Rochester, Minnesota Medicare Companies and Plans (2022)

Rochester, Minnesota 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, Rochester, MN supplemental plans are also available. Medicare plans in Rochester, Minnesota are sold by both large national companies and local insurers.

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The Highlights

  • Rochester, MN Medicare options include Advantage, standalone Part D, and Medicare supplement
  • Options for Medicare supplement in Rochester, Minnesota include Medigap 50% Cost Sharing Plan and Medigap High Deductible Plan
  • You can buy Medicare supplement coverage in Rochester, Minnesota if you have original Medicare and want coverage for out-of-pocket costs

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

Rochester, Minnesota 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 Rochester original Medicare plans don’t cover, like coinsurance and deductibles.

Ready to buy Rochester, Minnesota Medicare coverage? Enter your ZIP code to compare Rochester, MN Medicare options available to you right now.

Medicare Advantage Companies in Rochester, Minnesota

Medicare Advantage in Rochester, Minnesota 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 Rochester, MN 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 Rochester, Minnesota

Plan Name Monthly Prem. (Parts C & D) Deductible Additional Gap Coverage Preferred Pharmacy Copay/ Coinsurance 30-Day Supply MOOP for Part A & B Benefits
Blue Cross Medicare Advantage Choice (PPO) – H5959-009-0 $119.50 $300 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $37.00, Non-Preferred Drug: 45%, Specialty Tier: 27% $3,100
Blue Cross Medicare Advantage Choice MA Only (PPO) – H5959-008-0 $14.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $4,900
Blue Cross Medicare Advantage Complete (PPO) – H5959-011-0 $187.20 $0 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $9.00, Preferred Brand: $37.00, Non-Preferred Drug: 45%, Specialty Tier: 33% $2,700
Blue Cross Medicare Advantage Core (PPO) – H5959-012-0 $38.40 $445 . Tier 1 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $13.00, Preferred Brand: 21%, Non-Preferred Drug: 45%, Specialty Tier: 25% $6,700
Humana Gold Choice H8145-089 (PFFS) – H8145-089-0 $95.00 $415 No additional gap coverage, only the Donut Hole Discount Preferred Generic: $5.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: $100.00, Specialty Tier: 25% n/a
Humana Honor (PPO) – H5216-086-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $6,700
HumanaChoice H5216-080 (PPO) – H5216-080-2 $174.00 $350 . Tier 1, 2 and 3 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: 26% $6,700
HumanaChoice H5216-092 (PPO) – H5216-092-0 $38.00 $350 . 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: 50%, Specialty Tier: 26% $6,700
Lasso Healthcare Growth (MSA) – H1924-001-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. n/a
Lasso Healthcare Growth Plus (MSA) – H1924-004-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. n/a
Medica Advantage Solution H8889-004 (PPO) – H8889-004-0 $120.00 $445 . Tier 1 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $5.00, Generic: $12.00, Preferred Brand: $47.00, Non-Preferred Drug: 50%, Specialty Tier: 25% $7,550
Medica DUAL Solution (HMO D-SNP) – H2458-002-0 $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: $0.00 n/a
SecureBlue (HMO D-SNP) – H2425-001-0 $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 Tier 1: $0.00 n/a
UCare Classic (HMO-POS) – H2459-021-3 $217.00 $225 . Tier 1 and 2 exempt Yes, some additional gap coverage. Preferred Generic: $0.00, Generic: $7.00, Preferred Brand: $35.00, Non-Preferred Drug: 45%, Specialty Tier: 29% $4,000
UCare Complete (HMO-POS) – H2459-026-4 $129.00 $235 . Tier 1 and 2 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $0.00, Generic: $10.00, Preferred Brand: $47.00, Non-Preferred Drug: 45%, Specialty Tier: 28% $5,000
UCare Connect + Medicare (HMO D-SNP) – H5937-001-0 $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 Tier 1: $0.00 n/a
UCare Prime (HMO-POS) – H2459-028-0 $0.00 $445 . Tier 1 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: 20%, Preferred Brand: 20%, Non-Preferred Drug: 45%, Specialty Tier: 25% $7,000
UCare Standard (HMO-POS) – H2459-024-0 $79.00 $445 . Tier 1 exempt No additional gap coverage, only the Donut Hole Discount Preferred Generic: $3.00, Generic: $10.00, Preferred Brand: 17%, Non-Preferred Drug: 45%, Specialty Tier: 25% $6,000
UCare Value (HMO-POS) – H2459-001-0 $29.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $3,400
UCare Value Plus (HMO-POS) – H2459-030-0 $0.00 No Rx Coverage No Rx Coverage This Plan does NOT include Prescription Drug coverage. $5,500
UCare’s Minnesota Senior Health Options (HMO D-SNP) – H2456-002-0 $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: $0.00 n/a

