90091 999 0 2021 United Mine Workers of America Health & Retirement UMWAFUNDS.ORG H0022 001 0 2021 Buckeye Health Plan - MyCare Ohio (Medicare-Medicaid Plan) mmp.buckeyehealthplan.com 4349 Easton Way, Suite 300 Columbus OH 43219 8665498289 8665498289 711 711 8665498289 8665498289 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H0028 007 0 2021 Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0028 011 0 2021 Humana Gold Plus H0028-011 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H0028 013 0 2021 Humana Gold Plus H0028-013 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H0028 014 0 2021 Humana Gold Plus H0028-014 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H0028 015 0 2021 Humana Gold Plus SNP-DE H0028-015 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0028 016 0 2021 Humana Gold Plus H0028-016 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H0028 017 0 2021 Humana Gold Plus H0028-017 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H0028 018 0 2021 Humana Value Plus H0028-018 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $410.00 annual deductible only applies to drugs on certain tiers.~ H0028 019 0 2021 Humana Gold Plus H0028-019 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H0028 021 0 2021 Humana Gold Plus H0028-021 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H0028 023 0 2021 Humana Gold Plus H0028-023 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H0028 024 0 2021 Humana Gold Plus H0028-024 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~ H0028 025 1 2021 Humana Gold Plus H0028-025 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H0028 025 2 2021 Humana Gold Plus H0028-025 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H0028 027 0 2021 Humana Gold Plus H0028-027 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H0028 028 0 2021 Humana Gold Plus H0028-028 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H0028 029 0 2021 Humana Gold Plus H0028-029 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H0028 030 0 2021 Humana Gold Plus H0028-030 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H0028 031 0 2021 Humana Gold Plus SNP-DE H0028-031 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0028 032 0 2021 Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0028 033 0 2021 Humana Gold Plus SNP-DE H0028-033 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0028 034 0 2021 Humana Gold Plus SNP-DE H0028-034 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0028 035 0 2021 Humana Gold Plus H0028-035 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H0028 036 0 2021 Humana Gold Plus SNP-DE H0028-036 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0028 037 0 2021 Humana Gold Plus H0028-037 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H0028 039 0 2021 Humana Gold Plus - Diabetes and Heart (HMO C-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H0028 041 0 2021 Humana Gold Plus H0028-041 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H0028 042 0 2021 Humana Gold Plus H0028-042 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H0028 043 1 2021 Humana Gold Plus H0028-043 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H0028 043 2 2021 Humana Gold Plus H0028-043 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H0028 044 0 2021 Humana Gold Plus SNP-DE H0028-044 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0028 045 0 2021 Humana Gold Plus SNP-DE H0028-045 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0028 046 0 2021 Humana Gold Plus H0028-046 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H0028 047 0 2021 Humana Gold Plus H0028-047 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H0028 048 1 2021 Humana Gold Plus H0028-048 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H0028 048 2 2021 Humana Gold Plus H0028-048 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H0028 801 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H0028 802 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H0028 804 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H0028 805 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H0029 801 0 2021 Allwell Group (HMO) allwell.coordinatedcarehealth.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8558486940 8558486940 711 711 H0029 802 0 2021 Allwell Group (HMO) allwell.coordinatedcarehealth.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8558486940 8558486940 711 711 H0029 803 0 2021 Allwell Group (HMO) allwell.coordinatedcarehealth.