Medicare 2020

Medicare Advantage: Health plans with drug coverage

What’s in the chart

Type: This chart shows three types of health plans with drug coverage: HMO, PPO and HMO-POS. They are explained below.

Premium: The monthly charge for the plan. This is in addition to the standard Part B premium most beneficiaries pay to Medicare, which this year is projected to be $144.30.

Part B reduction: Some plans pay part of your monthly Part B premium. This “premium reduction,” also called a rebate or a “premium give back,” is considered an additional benefit offered by a plan. It’s usually returned to consumers as part of their monthly Social Security check. The chart indicates whether or not a plan offers a premium reduction. Since reductions can differ based on each beneficiary’s situation, you will need to contact the insurer for the amount.

Drug deductible: In some plans, you pay a deductible before drug coverage kicks in. A drug deductible might not apply to all drugs or tiers.

Doctor copay: This is your cost every time you see a doctor. The first dollar figure is for primary care physicians; the second is for specialists. Costs are listed for physicians inside the network (Net) and outside the network (Out).

Hospital copay: This is your cost for each inpatient hospital admission — both inside the network (Net) and outside the network (Out). For outpatient hospital coverage, refer to Medicare’s Plan Finder.

Yearly cost (Est.): Medicare’s estimate of your out-of-pocket costs under this plan, including your Part B premium and drugs. It is based on an average person in good health, but could vary greatly depending on the actual drugs and services you need. The best way to project costs is with Medicare’s Plan Finder.

Out-of-pocket cap: Your maximum payment for the year inside the network (Net) and outside the network (Out). The lower the cap the better.

IMPORTANT: These out-of-pocket limits do not apply to your prescription drug costs.

Generics in the gap: Whether a plan pays for generic drugs in the coverage gap, or “donut hole,” which in 2020 will begin when total drug costs hit $4,020. You will exit the donut hole when your out-of-pocket costs reach $6,350.

Rating: Medicare rates plans from 1 to 5 stars, based on customer satisfaction and certain health measures. The top rating is a 5. People with Medicare can switch into a 5-star plan at any time during the year, even if it’s not during an enrollment period.

What’s not in the chart

Private Fee for Service Plans (PFFS) and Special Needs Plans (SNPs): See explanation below and medicare.gov for details.

Medicare supplement plans: Also known as Medigap, this coverage helps pay some of the health care costs that Original Medicare doesn’t cover. Go here to shop for these plans.

Copayments for other services: Plans usually charge copayments for drugs, skilled nursing homes, ambulances, emergency rooms and many other services. Check individual plans for these details.

Goodies: Some plans offer some dental, hearing and vision coverage, exercise classes, transportation to the doctor and other extra benefits. Check plans for details.

Health plans without drugs: A few plans are cheaper because they do not offer drug coverage. Unless you have comparable coverage elsewhere, using these plans can result in stiff penalties if you ever want Medicare drug coverage in later years.

Health plans: how they differ

Medicare allows several types of private health plans, which cover all your care. Here is how they differ:

HMO (Health Maintenance Organization): Generally requires you to use providers within a network. A personal physician usually coordinates your care and may need to approve visits to specialists.

PPO (Preferred Provider Organization): Encourages you to use providers within a network, with low copayments, but also allows you to use providers outside the network at a higher cost. Usually allows you to see specialists within the network without prior approval of a personal physician. Some bigger companies allow you to use their PPOs in other states. Verify before signing up.

HMO-POS (HMO-Point of Service): A hybrid between an HMO and PPO. Usually requires you to stay within a network and may require you to seek approval of a personal physician before seeing network specialists. It may cover some care outside the network. Some POS plans approve very little coverage outside the network, so check plans for details.

PFFS (Private Fee for Service): Has network, but also allows members to get care outside the network if the provider will accept the plan’s payment, which many do not. Make sure provider will accept payment before incurring bills.

Special Needs Plans: People with certain chronic conditions like diabetes and COPD can sometimes qualify for a Special Needs Plan, which may include extra services for managing their disease. Make sure you qualify before purchasing. People living in nursing homes may also qualify for special plans, as can people on Medicaid.

