0.00 $250 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $6.00, Generic: $20.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 28%, Vaccines: $0.00 $5,000
Humana Gold Choice H8145-006 (PFFS) – H8145-006-0 $81.00 $445 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $6.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 25% n/a
HumanaChoice R5361-001 (Regional PPO) – R5361-001-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $6,700
HumanaChoice R5361-002 (Regional PPO) – R5361-002-0 $120.00 $420 . Tier 1 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $9.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 25% $6,700
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) – H5209-004-0 $0.00 for people who qualify for both Medicare and Medicaid. $0 for people who qualify for both Medicare and Medicaid. No additional gap coverage, only the Donut Hole Discount Tier 1: $0.00 n/a
NetworkPrime (MSA) – H1181-001-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. n/a
Secure Saver (MSA) – H4388-001-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. n/a
Spirit (HMO-POS) – H5211-001-0 $150.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $1,200
Spirit Rx (HMO-POS) – H5211-004-0 $226.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $9.00, Generic: $20.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33%, Vaccines: $0.00 $1,200
UW Health Quartz Med Advantage Core D (w/Rx) (HMO) – H5262-023-0 $0.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $15.00, Preferred Brand: $45.00, Non-Preferred Drug: 40%, Specialty Tier: 30% $5,600
UW Health Quartz Med Advantage Elite (HMO) – H5262-010-0 $50.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $3,450
UW Health Quartz Med Advantage Elite D (w/Rx) (HMO) – H5262-007-0 $100.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $15.00, Preferred Brand: $45.00, Non-Preferred Drug: 40%, Specialty Tier: 30% $3,450
UW Health Quartz Med Advantage Value (HMO) – H5262-009-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $4,900
UW Health Quartz Med Advantage Value D (w/Rx) (HMO) – H5262-008-0 $50.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $15.00, Preferred Brand: $45.00, Non-Preferred Drug: 40%, Specialty Tier: 30% $4,900
UnitedHealthcare Dual Complete LP1 (HMO D-SNP) – H3794-002-0 $0.00 for people who qualify for both Medicare and Medicaid. $0 for people who qualify for both Medicare and Medicaid. No additional gap coverage, only the Donut Hole Discount Tier 1: 15%, Tier 2: 15%, Tier 3: 15%, Tier 4: 15%, Tier 5: 15% n/a
UnitedHealthcare Medicare Advantage Assist (PPO C-SNP) – H0294-002-0 $14.00 $300 . Tier 1, 2 and 3 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $4.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 27% n/a
iCare Medicare Plan (HMO D-SNP) – H2237-001-0 $0.00 for people who qualify for both Medicare and Medicaid. $0 for people who qualify for both Medicare and Medicaid. No additional gap coverage, only the Donut Hole Discount Generic: $15.00, Brand: $45.00, Specialty Tier: 25% n/a

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Medicare Supplement Companies in Adams County, Wisconsin

If you choose original Medicare in Adams County, WI, you can get coverage for out-of-pocket costs like deductibles, co-pays, and coinsurance with a Adams County Medicare Supplement plan. Take a look at which companies offer Medicare Supplement plans in Adams County, WI and which plans are available.