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8558486940 8558486940 711 711 H0034 001 0 2021 Hamaspik Medicare Select (HMO D-SNP) www.hamaspik.com info@hamaspik.com 58 Route 59, Suite #1 Monsey NY 10952 8334262774 8453881122 711 711 8334262774 8453881122 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0034 002 0 2021 Hamaspik Medicare Choice (HMO D-SNP) www.hamaspik.com info@hamaspik.com 58 Route 59, Suite #1 Monsey NY 10952 8334262774 8453881122 711 711 8334262774 8453881122 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0062 001 0 2021 Allwell Medicare (HMO) allwell.superiorhealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8447966811 8447966811 711 711 H0062 002 0 2021 Allwell Medicare (HMO) allwell.superiorhealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8447966811 8447966811 711 711 H0062 003 0 2021 Allwell Medicare (HMO) allwell.superiorhealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8447966811 8447966811 711 711 H0062 801 0 2021 Allwell Group (HMO) allwell.superiorhealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8447966811 8447966811 711 711 H0062 802 0 2021 Allwell Group (HMO) allwell.superiorhealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8447966811 8447966811 711 711 H0062 803 0 2021 Allwell Group (HMO) allwell.superiorhealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8447966811 8447966811 711 711 H0074 001 0 2021 WellCare Premier (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H0088 001 0 2021 WellCare Premier (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H0088 002 0 2021 WellCare Absolute (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H0104 012 0 2021 Blue Advantage Complete (PPO) www.bcbsalmedicare.com 450 Riverchase Parkway East Birmingham AL 35244 8888734707 8888734707 711 711 8882348266 8882348266 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H0104 014 0 2021 Blue Advantage Complete (PPO) www.bcbsalmedicare.com 450 Riverchase Parkway East Birmingham AL 35173 8888734707 8888734707 711 711 8882348266 8882348266 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H0104 015 0 2021 Blue Advantage Premier (PPO) www.bcbsalmedicare.com 450 Riverchase Parkway East Birmingham AL 35244 8888734707 8888734707 711 711 8882348266 8882348266 711 711 H0104 801 0 2021 Blue Advantage Employer Group Plan 801 (PPO) www.bcbsalmedicare.com 450 Riverchase Parkway East Birmingham AL 35244 8553144990 8553144990 711 711 8553144990 8553144990 711 711 H0104 802 0 2021 Blue Advantage Employer Group Plan 802 (PPO) www.bcbsalmedicare.com 450 Riverchase Parkway East Birmingham AL 35244 8553144990 8553144990 711 711 8553144990 8553144990 711 711 H0104 804 0 2021 Blue Advantage Employer Group Plan 804 (PPO) www.bcbsalmedicare.com 450 Riverchase Parkway East Birmingham AL 35244 8888734707 8888734707 711 711 8882348266 8882348266 711 711 H0104 805 0 2021 Blue Advantage Employer Group Plan 805 (PPO) www.bcbsalmedicare.com 450 Riverchase Parkway East Birmingham AL 35244 8888734707 8888734707 711 711 8882348266 8882348266 711 711 H0104 806 0 2021 Blue Advantage Employer Group Plan 806 (PPO) www.bcbsalmedicare.com 450 Riverchase Parkway East Birmingham AL 35244 8554535185 8554535185 711 711 8554535185 8554535185 711 711 H0104 807 0 2021 Blue Advantage Employer Group Plan 807 (PPO) www.bcbsalmedicare.com 450 Riverchase Parkway East Birmingham AL 35244 8888734707 8888734707 711 711 8882348266 8882348266 711 711 H0104 808 0 2021 Blue Advantage Employer Group Plan 808 (PPO) www.bcbsalmedicare.com 450 Riverchase Parkway Birmingham AL 35244 8888734707 8888734707 711 711 8882348266 8882348266 711 711 H0104 809 0 2021 Blue Advantage Employer Group Plan 809 (PPO) www.bcbsalmedicare.com 450 Riverchase Parkway Birmingham AL 35244 8888734707 8888734707 711 711 8882348266 8882348266 711 711 H0107 003 0 2021 Blue Cross Medicare Advantage Classic (PPO) www.getbluemt.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H0107 004 0 2021 Blue Cross Medicare Advantage Optimum (PPO) www.getbluemt.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H0107 801 0 2021 Blue Cross Group Medicare Advantage Plan (PPO) getbluemt.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H0107 802 0 2021 Blue Cross Group Medicare Advantage Plan (PPO) getbluemt.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H0107 803 0 2021 Blue Cross Group Medicare Advantage Plan (PPO) getbluemt.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H0107 804 0 2021 Blue Cross Group Medicare Advantage Plan (PPO) www.getbluemt.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H0111 001 0 2021 WellCare Premier (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 This plan does not charge an annual deductible for all drugs. The $75.00 annual deductible only applies to drugs on certain tiers.