Coeur D Alene, Idaho Medicare Companies and Plans (2022)

Coeur D Alene, Idaho Medicare plans include Advantage plans from private health insurance companies as well as standalone Part D prescription drug coverage. For those that prefer original Medicare, Coeur D Alene, ID supplemental plans are also available. Medicare plans in Coeur D Alene, Idaho are sold by both large national companies and local insurers.

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The Highlights

  • Medicare Advantage plans in Coeur D Alene, Idaho may include prescription drug coverage, or you may need to buy Part D coverage separately
  • Medicare Advantage plans are available in Coeur D Alene with both PPO and HMO networks
  • You can buy Medicare supplement coverage in Coeur D Alene, Idaho if you have original Medicare and want coverage for out-of-pocket costs

If you’re eligible for Medicare in Coeur D Alene, Idaho, you have a lot of choices. Major health insurance companies provide Coeur D Alene, Idaho Medicare Advantage plans with a variety of coverage options to choose from. You can choose a plan that includes Coeur D Alene, ID Part D coverage or buy prescription coverage as a standalone policy.

Coeur D Alene, Idaho Medicare supplement plans are available from a number of companies if you choose to stick with original Medicare. These plans can pay for the out-of-pocket costs that Coeur D Alene original Medicare plans don’t cover, like coinsurance and deductibles.

Ready to buy Coeur D Alene, Idaho Medicare coverage? Enter your ZIP code to compare Coeur D Alene, ID Medicare options available to you right now.

Medicare Advantage Companies in Coeur D Alene, Idaho

Medicare Advantage in Coeur D Alene, Idaho is offered by some of the same local health insurance companies you may have been covered by before. Take a look at which companies in Coeur D Alene, ID offer Medicare Advantage as well as which plans they offer to find the coverage and provider network that’s best for you.

Medicare Advantage Companies in Coeur D Alene, Idaho

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 Patriot (HMO) – H4604-019-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $5,400
AARP Medicare Advantage Plan 1 (HMO) – H4604-013-0 $49.00 $195 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $45.00, Non-Preferred Drug: $95.00, Specialty Tier: 29% $5,500
AARP Medicare Advantage Plan 2 (HMO) – H4604-020-0 $15.00 $295 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $10.00, Preferred Brand: $45.00, Non-Preferred Drug: $95.00, Specialty Tier: 27% $6,700
Aetna Medicare Choice Plan (PPO) – H9431-002-0 $48.00 $0 Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 33% $7,550
Humana Gold Plus H5619-078 (HMO) – H5619-078-0 $59.00 $320 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $4.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 27% $6,000
Humana Honor (PPO) – H5216-046-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $5,000
HumanaChoice H5216-044 (PPO) – H5216-044-0 $29.00 $200 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $4.00, Generic: $15.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 29% $6,000
Molina Medicare Complete Care (HMO D-SNP) – H5628-008-0 $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 Preferred Generic: 25%, Generic: 25%, Preferred Brand: 25%, Non-Preferred Drug: 25%, Specialty Tier: 25% n/a
PacificSource Medicare Explorer 12 (PPO) – H4754-012-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $3,500
PacificSource Medicare Explorer Rx 11 (PPO) – H4754-011-0 $45.00 $150 . Tier 1 and 2 exempt Yes, some additional gap coverage. Preferred Generic: $3.00, Generic: $12.00, Preferred Brand: $37.00, Non-Preferred Drug: 31%, Specialty Tier: 30%, Select Care Drugs: $0.00 $6,700
Regence MedAdvantage + Rx Classic (PPO) – H1304-012-2 $87.00 $200 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $13.00, Preferred Brand: $40.00, Non-Preferred Drug: 40%, Specialty Tier: 29% $5,500
Regence MedAdvantage + Rx Enhanced (PPO) – H1304-004-0 $148.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $8.00, Preferred Brand: $40.00, Non-Preferred Drug: 40%, Specialty Tier: 33% $5,000
Regence MedAdvantage + Rx Primary (PPO) – H1304-011-2 $48.00 $200 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $13.00, Preferred Brand: $40.00, Non-Preferred Drug: 40%, Specialty Tier: 29% $5,500
Regence Valiance (PPO) – H1304-001-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $5,900
Secure Blue no Rx (PPO) – H1302-004-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $3,400
True Blue Rx (HMO) – H1350-019-1 $59.00 $125 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $5.00, Generic: $15.00, Preferred Brand: $37.00, Non-Preferred Brand: $90.00, Specialty Tier: 30% $6,200
True Blue Rx Gem (HMO) – H1350-024-3 $23.00 $190 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $10.00, Preferred Brand: $37.00, Non-Preferred Brand: $90.00, Specialty Tier: 29% $6,200
True Blue Rx Option I (HMO) – H1350-015-1 $146.00 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $12.00, Preferred Brand: $35.00, Non-Preferred Drug: $85.00, Specialty Tier: 33% $6,500
True Blue Rx Option II (HMO) – H1350-016-1 $105.00 $250 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $5.00, Generic: $15.00, Preferred Brand: $37.00, Non-Preferred Drug: $90.00, Specialty Tier: 28% $6,400
True Blue Special Needs Plan (HMO D-SNP) – H1350-009-0 $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, Tier 2: $0.00, Tier 3: $0.00, Tier 4: $0.00, Tier 5: $0.00 n/a
True Blue Special Needs Plan (HMO D-SNP) – H1350-025-0 $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, Tier 2: $0.00, Tier 3: $0.00, Tier 4: $0.00, Tier 5: $0.00 n/a
True Blue no Rx (HMO) – H1350-006-0 $29.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $3,000
UnitedHealthcare Nursing Home Plan (PPO I-SNP) – H0710-031-0 $36.00 $445 No additional gap coverage, only the Donut Hole Discount Tier 1: 25%, Tier 2: 25%, Tier 3: 25%, Tier 4: 25%, Tier 5: 25% n/a