Medicare Supplement Companies in Adams County, Wisconsin

Company Plans
Humana (Humana Insurance Company) Medigap 25% Cost Sharing Plan,
Medigap 50% Cost Sharing Plan,
Medigap Basic Plan,
Medigap High Deductible Plan
Humana (Humana Insurance Company) (Household) Medigap 25% Cost Sharing Plan,
Medigap 50% Cost Sharing Plan,
Medigap Basic Plan,
Medigap High Deductible Plan
Humana Healthy Living (Humana Insurance Company) Medigap 25% Cost Sharing Plan,
Medigap 50% Cost Sharing Plan,
Medigap Basic Plan
Humana Healthy Living (Humana Insurance Company) (Household) Medigap 25% Cost Sharing Plan,
Medigap 50% Cost Sharing Plan,
Medigap Basic Plan
Humana Value (HumanaDental Insurance Company) Medigap 25% Cost Sharing Plan,
Medigap 50% Cost Sharing Plan,
Medigap Basic Plan
Humana Value (HumanaDental Insurance Company) (Household) Medigap 25% Cost Sharing Plan,
Medigap 50% Cost Sharing Plan,
Medigap Basic Plan
Wisconsin Physicians Service Insurance Corporation Medigap 25% Cost Sharing Plan,
Medigap 50% Cost Sharing Plan,
Medigap Basic Plan
AARP – UnitedHealthcare Insurance Company (Level 1) Medigap Basic Plan
AARP – UnitedHealthcare Insurance Company (Level 1/Household) Medigap Basic Plan
AARP – UnitedHealthcare Insurance Company (Level 2) Medigap Basic Plan
AARP – UnitedHealthcare Insurance Company (Level 2/Household) Medigap Basic Plan
AARP – UnitedHealthcare Insurance Company (Standard) Medigap Basic Plan
AARP – UnitedHealthcare Insurance Company (Standard/Household) Medigap Basic Plan
Accendo Insurance Company Medigap Basic Plan
Aetna Health and Life Insurance Company Medigap Basic Plan
American Benefit Life Insurance Company Medigap Basic Plan
Americo Financial Life and Annuity Insurance Company Medigap Basic Plan
Americo Financial Life and Annuity Insurance Company (Class 1) Medigap Basic Plan
Anthem Blue Cross and Blue Shield – Wisconsin Medigap Basic Plan
Capitol Life Insurance Company Medigap Basic Plan
Catholic United Financial Medigap Basic Plan
Cigna Health & Life Insurance Company Medigap Basic Plan
Colonial Penn Life Insurance Company Medigap Basic Plan
Colonial Penn Life Insurance Company (Substandard) Medigap Basic Plan
Garden State Life Insurance Company Medigap Basic Plan,
Medigap High Deductible Plan
Globe Life and Accident Insurance Company (Direct to Consumer) Medigap Basic Plan
Guarantee Trust Life Insurance Company Medigap Basic Plan
Humana Achieve (Emphesys Insurance Company) Medigap Basic Plan
Humana Achieve (Emphesys Insurance Company) (Household) Medigap Basic Plan
Independence American Insurance Company Medigap Basic Plan
Lumico Life Insurance Company Medigap Basic Plan
Manhattan Life Assurance Company Medigap Basic Plan
Medico Insurance Company Medigap Basic Plan
National Guardian Life Insurance Company Medigap Basic Plan
National Health Insurance Company Medigap Basic Plan
National Health Insurance Company (Household) Medigap Basic Plan
Pan-American Life Insurance Company Medigap Basic Plan
Pekin Life Insurance Company Medigap Basic Plan
Philadelphia American Life Insurance Company Medigap Basic Plan
Physicians Life Insurance Company (Attained Age) Medigap Basic Plan,
Medigap High Deductible Plan
Physicians Life Insurance Company (Issue Age) Medigap Basic Plan,
Medigap High Deductible Plan
Prosperity Life Group Medigap Basic Plan
Puritan Life Insurance Company of America Medigap Basic Plan
Security Health Plan of Wisconsin, Inc. Medigap Basic Plan
Southern Guaranty Insurance Company Medigap Basic Plan
State Farm Mutual Automobile Insurance Company Medigap Basic Plan
Union Security Insurance Company Medigap Basic Plan
United American Insurance Company Medigap Basic Plan
United Commercial Travelers of America Medigap Basic Plan
United World Life Insurance Company Medigap Basic Plan,
Medigap High Deductible Plan

Adams County, Wisconsin Medicare Supplement Coverage by Plan

Not sure which Adams County Medicare supplement plan is right for you? Take a look at the details of each of the standard Wisconsin Medicare supplement plans to find out what’s covered.