~ H0111 002 0 2021 WellCare Prime (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H0111 003 0 2021 WellCare Flex Complete (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H0111 004 0 2021 WellCare Imperial (PPO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0111 005 0 2021 WellCare Endurance (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H0137 001 0 2021 Commonwealth Care Alliance (Medicare-Medicaid Plan) www.commonwealthonecare.org 30 Winter Street Boston MA 02108 8662751222 8662751222 711 711 8666102273 8666102273 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H0148 001 0 2021 Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan) blueshieldca.com/promise/calmediconnect 601 Potrero Grande Dr. Monterey Park CA 91755 8445159072 8445159072 711 711 8559053825 8559053825 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H0148 002 0 2021 Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan) blueshieldca.com/promise/calmediconnect 601 Potrero Grande Dr. Monterey Park CA 91755 8445159072 8445159072 711 711 8559053825 8559053825 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H0154 008 0 2021 VIVA Medicare Select (HMO) www.vivahealth.com/Medicare tmize@uabmc.edu 417 20th St North, Suite 1100 Birmingham AL 35203 8888308482 2059338482 711 711 8006331542 2059182067 711 711 H0154 011 0 2021 VIVA Medicare Premier (HMO) www.vivahealth.com/Medicare tmize@uabmc.edu 417 20th St North, Suite 1100 Birmingham AL 35203 8888308482 2059338482 711 711 8006331542 2059182067 711 711 H0154 012 0 2021 VIVA Medicare Extra Value (HMO D-SNP) www.vivahealth.com/Medicare tmize@uabmc.edu 417 20th St North, Suite 1100 Birmingham AL 35203 8888308482 2059338482 711 711 8006331542 2059182067 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0154 014 0 2021 VIVA Medicare Me (HMO) www.vivahealth.com/Medicare tmize@uabmc.edu 417 20th St North, Suite 1100 Birmingham AL 35203 8888308482 2059338482 711 711 8006331542 2059182067 711 711 H0154 015 1 2021 VIVA Medicare Plus (HMO) www.vivahealth.com/Medicare tmize@uabmc.edu 417 20th St North, Suite 1100 Birmingham AL 35203 8888308482 2059338482 711 711 8006331542 2059182067 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H0154 015 2 2021 VIVA Medicare Plus (HMO) www.vivahealth.com/Medicare tmize@uabmc.edu 417 20th St North, Suite 1100 Birmingham AL 35203 8888308482 2059338482 711 711 8006331542 2059182067 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H0154 016 0 2021 VIVA Medicare Prime (HMO) www.vivahealth.com/Medicare tmize@uabmc.edu 417 20th St North, Suite 1100 Birmingham AL 35203 8888308482 2059338482 711 711 8006331542 2059182067 711 711 H0154 017 0 2021 VIVA Medicare Classic (HMO) www.vivahealth.com/Medicare tmize@uabmc.edu 417 20th St North, Suite 1100 Birmingham AL 35203 8888308482 2059338482 711 711 8006331542 2059182067 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H0154 018 0 2021 VIVA Medicare Preferred (HMO) www.vivahealth.com/Medicare tmize@uabmc.edu 417 20th St North, Suite 1100 Birmingham AL 35203 8888308482 2059338482 711 711 8006331542 2059182067 711 711 H0154 019 0 2021 VIVA Medicare Extra Care (HMO D-SNP) www.vivahealth.com/Medicare tmize@uabmc.edu 417 20th St North, Suite 1100 Birmingham AL 35203 8888308482 2059338482 711 711 8006331542 2059182067 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0154 801 0 2021 VIVA Medicare Group Plan with Rx (CY) (HMO) www.vivahealth.com/Medicare tmize@uabmc.edu 417 20th St North, Suite 1100 Birmingham AL 35203 8888308482 2059338482 711 711 8006331542 2059182067 711 711 H0154 802 0 2021 VIVA Medicare Group Plan (no Rx) (HMO) www.vivahealth.com/Medicare tmize@uabmc.edu 417 20th St North, Suite 1100 Birmingham AL 35203 8888308482 2059338482 711 711 8006331542 2059182067 711 711 H0154 803 0 2021 VIVA Medicare Plus Group Plan with Rx (not CY) (HMO) www.vivahealth.com/Medicare tmize@uabmc.edu 417 20th St North, Suite 1100 Birmingham AL 35203 8888308482 2059338482 711 711 8006331542 2059182067 711 711 H0169 001 0 2021 UnitedHealthcare Dual Complete (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8443686883 8443686883 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0169 002 0 2021 UnitedHealthcare Dual Complete (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8443686886 8443686886 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0169 003 0 2021 UnitedHealthcare Dual Complete (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8443687149 8443687149 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0169 004 0 2021 UnitedHealthcare Dual Complete LP1 (HMO-POS D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8662629947 8662629947 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0174 002 0 2021 WellCare TexanPlus Classic (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H0174 003 0 2021 WellCare TexanPlus Classic (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H0174 004 0 2021 WellCare Access (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0174 005 0 2021 WellCare Value (HMO-POS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H0174 006 0 2021 WellCare Liberty (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0174 007 0 2021 