You can sort the table by clicking in the column header. Use any term in the search box below to filter your results.

PLAN TYPE COUNTIES SERVED PREM. PART B REDUCTION DRUG DEDUCT. DOCTOR COPAY (PER VISIT) HOSPITAL COPAY YEARLY COST (EST.) OUT-OF-POCKET CAP GENERICS IN GAP? RATINGS OUT OF 5 STARS
AARP Medicare Advantage
H1045-028
Contact: 800-555-5757
HMO-POS Her., Hills., Pasco, Pin. $0 No $0 Net: $0, $35
Out: No data available
Net: $250 daily for 8 days
Out: N/A
$3,834 Net: $4,900
Out: N/A
No ★★★★
AARP Medicare Advantage Choice
H2406-011
Contact: 800-555-5757
PPO Her., Hills., Pasco, Pin. $0 No $150 Net: $5, $35
Out: $45, $70
Net: $270 daily for 8 days
Out: 40%/stay
$3,918 Net: $5,500
In and Out of network: $10,000
No ★★★-1/2
AARP Medicare Advantage Choice Plan 2
R0759-001
Contact: 800-555-5757
PPO Her., Hills., Pasco, Pin. $0 No $395 Net: $10, $50
Out: $40, $70
Net: $395 daily for 4 days
Out:40%/stay
$4,422 Net: $6,700
In and Out of network: $10,000
No ★★★-1/2
AARP Medicare Advantage Focus
H1045-045
Contact: 800-555-5757
HMO-POS Hills., Pasco, Pin. $0 No $0 Net: $0, $20
Out: No data available
Net: $195 daily for 8 days
Out: N/A
$3,702 Net: $3,900
Out: N/A
Yes ★★★★
Acclaim by Ultimate
H2962-011
Contact: 855-858-7526
HMO Pin. $0 Yes $0 Net: $0, $20
Out: N/A
Net: $125 daily for 5 days
Out: N/A
$1,698 Net: $2,800
Out: N/A
Yes ★★★★
Acclaim Plus by Ultimate
H2962-012
Contact: 855-858-7526
HMO Pin. $0 No $0 Net: $0, $0
Out: N/A
Net: $25 daily for 5 days
Out: N/A
$2,610 Net: $1,500
Out: N/A
Yes ★★★★
Aetna Medicare Choice
H1609-028
Contact: 833-859-6031; TTY: 711
HMO-POS Hills., Pin. $0 No $195 Net: $0, $40
Out: N/A, $50
Net: $350 daily for 4 days
Out: 50%/stay
$3,930 Net: $6,700
In and Out of network: $10,000
Yes ★★★★-1/2
Aetna Medicare Premier
H5521-033
Contact: 833-859-6031; TTY: 711
PPO Her., Hills., Pasco, Pin. $0 No $300 Net: $15, $50
Out: $50, $50
Net: $395 daily for 4 days
Out: 50%/stay
$4,338 Net: $6,700
In and Out of network: $10,000
Yes ★★★★-1/2
Aetna Medicare Premier Plus
H5521-270
Contact: 833-859-6031; TTY: 711
PPO Her., Hills., Pasco, Pin. $0 No $150 Net: $0, $35
Out: $55, $70
Net: $295 daily for 4 days
Out: 50%/stay
$3,882 Net: $5,500
In and Out of network: $10,000
Yes ★★★★-1/2
Aetna Medicare Summit Select
H1609-034
Contact: 833-859-6031; TTY: 711
HMO Her., Hills., Pasco, Pin. $0 No $0 Net: $0, $25
Out: N/A
Net: $95 daily for 7 days
Out: N/A
$3,402 Net: $3,200
Out: N/A
Yes ★★★★-1/2
BayCarePlus Complete
H2235-001
Contact: 866-947-5820
HMO Hills., Pasco, Pin. $0 No $0 Net: $0, $35
Out: N/A
Net: $195 daily for 6 days
Out: N/A
$3,450 Net: $3,700
Out: N/A
No Too new to be measured
BayCarePlus Rewards