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Medicare Supplement Companies in Coeur D Alene, Idaho

Original Medicare leaves you with some out-of-pocket costs such as deductibles and coinsurance. With a Coeur D Alene, Idaho Medicare supplement plan, you can get coverage for some or all of those costs. Medicare supplement plans in Idaho are standardized, but companies can choose which plans they will sell. Take a look at which companies sell Medicare supplement (Medigap) insurance and which plans they offer.

Medicare Supplement Companies in Coeur D Alene, Idaho

Company Plans
AARP – UnitedHealthcare Insurance Company (Level 2) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
AARP – UnitedHealthcare Insurance Company (Standard) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
Accendo Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Aetna Health and Life Insurance Company Medigap Plan A,
Medigap Plan B,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
Blue Cross of Idaho Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan N
Central States Health and Life Co. of Omaha Medigap Plan A,
Medigap Plan C,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Cigna Health & Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
Colonial Penn Life Insurance Company Medigap Plan A,
Medigap Plan B,
Medigap Plan D,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan M,
Medigap Plan N
Colonial Penn Life Insurance Company (Substandard) Medigap Plan A,
Medigap Plan B,
Medigap Plan D,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan M,
Medigap Plan N
Equitable Life & Casualty Insurance Company (Std Prem) Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Equitable Life & Casualty Insurance Company (Ult Prem) Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Everence Association Inc. Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Federal Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
GPM Health and Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Garden State Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan M,
Medigap Plan N
Globe Life and Accident Insurance Company (Direct to Consumer) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Great Southern Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
Great Southern Life Insurance Company (Class 1) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
Guarantee Trust Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Humana (Humana Insurance Company) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
Humana (Humana Insurance Company) (Household) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
Humana Value (HumanaDental Insurance Company) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan N
Humana Value (HumanaDental Insurance Company) (Household) Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan N
Manhattan Life Assurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Mountain Health Co-Op Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
National Health Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan N
Omaha Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Oxford Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Philadelphia American Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Puritan Life Insurance Company of America Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Regence BlueCross BlueShield of Idaho Medigap Plan A,
Medigap Plan C,
Medigap Plan G,
Medigap Plan K,
Medigap Plan N
Sentinel Security Life Insurance Company Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F
State Farm Mutual Automobile Insurance Company Medigap Plan A,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Transamerica Life Insurance Company (Direct) Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan G,
Medigap Plan K,
Medigap Plan L,
Medigap Plan M,
Medigap Plan N
USAA Life Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
Union Security Insurance Company Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
United American Insurance Company Medigap Plan A,
Medigap Plan B,
Medigap Plan C,
Medigap Plan D,
Medigap Plan F,
Medigap Plan F-high deductible,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan K,
Medigap Plan L,
Medigap Plan N
United Commercial Travelers of America Medigap Plan A,
Medigap Plan F,
Medigap Plan G,
Medigap Plan N
United Insurance Company of America Medigap Plan A,
Medigap Plan D,
Medigap Plan F,
Medigap Plan G,
Medigap Plan G-high deductible,
Medigap Plan N
Regence BlueCross BlueShield of Idaho (Modified) Medigap Plan F

