Medicare 2021

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 is projected to be $148.50 for 2021.

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 2021 will begin when total drug costs hit $4,130. You will exit the donut hole when your out-of-pocket costs reach $6,550.

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 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% per stay
$3,631 Net: $6,700
In and Out of network: $10,000
No ★★★-1/2
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: $295 daily for 5 days
Out: 40% per stay
$3,199 Net: $5,500
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: N/A
Net: $195 daily for 5 days
Out: N/A
$2,947 Net: $3,400
Out: N/A
Yes ★★★-1/2
AARP Medicare Advantage
H1045-028
Contact: 800-555-5757
HMO-POS Her., Hills., Pasco, Pin. $0 No $0 Net: $0, $35
Out: N/A
Net: $280 daily for 6 days
Out: N/A
$3,127 Net: $4,900
Out: N/A
No ★★★-1/2
Aetna Medicare Choice
H1609-028
Contact: 833-859-6031; TTY 711
HMO-POS Hills., Pin. $0 No $195 Net: $0, $40
Out: Not available, $50
Net: $350 daily for 4 days
Out: 50% per stay
$3,211 Net: $6,700
In and Out of network: $10,000
Yes ★★★★
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% per stay
$3,175 Net: $5,500
In and Out of network: $10,000
Yes ★★★★
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% per stay
$3,439 Net: $6,700
In and Out of network: $10,000
Yes ★★★★
Aetna Medicare Select
H1609-034
Contact: 833-859-6031; TTY 711
HMO Her., Hills., Pasco, Pin. $0 No $0 Net: $0, $20
Out: N/A
Net: $75 daily for 7 days
Out: N/A
$2,707 Net: $3,200
Out: N/A
Yes ★★★★
BayCare Plus Complete
H2235-001
Contact: 877-549-1741; TTY 711
HMO Hills., Pasco, Pin. $0 No $0 Net: $0, $15
Out: N/A
Net: $175 daily for 5 days
Out: N/A
$2,827 Net: $3,500
Out: N/A
No Too new to measure
BayCarePlus Premier
H2235-003
Contact: 877-549-1741; TTY 711
HMO Pin. $33 No $0 Net: $0, $10
Out: N/A
Net: $150 daily for 5 days
Out: N/A
$3,103 Net: $2,800
Out: No
No Too new to measure
BayCarePlus Rewards
H2235-H2235-002
Contact: 877-549-1741; TTY 711
HMO Hills., Pasco, Pin. $0 Yes $0 Net: $0, $35
Out: N/A
Net: $250 daily for 6 days
Out: N/A
$1,771 Net: $4,500
Out: N/A
No Too new to measure
BayCarePlus Signature
H2235-004
Contact: 877-549-1741; TTY 711
HMO Hills., Pasco $28 No $0 Net: $0, $10
Out: N/A
Net: $150 daily for 5 days
Out: N/A
$3,043 Net: $2,800
Out: N/A
No Too new to measure
BlueMedicare Choice
R3332-001
Contact: 844-396-2763; TTY 800-955-8770
PPO Her., Hills., Pasco, Pin. $47.90 No $250 Net: $10, $50
Out: 50%, 50%
Net: $345 daily for 5 days
Out: $495 daily for 27 days
$4,230 Net: $6,500
In and Out of network: $10,000
Yes ★★★-1/2
BlueMedicare Classic
H1035-021
Contact: 844-396-2763; TTY 800-955-8770
HMO Her., Hills., Pin. $0 No $0 Net: $0, $40
Out: N/A
Net: $225 daily for 7 days
Out: N/A
$3,079 Net: $4,900
Out: N/A
Yes ★★★★-1/2
BlueMedicare Premier
H1035-034
Contact: 844-396-2763; TTY 800-955-8770
HMO Her., Hills., Pasco, Pin. $0 No $0 Net: $0, $20
Out: N/A
Net: $125 daily for 8 days
Out: N/A
$2,635 Net: $3,400
Out: N/A