H2235-002
Contact: 866-947-5820
HMO Hills., Pasco, Pin. $0 Yes $0 Net: $0, $40
Out: N/A
Net: $250 daily for 6 days
Out: N/A
$2,466 Net: $5,300
Out: N/A
No Too new to be measured
BlueMedicare Choice
R3332-001
Contact: 844-296-9346; TTY 800-955-8770
PPO Her., Hills., Pasco, Pin. $47.90 No $250 Net: $10, $45
Out: 50%, 50%
Net: $295 daily for 5 days
Out: $495 daily for 27 days
$4,697 Net: $6,500
In and Out of network: $10,000
Yes ★★★-1/2
BlueMedicare Classic
H1035-021
Contact: 844-296-9346; TTY 800-955-8770
HMO Her., Hills., Pasco $0 No $0 Net: $0, $40
Out: N/A
Net: $225 daily for 7 days
Out: N/A
$3,558 Net: $5,000
Out: N/A
Yes ★★★★★
BlueMedicare Classic Plus
H1035-023
Contact: 844-296-9346; TTY 800-955-8770
HMO Hills. $0 No $0 Net: $0, $25
Out: N/A
Net: $150 daily for 7 days
Out: N/A
$2,898 Net: $2,500
Out: N/A
Yes ★★★★★
BlueMedicare Premier
H1035-034
Contact: 844-296-9346; TTY 800-955-8770
HMO Pin. $0 No $0 Net: $0, $20
Out: N/A
Net: $150 daily for 8 days
Out: N/A
$2,934 Net: $3,400
Out: N/A
Yes ★★★★★
BlueMedicare Saver
H1035-037
Contact: 844-296-9346; TTY 800-955-8770
HMO Hills., Pin. $0 Yes $50 Net: $0 ,$45
Out: N/A
Net: $275 daily for 7 days
Out: N/A
$3,366 Net: $6,700
Out: N/A
Yes ★★★★★
BlueMedicare Select
H5434-002
Contact: 844-296-9346; TTY 800-955-8770
PPO Hills., Pin. $145.50 No $305 Net: $5, $45
Out: 40%, 40%
Net: $225 daily for 7 days
Out: $200 daily for 27 days
$5,484 Net: $5,900
In and Out of network: $10,000
Yes ★★★-1/2
BlueMedicare Value
H5434-023
Contact: 844-296-9346; TTY 800-955-8770
PPO Pasco, Pin. $0 No $0 Net: $0-$10, $35-$45
Out: 50%, 50%
Net: $325 daily for 6 days
Out: 50%/stay
$4,002 Net: $4,500
In and Out of network: $10,000
Yes ★★★-1/2
Bright Advantage
H4709-003
Contact: 833-412-6731
HMO Pasco $0 No $0 Net: $0, $25
Out: N/A
Net: $250 daily for 7 days
Out: N/A
$3,642 Net: $3,400
Out: N/A
Yes Too new to be measured
Bright Advantage Flex
H3281-003
Contact: 833-412-6731
PPO Pasco $0 No $0 Net: $0, $30
Out: 40%, 40%
Net: $295 daily for 5 days
Out: 40%/day
$3,618 Net: $4,750
In and Out of network: $10,000
Yes Too new to be measured
CareFree
H1019-104
Contact: 800-794-4105
HMO Hills., Pasco, Pin. $0 Yes $0 Net: $0, $20
Out: N/A
Net: $150 daily for 4 days
Out: N/A
$1,998 Net: $2,500
Out: N/A
No ★★★★★
CareOne PLUS
H1019-103
Contact: 800-794-4105
HMO Hills., Pasco, Pin. $0 No $0* Net: $0, $10
Out: N/A
Net: $25 daily for 5 days
Out: N/A
$2,922 Net: $1,500
Out: N/A
Yes ★★★★★
Cigna-HealthSpring Preferred
H5410-029
Contact: 855-980-3041
HMO Her., Hills., Pasco, Pin. $0 No $0 Net: $0, $0
Out: N/A
Net: $195 daily for 6 days
Out: N/A
$3,246 Net: $3,400
Out: N/A
No ★★★★★
Cigna-HealthSpring Preferred Part B Savings