Coeur D Alene, Idaho Standard Medicare Plan Coverage

Wondering what’s covered by each of the standard Idaho Medicare supplement plans? Take a look at all of the Coeur D Alene, Idaho Medicare supplement plans with coverage details.

Coeur D Alene, Idaho Standard Medicare Plan Coverage

Plan Name Monthly Cost Copays Coinsurance Deductibles Plan Benefits
Medigap Plan A Premiums range from $91-$405 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: No
Part A deductible: No
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: No
Medigap Plan B Premiums range from $137-$419 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services $0 Hospital (Part A) deductible,
$203 Medical (Part B) deductible
Skilled nursing facility: No
Part A deductible: Yes
Part B deductible: No
Part B excess charges: No
Foreign travel emergency: No
Medigap Plan C Premiums range from $162-$520 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services $0 Hospital (Part A) deductible,
$0 Medical (Part B) deductible
Skilled nursing facility: Yes
Part A deductible: Yes
Part B deductible: Yes
Part B excess charges: No
Foreign travel emergency: Yes
Medigap Plan D Premiums range from $134-$590 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services $0 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: Yes
Medigap Plan F Premiums range from $153-$617 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services $0 Hospital (Part A) deductible,
$0 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
Medigap Plan F-high deductible Premiums range from $38-$162 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services after you pay $2,370 deductible $2,370 total plan deductible.
After, you pay: $0 Hospital (Part A) deductible,
$0 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
Medigap Plan G Premiums range from $121-$492 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services $0 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: Yes
Foreign travel emergency: Yes
Medigap Plan G-high deductible Premiums range from $38-$158 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services after you pay $2,370 deductible $2,370 total plan deductible.
After, you pay: $0 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: Yes
Foreign travel emergency: Yes
Medigap Plan K Premiums range from $61-$282 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 Plan L Premiums range from $97-$355 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 Plan M Premiums range from $119-$441 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services $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: Yes
Medigap Plan N Premiums range from $97-$418 depending on your age, sex, health status, and when you buy. $0 Generally your cost for approved Part B services with some $20 and $50 copays $0 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: Yes

Standalone Medicare Part D Plans in Coeur D Alene, Idaho

Prescription drug coverage for Medicare in Coeur D Alene, Idaho is covered by a Part D plan. You can purchase Part D coverage in Coeur D Alene, Idaho as a standalone plan if it’s not included in your Medicare Advantage coverage. Take a look at the options for standalone Part D plans here.