Yes ★★★★-1/2
BlueMedicare Saver
H1035-037
Contact: 844-396-2763; 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
$2,563 Net: $6,700
Out: N/A
Yes ★★★★-1/2
BlueMedicare Select
H5434-002
Contact: 844-396-2763; TTY 800-955-8770
PPO Hills, Pin. $146.80 No $305 Net: $5, $45
Out: 40%, 40%
Net: $225 daily for 7 days
Out: $200 daily for 27 days
$4,973 Net: $5,900
In and Out of network: $10,000
Yes ★★★-1/2
BlueMedicare Value
H5434-035
Contact: 844-396-2763; TTY 800-955-8770
PPO Her., Hills., Pasco, Pin. $0 No $150 Net: $10, $45
Out: 50%, 50%
Net: $325 daily for 6 days
Out: $50% per stay
$3,331 Net: $4,500
In and Out of network: $10,000
Yes ★★★-1/2
Bright Advantage Choice
H3281-003
Contact: 877-930-3323; TTY 711
PPO Pasco $0 No $0 Net: $0, $20
Out: $0, $20
Net: $250 daily for 5 days
Out: 40% daily for 90 days
$3,055 Net: $5,400
In and Out of network: $10,000
Yes Too new to measure
Bright Advantage Health Dollars
H4709-003
Contact: 877-930-3323; TTY 711
HMO Pasco $0 No $0 Net: $0, $0
Out: N/A
Net: $190 daily for 7 days
Out: N/A
$2,383 Net: $3,400
Out: N/A
Yes Too new to measure
Bright Advantage Part B Savings
H3281-010
Contact: 877-930-3323; TTY 711
PPO Pasco $0 Yes $400 Net: $0, $40
Out: $0, $40
Net: $295 daily for 6 days
Out: 30% daily for 90 days
$2,311 Net: $6,700
In and Out of network: $10,000
Yes Too new to measure
CareFree
H1019-104-2
Contact: 800-794-4105
HMO Hills., Pasco, Pin. $0 Yes $0 Net: $0, $20
Out: N/A
Net: $125 daily for 4 days
Out: N/A
$1,243 Net: $2,750
Out: N/A
No ★★★★★
CareOne PLATINUM
H1019-111
Contact: 800-794-4105
HMO Hills., Pasco, Pin. $0 No $0 Net: $0, $10
Out: N/A
Net: $50 daily for 5 days
Out: N/A
$2,479 Net: $3,400
Out: N/A
Yes ★★★★★
CareOne PLUS
H1019-103-2
Contact: 800-794-4105
HMO Hills., Pasco, Pin. $0 No $0 Net: $0, $5
Out: N/A
Net: $20 daily for 5 days
Out: N/A
$2,431 Net: $1,900
Out: N/A
Yes ★★★★★
Cigna Preferred Medicare
H5410-029
Contact: 855-980-3046
HMO Her., Hills., Pasco, Pin. $0 No $0 Net: $0, $0
Out: N/A
Net: $150 daily for 6 days
Out: N/A
$2,707 Net: $3,650
Out: N/A
No ★★★★★
Cigna Preferred Savings Medicare
H5410-030
Contact: 855-980-3046
HMO Her., Hills., Pasco, Pin. $0 Yes $0 Net: $0, $15
Out: N/A
Net: $175 daily for 6 days
Out: N/A
$1,651 Net: $3,950
Out: N/A
No ★★★★★
Cigna Primary Medicare
H5410-035
Contact: 855-980-3046
HMO Her., Hills., Pasco, Pin. $18 No $445 Net: $0, $0
Out: N/A
Net: $500 per stay
Out: N/A
$2,898 Net: $3,500
Out: N/A
No ★★★★★
Devoted Health Core Greater Tampa Bay
H1290-004
Contact: 800-376-5889
HMO Her., Hills., Pasco, Pin. $0 No $0 Net: $0, $10
Out: N/A
Net: $90 daily for 7 days
Out: N/A
$2,599 Net: $2,900
Out: N/A
Yes Too new to measure
Devoted Health Essentials Greater Tampa Bay
H1290-016
Contact: 800-376-5889
HMO Her., Hills., Pasco, Pin. $0 Yes $0 Net: $0, $30
Out: N/A
Net: $195 daily for 6 days
Out: N/A
$1,639 Net: $3,400
Out: N/A
No Too new to measure
Devoted Health Prime Greater Tampa Bay
H1290-009
Contact: 800-376-5889
HMO Her., Hills., Pasco, Pin. $31 No $445 Net: $0, $0
Out: N/A
Net: $0
Out: N/A
$2,873 Net: $3,400
Out: N/A