H5410-030
Contact: 855-980-3041
HMO Her., Hills., Pasco, Pin. $0 Yes $0 Net: $0, $20
Out: N/A
Net: $250 daliy for 6 days
Out: N/A
$2,862 Net: $4,900
Out: N/A
No ★★★★★
Cigna-HealthSpring Primary
H5410-035
Contact: 855-980-3041
HMO Her., Hills., Pasco, Pin. $10.30 No $435 Net: $0, $0
Out: N/A
Net: $500/stay
Out: N/A
$3,526 Net: $3,400
Out: N/A
No ★★★★★
Devoted Health Essentials Greater Tampa Bay
H1290-016
Contact: 800-376-5889
HMO Hills., Pin. $0 Yes $0 Net: $0, $20
Out: N/A
Net: $150 daily for 5 days
Out: N/A
$2,238 Net: $3,400
Out: N/A
No Too new to be measured
Devoted Health Greater Tampa Bay
H1290-004
Contact: 800-376-5889
HMO Hills., Pin. $0 No $0 Net: $0, $10
Out: N/A
Net: $50 daily for 7 days
Out: N/A
$3,078 Net: $2,400
Out: N/A
Yes Too new to be measured
Devoted Health Prime Greater Tampa Bay
H1290-009
Contact: 800-376-5889
HMO Hills., Pin. $28.50 No $435 Net: $0, $0
Out: N/A
Net: $0, $0
Out: N/A
$3,480 Net: $3,400
Out: N/A
No Too new to be measured
Elite by Ultimate
H2962-013
Contact: 855-858-7526
HMO Pasco $0 Yes $0 Net: $0, $20
Out: N/A
Net: $125 daily for 5 days
Out: N/A
$1,698 Net: $2,800
Out: N/A
Yes ★★★★
Freedom Medicare Plan Rx
H5427-060
Contact: 800-401-2740
HMO Hills., Pasco, Pin. $0 No $0 Net: $0, $35
Out: N/A
Net: $150 daily for 7 days
Out: N/A
$3,558 Net: $3,400
Out: N/A
Yes ★★★★-1/2
Humana Choice R5826-005
R5826-005
Contact: 855-795-9488
PPO Her., Hills., Pasco, Pin. $101 No $100 Net: $5, $45
Out: $65, $65
Net: $250 daily for 7 days
Out: 40%/stay
$5,310 Net: $6,700
In and Out of network: $10,000
No ★★★
Humana Choice R5826-074
R5826-074
Contact: 800-833-2364
PPO Her., Hills., Pasco, Pin. $0 No $395 Net: $25, $50
Out: 50%, 50%
Net: $625 daily for 3 days
Out: $725 daily for 14 days
$4,710 Net: $6,700
In and Out of network: $10,000
No ★★★
Humana Choice Florida H5216-072
H5216-072
Contact: 800-833-2364
PPO Her., Hills., Pasco, Pin. $0 No $150 Net: $5, $40
Out: $65, $65
Net: $345 daily for 4 days
Out: $495 daily for 27 days
$4,110 Net: $4,900
In and Out of network: $10,000
No ★★★★
Humana Gold Plus H1036-025
H1036-025
Contact: 800-833-2364
HMO Her., Hills., Pasco, Pin. $0 No $0 Net: $0, $10
Out: N/A
Net: $40 daily for 5 days
Out: N/A
$2,862 Net: $1,900
Out: N/A
Yes ★★★★-1/2
Humana Gold Plus H1036-265
H1036-265
Contact: 800-833-2364
HMO Her., Hills., Pasco, Pin. $0 Yes $0 Net: $0, $25
Out: N/A
Net: $150 daily for 8 days
Out: N/A
$2,154 Net: $2,750
Out: N/A
No ★★★★-1/2
Optimum Gold Plus Plan
H5594-032
Contact: 866-245-5360
HMO Her. $0 Yes $0 Net: $0, $20
Out: N/A
Net: $150 daily for 7 days
Out: N/A
$1,914 Net: $2,500
Out: N/A
Yes ★★★★-1/2
Optimum Gold Rewards Plan
H5594-001