WellCare Dividend Prime (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H0174 008 0 2021 WellCare Guardian (HMO C-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H0174 009 0 2021 WellCare Compass (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H0174 010 0 2021 WellCare Value (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H0192 001 0 2021 AmeriHealth Caritas VIP Care Plus (Medicare-Medicaid Plan) www.amerihealthcaritasvipcareplus.com 200 Stevens Drive Philadelphia PA 19113 8886670318 8886670318 711 711 8886670318 8886670318 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H0251 002 0 2021 UnitedHealthcare Dual Complete (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30769 Salt Lake City UT 84130 8888343721 8888343721 711 711 8006901606 8006901606 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0251 004 0 2021 UnitedHealthcare Dual Complete ONE (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30769 Salt Lake City UT 84130 8888343721 8888343721 711 711 8006901606 8006901606 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0251 005 0 2021 UnitedHealthcare Dual Complete ONE Plus (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30769 Salt Lake City UT 84130 8888343721 8888343721 711 711 8006901606 8006901606 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0270 001 0 2021 WellCare Premier (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H0270 002 0 2021 WellCare Imperial (PPO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0271 002 0 2021 UnitedHealthcare Medicare Advantage Assure (PPO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H0271 003 0 2021 UnitedHealthcare Medicare Advantage Assure (PPO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H0271 004 0 2021 UnitedHealthcare Medicare Advantage Assure (PPO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H0271 005 0 2021 UnitedHealthcare Dual Complete (PPO D-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8664801086 8664801086 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0271 006 0 2021 UnitedHealthcare Dual Complete (PPO D-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8664801086 8664801086 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0271 007 0 2021 UnitedHealthcare Medicare Advantage Assure (PPO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H0271 008 0 2021 UnitedHealthcare Medicare Advantage Assure (PPO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H0271 010 0 2021 UnitedHealthcare Medicare Advantage Assure (PPO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H0271 011 0 2021 UnitedHealthcare Medicare Advantage Assure (PPO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H0271 012 0 2021 UnitedHealthcare Medicare Advantage Assure (PPO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H0271 013 0 2021 UnitedHealthcare Dual Complete (PPO D-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8664801086 8664801086 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0271 014 0 2021 UnitedHealthcare Dual Complete (PPO D-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8664801086 8664801086 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0271 016 0 2021 UnitedHealthcare Dual Complete (PPO D-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8664801086 8664801086 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0271 017 0 2021 UnitedHealthcare Medicare Advantage Assure (PPO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H0271 018 0 2021 UnitedHealthcare Medicare Advantage Assure (PPO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H0271 019 0 2021 UnitedHealthcare Medicare Advantage Assure (PPO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H0271 020 0 2021 UnitedHealthcare Dual Complete (PPO D-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8664801086 8664801086 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0271 022 0 2021 UnitedHealthcare Medicare Advantage Assure (PPO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H0292 001 0 2021 Humana Community (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H0292 002 0 2021 Humana Gold Plus H0292-002 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H0294 002 0 2021 UnitedHealthcare Medicare Advantage Assist (PPO C-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8002041002 8002041002 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H0294 004 0 2021 AARP Medicare Advantage Open Plan 1 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8002041002 8002041002 711 711 This plan does not charge an annual deductible for all drugs. The $325.00 annual deductible only applies to drugs on certain tiers.~ H0294 010 0 2021 UnitedHealthcare Medicare Advantage Assist (PPO C-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8002041002 8002041002 711 711 This plan does not charge an annual deductible for all drugs. The $345.00 annual deductible only applies to drugs on certain tiers.