No Too new to measure
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
$3,271 Net: $3,400
Out: N/A
Yes ★★★★
Humana Gold Plus H1036-025
H1036-025
Contact: 855-795-9488
HMO Her., Hills., Pasco, Pin. $0 No $0 Net: $0, $5
Out: N/A
Net: $25 daily for 5 days
Out: N/A
$2,347 Net: $1,900
Out: N/A
Yes ★★★★-1/2
Humana Gold Plus H1036-265
H1036-265
Contact: 855-795-9488
HMO Her., Hills., Pasco, Pin. $0 Yes $0 Net: $0, $25
Out: N/A
Net: $150 daily for 8 days
Out: N/A
$1,315 Net: $2,750
Out: N/A
No ★★★★-1/2
HumanaChoice Florida H5216-072
H5216-072
Contact: 855-795-9488
PPO Her., Hills., Pasco, Pin. $0 No $150 Net: $5, $40
Out: $65, $65
Net: $343 daily for 4 days
Out: $495 daily for 27 days
$3,463 Net: $4,900
In and Out of network: $10,000
No ★★★★
HumanaChoice R5826-005
R5826-005
Contact: 855-795-9488
PPO Her., Hills., Pasco, Pin. $105.00 No $100 Net: $5, $45
Out: $65, $65
Net: $250 daily for 7 days
Out: 40% per stay
$4,687 Net: $6,700
In and Out of network: $10,000
No ★★★-1/2
HumanaChoice R5826-074
R5826-074
Contact: 855-795-9488
PPO Her., Hills., Pasco, Pin. $0 No $395 Net: $35, $50
Out: 50%, 50%
Net: $625 daily for 3 days
Out: $725 daily for 14 days
$4,015 Net: $7,550
In and Out of network: $10,500
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: $125 daily for 7 days
Out: N/A
$1,399 Net: $1,900
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
$1,495 Net: $1,900
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
$2,731 Net: $1,500
Out: N/A
Yes ★★★★-1/2
Premier by Ultimate
H2962-001
Contact: 855-858-7526
HMO Her., Hills., Pasco, Pin. $0 Yes $0 Net: $0, $20
Out: N/A
Net: $125 daily for 5 days
Out: N/A
$1,255 Net: $2,800
Out: N/A
Yes ★★★★
Premier Plus by Ultimate
H2962-014
Contact: 855-858-7526
HMO Her., Hills., Pasco, Pin. $0 No $0 Net: $0, $0
Out: N/A
Net: $0
Out: N/A
$2,431 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
$2,287 Net: $3,450
Out: N/A
Yes ★★★★
Simply Select
H5471-099
Contact: 888-870-7138
HMO Her., Hills., Pasco, Pin. $30.80 No $445 Net: $0, $5
Out: N/A
Net: $25 daily for 8 days
Out: N/A
$2,669 Net: $3,450
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: $80 daily for 7 days
Out: N/A
$2,779 Net: $3,400
Out: N/A
Yes Too new to measure
WellCare Dividend Prime
H1032-200
Contact: 866-527-0056
HMO Her., Hills., Pasco, Pin. $0 Yes $0 Net: $0, $20
Out: N/A
Net: $100 daily for 5 days
Out: N/A
$1,416 Net: $2,500
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: $50 daily for 10 days
Out: N/A
$2,599 Net: $1,200
Out: N/A
Yes ★★★★
WellCare Premier
H5199-012
Contact: 866-527-0056
PPO Her., Hills., Pasco, Pin. $0 No $100 Net: $0, $25
Out: $0, $0-$275
Net: $225 daily for 6 days
Out: $225 daily for 6 days
$3,223 Net: $3,400
In and Out of network: $5,100
Yes Too new to measure
WellCare Prime
H5199-010
Contact: 866-527-0056
PPO Her., Hills., Pasco, Pin. $75 No $0 Net: $0, $15
Out: $0, $15
Net: $100 daily for 6 days
Out: $100 daily for 6 days
$3,715 Net: $1,700
In and Out of network: $5,000
Yes Too new to measure

*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