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Medicare Supplement Companies in Rochester, Minnesota

Original Medicare leaves you with some out-of-pocket costs such as deductibles and coinsurance. With a Rochester, Minnesota Medicare supplement plan, you can get coverage for some or all of those costs. Medicare supplement plans in Minnesota 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 Rochester, Minnesota

Company Plans
Americo Financial Life and Annuity Insurance Company Medigap $20 & $50 Copay Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new
BlueCross BlueShield of Minnesota Medigap $20 & $50 Copay Plan,
Medigap 50% Cost Sharing Plan,
Medigap 75% Cost Sharing Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new,
Medigap High Deductible Plan,
Medigap High Deductible Plan-new
BlueCross BlueShield of Minnesota (Eligible Before 1-1-20) Medigap $20 & $50 Copay Plan,
Medigap 50% Cost Sharing Plan,
Medigap 75% Cost Sharing Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new,
Medigap High Deductible Plan,
Medigap High Deductible Plan-new
Catholic United Financial Medigap $20 & $50 Copay Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan
Cigna Health & Life Insurance Company Medigap $20 & $50 Copay Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new,
Medigap High Deductible Plan
Colonial Penn Life Insurance Company Medigap $20 & $50 Copay Plan,
Medigap 75% Cost Sharing Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new,
Medigap High Deductible Plan,
Medigap High Deductible Plan-new
Continental Life Insurance Company of Brentwood, Tennessee (Aetna) Medigap $20 & $50 Copay Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new,
Medigap High Deductible Plan,
Medigap High Deductible Plan-new
Health Partners Plans, Inc. Medigap $20 & $50 Copay Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan
Health Partners Plans, Inc. (Eligible Before 1-1-20) Medigap $20 & $50 Copay Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan
Humana (Humana Insurance Company) Medigap $20 & $50 Copay Plan,
Medigap 50% Cost Sharing Plan,
Medigap 75% Cost Sharing Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap High Deductible Plan
Lumico Life Insurance Company Medigap $20 & $50 Copay Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new,
Medigap High Deductible Plan
Medica Health Plans Medigap $20 & $50 Copay Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new,
Medigap High Deductible Plan
National Guardian Life Insurance Company Medigap $20 & $50 Copay Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new
National Health Insurance Company Medigap $20 & $50 Copay Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new,
Medigap High Deductible Plan
Puritan Life Insurance Company of America Medigap $20 & $50 Copay Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new,
Medigap High Deductible Plan,
Medigap High Deductible Plan-new
Sanford Health Plan of Minnesota Medigap $20 & $50 Copay Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new,
Medigap High Deductible Plan
State Farm Mutual Automobile Insurance Company Medigap $20 & $50 Copay Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new
UCare Health, Inc. Medigap $20 & $50 Copay Plan,
Medigap Basic Plan,
Medigap Extended Basic Plan
AARP – UnitedHealthcare Insurance Company (Standard) Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new
AARP – UnitedHealthcare Insurance Company (Standard/Household) Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new
Omaha Insurance Company Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new
Transamerica Life Insurance Company (Direct) Medigap Basic Plan,
Medigap Extended Basic Plan,
Medigap Extended Basic Plan-new

Rochester, Minnesota Standard Medicare Plan Coverage

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

Rochester, Minnesota Standard Medicare Plan Coverage

Plan Name Monthly Cost Copays Coinsurance Deductibles Plan Benefits
Medigap $20 & $50 Copay Plan Premiums range from $152-$344 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
Medigap 50% Cost Sharing Plan Premiums range from $132-$173 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 75% Cost Sharing Plan Premiums range from $185-$259 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 Basic Plan Premiums range from $142-$342 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: Yes
Medigap Extended Basic Plan Premiums range from $217-$756 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 Extended Basic Plan-new Premiums range from $200-$605 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 High Deductible Plan Premiums range from $63-$195 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: No
Foreign travel emergency: Yes
Medigap High Deductible Plan-new Premiums range from $67-$107 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: No
Foreign travel emergency: Yes

Standalone Medicare Part D Plans in Rochester, Minnesota

Prescription drug coverage for Medicare in Rochester, Minnesota is covered by a Part D plan. You can purchase Part D coverage in Rochester, Minnesota 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 Rochester, Minnesota