Standalone Medicare Part D Plans in Coeur D Alene, Idaho

Plan Details Tiers
SilverScript SmartRx (PDP)
S5601 – 206 – 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: 49%
Tier 5: 25%
Clear Spring Health Premier Rx (PDP)
S6946 – 055 – 0
by Clear Spring Health
Monthly Premium: $15.00
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: 45%
Tier 5: 25%
WellCare Wellness Rx (PDP)
S4802 – 200 – 0
by WellCare
Monthly Premium: $15.80
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $5.00
Tier 3: $40.00
Tier 4: 46%
Tier 5: 25%
Humana Walmart Value Rx Plan (PDP)
S5884 – 210 – 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%
WellCare Value Script (PDP)
S4802 – 162 – 0
by WellCare
Monthly Premium: $17.70
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: $43.00
Tier 4: 47%
Tier 5: 25%
WellCare Medicare Rx Select (PDP)
S5810 – 307 – 0
by WellCare
Monthly Premium: $22.80
Annual Deductable: $425
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: 25%
Cigna Secure-Essential Rx (PDP)
S5617 – 310 – 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: 44%
Tier 5: 25%
Express Scripts Medicare – Saver (PDP)
S5660 – 247 – 0
by Express Scripts Medicare
Monthly Premium: $24.30
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%
Mutual of Omaha Rx Premier (PDP)
S7126 – 100 – 0
by Mutual of Omaha Rx
Monthly Premium: $24.80
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: 44%
Tier 5: 25%
Clear Spring Health Value Rx (PDP)
S6946 – 026 – 0
by Clear Spring Health
Monthly Premium: $30.90
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%
WellCare Classic (PDP)
S4802 – 021 – 0
by WellCare
Monthly Premium: $33.00
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 – 062 – 0
by Aetna Medicare
Monthly Premium: $34.30
Annual Deductable: $250
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: 43%
Tier 5: 28%
Express Scripts Medicare – Value (PDP)
S5660 – 133 – 0
by Express Scripts Medicare
Monthly Premium: $34.70
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $8.00
Tier 3: $34.00
Tier 4: 46%
Tier 5: 25%
Elixir RxPlus (PDP)
S7694 – 031 – 0
by Elixir Insurance
Monthly Premium: $35.50
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: 15%
Tier 4: 28%
Tier 5: 25%
AARP MedicareRx Saver Plus (PDP)
S5921 – 375 – 0
by UnitedHealthcare
Monthly Premium: $36.10
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: $35.00
Tier 4: 40%
Tier 5: 25%
WellCare Medicare Rx Saver (PDP)
S5810 – 065 – 0
by WellCare
Monthly Premium: $36.50
Annual Deductable: $445
Zero Premium If Full LIS Benefits: Yes
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $3.00
Tier 3: $39.00
Tier 4: 35%
Tier 5: 25%
Humana Basic Rx Plan (PDP)
S5884 – 147 – 0
by Humana
Monthly Premium: $36.70
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%
Cigna Secure Rx (PDP)
S5617 – 153 – 0
by Cigna
Monthly Premium: $37.70
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: $38.00
Tier 4: 50%
Tier 5: 25%
AARP MedicareRx Walgreens (PDP)
S5921 – 412 – 0
by UnitedHealthcare
Monthly Premium: $39.60
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-Extra Rx (PDP)
S5617 – 276 – 0
by Cigna
Monthly Premium: $48.60
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%
Humana Premier Rx Plan (PDP)
S5884 – 177 – 0
by Humana
Monthly Premium: $62.80
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%
SilverScript Plus (PDP)
S5601 – 063 – 0
by Aetna Medicare
Monthly Premium: $67.50
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%
WellCare Medicare Rx Value Plus (PDP)
S5768 – 154 – 0
by WellCare
Monthly Premium: $76.00
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: 49%
Tier 5: 33%
Express Scripts Medicare – Choice (PDP)
S5660 – 216 – 0
by Express Scripts Medicare
Monthly Premium: $76.70
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: 49%
Tier 5: 31%
Mutual of Omaha Rx Plus (PDP)
S7126 – 030 – 0
by Mutual of Omaha Rx
Monthly Premium: $79.70
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: 35%
Tier 5: 25%
Regence Medicare Script Basic (PDP)
S5916 – 001 – 0
by Regence BlueShield of Idaho
Monthly Premium: $93.50
Annual Deductable: $300
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $3.00
Tier 2: $10.00
Tier 3: $40.00
Tier 4: 30%
Tier 5: 27%
AARP MedicareRx Preferred (PDP)
S5820 – 030 – 0
by UnitedHealthcare
Monthly Premium: $95.50
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%
Regence Medicare Script Enhanced (PDP)
S5916 – 002 – 0
by Regence BlueShield of Idaho
Monthly Premium: $123.50
Annual Deductable: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $3.00
Tier 2: $10.00
Tier 3: $47.00
Tier 4: 40%
Tier 5: 33%

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