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| Plan Name | Contract ID/Plan ID | Star Rating | Monthly Premium | Deductible | Gap Coverage? | CoPay/Coinsurance Amts for 30-day Supply | Details |
|---|---|---|---|---|---|---|---|
| Care Improvement Plus Medicare Advantage (PPO) | H0084 / 001 | 2.5 out of 5 stars | $0.00 | $0 | No | Generic-$6.00 Preferred Brand-$45.00 Non-Preferred Brand-$95.00 Specialty Tier-33% |
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| Care Improvement Plus Gold Rx (PPO SNP) | H0084 / 004 | 2.5 out of 5 stars | $0.00 | $0 | No | Generic-$6.00 Preferred Brand-$45.00 Non-Preferred Brand-$95.00 Specialty Tier-33% |
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| Care Improvement Plus Copper RX (PPO SNP) | H0084 / 027 | 2.5 out of 5 stars | $0.00 | $0 | No | Generic-$6.00 Preferred Brand-$45.00 Non-Preferred Brand-$95.00 Specialty Tier-33% |
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| HealthSpring Preferred (HMO) | H2165 / 018 | 2.5 out of 5 stars | $0.00 | $0 | Yes | Preferred Generic-$3.00 Non-Preferred Generic-$8.00 Preferred Brand-$35.00 Non-Preferred Brand-$70.00 Specialty Tier-33% |
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| Humana Gold Plus H4529-014 (HMO) | H4529 / 014 | 3 out of 5 stars | $0.00 | $0 | Yes | Preferred Generic-$7.00 Non-Preferred Generic-$11.00 Preferred Brand-$40.00 Non-Preferred Brand-$85.00 Specialty Tier-33% |
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| Care Improvement Plus Gold Rx (Regional PPO SNP) | R6801 / 009 | 3 out of 5 stars | $0.00 | $0 | No | Generic-$8.00 Preferred Brand-$45.00 Non-Preferred Brand-$95.00 Specialty Tier-33% |
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| Care Improvement Plus Medicare Advantage (Regional PPO) | R6801 / 012 | 3 out of 5 stars | $0.00 | $0 | No | Generic-$8.00 Preferred Brand-$45.00 Non-Preferred Brand-$95.00 Specialty Tier-33% |
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| Care Improvement Plus Copper RX (Regional PPO SNP) | R6801 / 022 | 3 out of 5 stars | $0.00 | $0 | No | Generic-$8.00 Preferred Brand-$45.00 Non-Preferred Brand-$95.00 Specialty Tier-33% |
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| Care Improvement Plus Chrome RX (Regional PPO SNP) | R6801 / 021 | 3 out of 5 stars | $31.80 | $325.00 | No | Tier 1-25% Tier 2-25% Tier 3-25% Tier 4-25% |
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| Care Improvement Plus Dual Advantage (Regional PPO SNP) | R6801 / 011 | 3 out of 5 stars | $31.80 | $325.00 | No | Tier 1-NA Tier 2-NA Tier 3-NA Tier 4-NA |
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| Care Improvement Plus Silver Rx (Regional PPO SNP) | R6801 / 008 | 3 out of 5 stars | $31.80 | $325.00 | No | Tier 1-25% Tier 2-25% Tier 3-25% Tier 4-25% |
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| HealthSpring TotalCare (HMO SNP) | H2165 / 019 | 2.5 out of 5 stars | $31.80 | $325.00 | No | Tier 1-15% |
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| Care Improvement Plus Dual Advantage (PPO SNP) | H0084 / 005 | 2.5 out of 5 stars | $31.80 | $325.00 | No | Tier 1-NA Tier 2-NA Tier 3-NA Tier 4-NA |
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| Care Improvement Plus Chrome RX (PPO SNP) | H0084 / 026 | 2.5 out of 5 stars | $31.80 | $325.00 | No | Tier 1-25% Tier 2-25% Tier 3-25% Tier 4-25% |
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| Care Improvement Plus Silver Rx (PPO SNP) | H0084 / 003 | 2.5 out of 5 stars | $31.80 | $325.00 | No | Tier 1-25% Tier 2-25% Tier 3-25% Tier 4-25% |
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| HealthSpring Preferred (PPO) | H7787 / 001 | 3 out of 5 stars | $35.00 | $0 | No | Preferred Generic-$0 Non-Preferred Generic-$4.00 Preferred Brand-$30.00 Non-Preferred Brand-$60.00 Specialty Tier-33% |
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| Humana Prime Choice H4520-006 (PPO) | H4520 / 006 | 3 out of 5 stars | $57.00 | $0 | Yes | Preferred Generic-$7.00 Non-Preferred Generic-$12.00 Preferred Brand-$42.00 Non-Preferred Brand-$83.00 Specialty Tier-33% |
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| HumanaChoice R5826-012 (Regional PPO) | R5826 / 012 | 3.5 out of 5 stars | $59.00 | $125.00 | No | Preferred Generic-$7.00 Non-Preferred Generic-$12.00 Preferred Brand-$45.00 Non-Preferred Brand-$89.00 Specialty Tier-30% |
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| Today's Options Premier Plus 650D (PFFS) | H6169 / 033 | 2.5 out of 5 stars | $92.00 | $85.00 | No | Preferred Generic-$5.00 Non-Preferred Generic-$12.00 Preferred Brand-$45.00 Non-Preferred Brand-$95.00 Specialty Tier-29% |
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| Today's Options Premier Plus 350A (PFFS) | H6169 / 024 | 2.5 out of 5 stars | $152.00 | $0 | No | Preferred Generic-$2.00 Non-Preferred Generic-$7.00 Preferred Brand-$40.00 Non-Preferred Brand-$80.00 Specialty Tier-33% |
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