Plan Details Tiers
SilverScript SmartRx (PDP)
S5601 – 200 – 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 – 051 – 0
by Clear Spring Health
Monthly Premium: $14.30
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 – 194 – 0
by WellCare
Monthly Premium: $15.30
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $0.00
Tier 2: $4.00
Tier 3: $40.00
Tier 4: 47%
Tier 5: 25%
WellCare Value Script (PDP)
S4802 – 158 – 0
by WellCare
Monthly Premium: $15.70
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%
Humana Walmart Value Rx Plan (PDP)
S5884 – 204 – 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: 16%
Tier 4: 35%
Tier 5: 25%
Cigna Secure-Essential Rx (PDP)
S5617 – 304 – 0
by Cigna
Monthly Premium: $22.90
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: 50%
Tier 5: 25%
Mutual of Omaha Rx Premier (PDP)
S7126 – 094 – 0
by Mutual of Omaha Rx
Monthly Premium: $23.00
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%
WellCare Medicare Rx Select (PDP)
S5810 – 302 – 0
by WellCare
Monthly Premium: $23.40
Annual Deductable: $445
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%
Express Scripts Medicare – Saver (PDP)
S5660 – 241 – 0
by Express Scripts Medicare
Monthly Premium: $25.20
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%
WellCare Classic (PDP)
S4802 – 089 – 0
by WellCare
Monthly Premium: $28.20
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: $31.00
Tier 4: 33%
Tier 5: 25%
Clear Spring Health Value Rx (PDP)
S6946 – 022 – 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%
AARP MedicareRx Saver Plus (PDP)
S5921 – 370 – 0
by UnitedHealthcare
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: $6.00
Tier 3: $34.00
Tier 4: 40%
Tier 5: 25%
Cigna Secure Rx (PDP)
S5617 – 123 – 0
by Cigna
Monthly Premium: $33.70
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: $30.00
Tier 4: 50%
Tier 5: 25%
SilverScript Choice (PDP)
S5601 – 050 – 0
by Aetna Medicare
Monthly Premium: $33.90
Annual Deductable: $240
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: 46%
Tier 5: 28%
Humana Basic Rx Plan (PDP)
S5884 – 145 – 0
by Humana
Monthly Premium: $34.90
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: 31%
Tier 5: 25%
AARP MedicareRx Walgreens (PDP)
S5921 – 406 – 0
by UnitedHealthcare
Monthly Premium: $35.60
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%
WellCare Medicare Rx Saver (PDP)
S5810 – 059 – 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: $33.00
Tier 4: 39%
Tier 5: 25%
Cigna Secure-Extra Rx (PDP)
S5617 – 270 – 0
by Cigna
Monthly Premium: $49.20
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%
Express Scripts Medicare – Value (PDP)
S5660 – 127 – 0
by Express Scripts Medicare
Monthly Premium: $49.70
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: $41.00
Tier 4: 50%
Tier 5: 25%
Elixir RxPlus (PDP)
S7694 – 025 – 0
by Elixir Insurance
Monthly Premium: $54.90
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $7.00
Tier 3: 15%
Tier 4: 33%
Tier 5: 25%
Humana Premier Rx Plan (PDP)
S5884 – 171 – 0
by Humana
Monthly Premium: $60.80
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%
MedicareBlue Rx Standard (PDP)
S5743 – 001 – 0
by Wellmark Blue Cross and Blue Shield of Iowa
Monthly Premium: $66.40
Annual Deductable: $445
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: No
Tier 1: $1.00
Tier 2: $7.00
Tier 3: $29.00
Tier 4: 31%
Tier 5: 25%
SilverScript Plus (PDP)
S5601 – 051 – 0
by Aetna Medicare
Monthly Premium: $70.20
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%
Mutual of Omaha Rx Plus (PDP)
S7126 – 024 – 0
by Mutual of Omaha Rx
Monthly Premium: $75.10
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%
WellCare Medicare Rx Value Plus (PDP)
S5768 – 148 – 0
by WellCare
Monthly Premium: $76.70
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: 50%
Tier 5: 33%
Express Scripts Medicare – Choice (PDP)
S5660 – 195 – 0
by Express Scripts Medicare
Monthly Premium: $81.00
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%
AARP MedicareRx Preferred (PDP)
S5820 – 024 – 0
by UnitedHealthcare
Monthly Premium: $86.50
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%
MedicareBlue Rx Premier (PDP)
S5743 – 004 – 0
by Wellmark Blue Cross and Blue Shield of Iowa
Monthly Premium: $104.70
Annual Deductable: $0
Zero Premium If Full LIS Benefits: No
ICL: $4,130
Additional Gap Coverage: Yes
Tier 1: $0.00
Tier 2: $0.00
Tier 3: 17%
Tier 4: 40%
Tier 5: 33%

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