Adams County, Wisconsin Medicare Supplement Coverage by Plan

Plan Name Monthly Cost Copays Coinsurance Deductibles Plan Benefits
Medigap 25% Cost Sharing Plan Premiums range from $105-$569 depending on your age, sex, health status, and when you buy. 5% Generally your cost for approved Part B services up to $3,110. Then, you’ll pay $0 for the rest of the year. $371 (25% of Part A deductible) Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: No
Medigap 50% Cost Sharing Plan Premiums range from $78-$448 depending on your age, sex, health status, and when you buy. 10% Generally your cost for approved Part B services up to $6,220. Then, you’ll pay $0 for the rest of the year. $742 (50% of Part A deductible) Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: No
Medigap Basic Plan Premiums range from $98-$912 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services $1,484 Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: No
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: No
Medigap High Deductible Plan Premiums range from $52-$366 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services $2,370 total plan deductible.
After, you pay: $0 Hospital (Part A) deductible,
$0 (or $203 if not eligible for this benefit)** Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: Yes
Part B excess charges: Yes
Foreign travel emergency: Yes

Standalone Medicare Part D Plans in Adams County, Wisconsin

If you’re looking to buy a standalone Adams County, WI Medicare Part D plan for prescription drug coverage, you have several options. Review the companies that offer Part D as a standalone policy and what sort of Medicare prescription coverage is available in Adams County, Wisconsin.