Contact: 866-245-5360
HMO Her., Hills., Pasco, Pin. $0 Yes $0 Net: $0, $20
Out: N/A
Net: $150 daily for 7 days
Out: N/A
$1,998 Net: $2,500
Out: N/A
Yes ★★★★-1/2
Optimum Platinum Plan
H5594-002
Contact: 866-245-5360
HMO Her., Hills., Pasco, Pin. $0 No $0 Net: $0, $5
Out: N/A
Net: $0
Out: N/A
$2,982 Net: $1,500
Out: N/A
Yes ★★★★-1/2
Premier by Ultimate
H2962-001
Contact: 855-858-7526
HMO Her. $0 Yes $0 Net: $0, $20
Out: N/A
Net: $125 daily for 5 days
Out: N/A
$1,698 Net: $2,800
Out: N/A
Yes ★★★★
Premier Plus by Ultimate
H2962-014
Contact: 855-858-7526
HMO Her., Pasco $0 No $0 Net: $0, $0
Out: N/A
Net: $25 daily for 5 days
Out: N/A
$2,610 Net: $1,500
Out: N/A
Yes ★★★★
Simply More
H5471-078
Contact: 888-870-7138
HMO Her., Hills., Pasco, Pin. $0 No $0 Net: $0, $10
Out: N/A
Net: $50 daily for 8 days
Out: N/A
$2,586 Net: $3,400
Out: N/A
Yes ★★★★
Simply Select
H5471-099
Contact: 888-870-7138
HMO Her., Hills., Pasco, Pin. $28.50 No $435 Net: $0, $5
Out: N/A
Net: $25 daily for 8 days
Out: N/A
$3,084 Net: $3,400
Out: N/A
Yes ★★★★
SOLIS SPF 009
H0982-009
Contact: 844-447-6547
HMO Hills. $0 No $0 Net: $0, $5
Out: N/A
Net: $100 daily for 7 days
Out: N/A
$3,390 Net: $3,400
Out: N/A
Yes Too new to be measured
WellCare Dividend
H1032-032
Contact: 866-527-0056
HMO Her., Hills., Pasco, Pin. $0 Yes $0 Net: $0, $40
Out: N/A
Net: $200 daily for 7 days
Out: N/A
$2,646 Net: $6,700
Out: N/A
Yes ★★★★
WellCare Dividend Prime
H1032-200
Contact: 866-527-0056
HMO Her., Hills., Pasco, Pin. $0 Yes $0 Net: $0, $40
Out: N/A
Net: $200 daily for 5 days
Out: N/A
$2,370 Net: $3,400
Out: N/A
Yes ★★★★
WellCare Elite
H1032-201
Contact: 866-527-0056
HMO Her., Hills., Pasco, Pin. $0 No $0 Net: $0, $5
Out: N/A
Net: $150 daily for 10 days
Out: N/A
$3,174 Net: $3,400
Out: N/A
Yes ★★★★
WellCare Essential
H1032-174
Contact: 866-527-0056
HMO-POS Her., Hills., Pasco, Pin. $0 No $0 Net: $0, $30
Out: 45%, 45%
Net: $150 daily for 10 days
Out: 45%/stay
$3,618 Net: $6,700
Out: $6,700
Yes ★★★★
WellCare Premier
H5199-012
Contact: 866-527-0056
PPO Her., Hills., Pasco $0 No $100 Net: $0, $35
Out: $0, $0-$300
Net: $275 daily for 6 days
Out: $275 daily for 6 days
$3,990 Net: $3,400
In and Out of network: $5,100
Yes Not enough data available
WellCare Prime
H5199-010
Contact: 866-527-0056
PPO Her., Hills., Pasco $75 No $0 Net: $0, $20
Out: $0, $0-$250
Net: $125 daily for 10 days
Out: $125 daily for 10 days
$4,590 Net: $2,000
In and Out of network: $5,000
Yes Not enough data available

*Drug deductible applies only to tiers 1 and 2 from a preferred cost-sharing retail pharmacy.

Compiled by Times correspondent Donna Winchester

Source: Centers for Medicare & Medicaid Services