Standalone Medicare Part D plans in Adams County, Wisconsin

Plan Details Tiers
SilverScript SmartRx (PDP)
S5601 – 191 – 0
by Aetna Medicare
Monthly Premium: $7.30
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $19.00
Tier 3: $46.00
Tier 4: 46%
Tier 5: 25%
Clear Spring Health Premier Rx (PDP)
S6946 – 042 – 0
by Clear Spring Health
Monthly Premium: $13.60
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $3.00
Tier 3: $40.00
Tier 4: 44%
Tier 5: 25%
WellCare Wellness Rx (PDP)
S4802 – 185 – 0
by WellCare
Monthly Premium: $14.60
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $7.00
Tier 3: $43.00
Tier 4: 47%
Tier 5: 25%
WellCare Value Script (PDP)
S4802 – 132 – 0
by WellCare
Monthly Premium: $14.80
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $8.00
Tier 3: $43.00
Tier 4: 47%
Tier 5: 25%
Humana Walmart Value Rx Plan (PDP)
S5884 – 195 – 0
by Humana
Monthly Premium: $17.20
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $4.00
Tier 3: 19%
Tier 4: 35%
Tier 5: 25%
Cigna Secure-Essential Rx (PDP)
S5617 – 295 – 0
by Cigna
Monthly Premium: $24.00
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $2.00
Tier 3: 18%
Tier 4: 46%
Tier 5: 25%
Mutual of Omaha Rx Premier (PDP)
S7126 – 085 – 0
by Mutual of Omaha Rx
Monthly Premium: $24.00
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $2.00
Tier 3: 23%
Tier 4: 46%
Tier 5: 25%
Anthem MediBlue Rx Enhanced (PDP)
S5596 – 080 – 0
by Anthem MediBlue Rx (PDP)
Monthly Premium: $24.60
Annual Deductable: $290
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $0.00
Tier 2: $2.00
Tier 3: 20%
Tier 4: 37%
Tier 5: 26%
WellCare Medicare Rx Select (PDP)
S5810 – 290 – 0
by WellCare
Monthly Premium: $26.80
Annual Deductable: $300
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $3.00
Tier 3: $47.00
Tier 4: 42%
Tier 5: 27%
Express Scripts Medicare – Saver (PDP)
S5660 – 232 – 0
by Express Scripts Medicare
Monthly Premium: $27.50
Annual Deductable: $285
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $2.00
Tier 2: $7.00
Tier 3: $35.00
Tier 4: 50%
Tier 5: 28%
Clear Spring Health Value Rx (PDP)
S6946 – 013 – 0
by Clear Spring Health
Monthly Premium: $29.30
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $3.00
Tier 3: $42.00
Tier 4: 34%
Tier 5: 25%
Express Scripts Medicare – Value (PDP)
S5660 – 118 – 0
by Express Scripts Medicare
Monthly Premium: $31.60
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $3.00
Tier 3: $30.00
Tier 4: 50%
Tier 5: 25%
AARP MedicareRx Walgreens (PDP)
S5921 – 397 – 0
by UnitedHealthcare
Monthly Premium: $32.00
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $6.00
Tier 3: $40.00
Tier 4: 40%
Tier 5: 25%
Cigna Secure Rx (PDP)
S5617 – 223 – 0
by Cigna
Monthly Premium: $32.10
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $2.00
Tier 3: $30.00
Tier 4: 50%
Tier 5: 25%
WellCare Classic (PDP)
S4802 – 097 – 0
by WellCare
Monthly Premium: $33.90
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $2.00
Tier 3: $30.00
Tier 4: 33%
Tier 5: 25%
SilverScript Choice (PDP)
S5601 – 032 – 0
by Aetna Medicare
Monthly Premium: $36.00
Annual Deductable: $205
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $5.00
Tier 3: $35.00
Tier 4: 42%
Tier 5: 29%
Humana Basic Rx Plan (PDP)
S5884 – 139 – 0
by Humana
Monthly Premium: $37.90
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $1.00
Tier 3: 20%
Tier 4: 35%
Tier 5: 25%
Elixir RxPlus (PDP)
S7694 – 016 – 0
by Elixir Insurance
Monthly Premium: $39.10
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $6.00
Tier 3: 15%
Tier 4: 25%
Tier 5: 25%
WellCare Medicare Rx Saver (PDP)
S5810 – 050 – 0
by WellCare
Monthly Premium: $39.50
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $2.00
Tier 3: $35.00
Tier 4: 37%
Tier 5: 25%
AARP MedicareRx Saver Plus (PDP)
S5921 – 361 – 0
by UnitedHealthcare
Monthly Premium: $40.00
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $7.00
Tier 3: $31.00
Tier 4: 40%
Tier 5: 25%
SilverScript Plus (PDP)
S5601 – 033 – 0
by Aetna Medicare
Monthly Premium: $52.20
Annual Deductable: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $0.00
Tier 2: $2.00
Tier 3: $47.00
Tier 4: 50%
Tier 5: 33%
Anthem MediBlue Rx Plus (PDP)
S5596 – 057 – 0
by Anthem MediBlue Rx (PDP)
Monthly Premium: $54.30
Annual Deductable: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $3.00
Tier 3: $43.00
Tier 4: 45%
Tier 5: 33%
Cigna Secure-Extra Rx (PDP)
S5617 – 261 – 0
by Cigna
Monthly Premium: $54.60
Annual Deductable: $100
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $4.00
Tier 2: $10.00
Tier 3: $42.00
Tier 4: 50%
Tier 5: 31%
Anthem MediBlue Rx Standard (PDP)
S5596 – 056 – 0
by Anthem MediBlue Rx (PDP)
Monthly Premium: $54.90
Annual Deductable: $320
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $2.00
Tier 3: $30.00
Tier 4: 35%
Tier 5: 25%
Humana Premier Rx Plan (PDP)
S5884 – 162 – 0
by Humana
Monthly Premium: $63.30
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $4.00
Tier 3: $45.00
Tier 4: 49%
Tier 5: 25%
WellCare Medicare Rx Value Plus (PDP)
S5768 – 139 – 0
by WellCare
Monthly Premium: $76.10
Annual Deductable: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $4.00
Tier 3: $47.00
Tier 4: 45%
Tier 5: 33%
WPS MedicareRx Plan 1 (PDP)
S5753 – 006 – 0
by WPS Health Insurance
Monthly Premium: $79.30
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $3.00
Tier 2: $15.00
Tier 3: $42.00
Tier 4: 49%
Tier 5: 25%
Express Scripts Medicare – Choice (PDP)
S5660 – 186 – 0
by Express Scripts Medicare
Monthly Premium: $80.80
Annual Deductable: $100
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $2.00
Tier 2: $7.00
Tier 3: $42.00
Tier 4: 50%
Tier 5: 31%
Mutual of Omaha Rx Plus (PDP)
S7126 – 015 – 0
by Mutual of Omaha Rx
Monthly Premium: $86.60
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $2.00
Tier 3: 20%
Tier 4: 37%
Tier 5: 25%
AARP MedicareRx Preferred (PDP)
S5820 – 015 – 0
by UnitedHealthcare
Monthly Premium: $92.80
Annual Deductable: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $5.00
Tier 2: $10.00
Tier 3: $45.00
Tier 4: 40%
Tier 5: 33%
WPS MedicareRx Plan 2 (PDP)
S5753 – 007 – 0
by WPS Health Insurance
Monthly Premium: $132.30
Annual Deductable: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $0.00
Tier 2: $11.00
Tier 3: $42.00
Tier 4: 45%
Tier 5: 33%

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