~ H0294 011 0 2021 AARP Medicare Advantage Open (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8002041002 8002041002 711 711 This plan does not charge an annual deductible for all drugs. The $385.00 annual deductible only applies to drugs on certain tiers.~ H0294 012 0 2021 AARP Medicare Advantage Open Premier (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8002041002 8002041002 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H0294 014 0 2021 AARP Medicare Advantage Patriot Plan 1 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8002041002 8002041002 711 711 H0294 015 0 2021 AARP Medicare Advantage Walgreens (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8002041002 8002041002 711 711 This plan does not charge an annual deductible for all drugs. The $245.00 annual deductible only applies to drugs on certain tiers.~ H0294 016 0 2021 AARP Medicare Advantage Open Plan 2 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8002041002 8002041002 711 711 This plan does not charge an annual deductible for all drugs. The $290.00 annual deductible only applies to drugs on certain tiers.~ H0294 017 0 2021 AARP Medicare Advantage Open (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8002041002 8002041002 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~ H0302 001 0 2021 Blue Medicare Advantage Plus (HMO) azbluemedicare.com ContactAdvantage@azblue.com 13985 W. Grand Ave, Suite 200 Surprise AZ 85374 8004220761 8004220761 711 711 8004468331 8004468331 711 711 H0302 006 0 2021 Blue Medicare Advantage Classic (HMO) azbluemedicare.com ContactAdvantage@azblue.com 13985 W. Grand Ave, Suite 200 Surprise AZ 85374 8004220761 8004220761 711 711 8004468331 8004468331 711 711 H0302 008 0 2021 Blue Medicare Advantage Classic (HMO) azbluemedicare.com ContactAdvantage@azblue.com 13985 W. Grand Ave, Suite 200 Surprise AZ 85374 8004220761 8004220761 711 711 8004468331 8004468331 711 711 H0302 009 0 2021 Blue Medicare Advantage Standard (HMO) azbluemedicare.com ContactAdvantage@azblue.com 13985 W. Grand Ave, Suite 200 Surprise AZ 85374 8004220761 8004220761 711 711 8004468331 8004468331 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H0302 801 0 2021 Blue Medicare Advantage Employer Plan (HMO) azbluemedicare.com ContactAdvantage@azblue.com 13985 W. Grand Ave, Suite 200 Surprise AZ 85374 8004220761 8004220761 711 711 8004468331 8004468331 711 711 H0321 002 0 2021 UnitedHealthcare Dual Complete LP (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30769 Salt Lake City UT 84130 8888343721 8888343721 711 711 8776140623 8776140623 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0321 004 0 2021 UnitedHealthcare Dual Complete ONE (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30769 Salt Lake City UT 84130 8888343721 8888343721 711 711 8776140623 8776140623 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0332 001 0 2021 KelseyCare Advantage Essential (HMO) www.kelseycareadvantage.com 11511 Shadow Creek Parkway Pearland TX 77584 8006637146 7134425646 711 711 8665358343 7134422273 711 711 H0332 002 0 2021 KelseyCare Advantage Rx (HMO) www.kelseycareadvantage.com 11511 Shadow Creek Parkway Pearland TX 77584 8006637146 7134425646 711 711 8665358343 7134422273 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H0332 003 0 2021 KelseyCare Advantage Essential+Choice (HMO-POS) www.kelseycareadvantage.com 11511 Shadow Creek Parkway Pearland TX 77584 8006637146 7134425646 711 711 8665358343 7134422273 711 711 H0332 004 0 2021 KelseyCare Advantage Rx+Choice (HMO-POS) www.kelseycareadvantage.com 11511 Shadow Creek Parkway Pearland TX 77584 8006637146 7134425646 711 711 8665358343 7134422273 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H0332 007 0 2021 KelseyCare Advantage Essential Select (HMO-POS) www.kelseycareadvantage.com 11511 Shadow Creek Parkway Pearland TX 77584 8006637146 7134425646 711 711 8665358343 7134422273 711 711 H0332 008 0 2021 KelseyCare Advantage Rx Select (HMO-POS) www.kelseycareadvantage.com 11511 Shadow Creek Parkway Pearland TX 77584 8006637146 7134425646 711 711 8665358343 7134422273 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H0332 801 0 2021 KelseyCare Advantage Essential Retiree (HMO) www.kelseycareadvantage.com 11511 Shadow Creek Parkway Pearland TX 77584 8006637146 7134425646 711 711 8665340554 7134422273 711 711 H0332 803 0 2021 KelseyCare Advantage Rx Retiree (HMO) www.kelseycareadvantage.com 11511 Shadow Creek Parkway Pearland TX 77584 8006637146 7134425646 711 711 8665340554 7134422273 711 711 H0332 804 0 2021 KelseyCare Advantage Essential+Choice Retiree (HMO) www.kelseycareadvantage.com 11511 Shadow Creek Parkway Pearland TX 77584 8006637146 7134425646 711 711 8665340554 7134422273 711 711 H0332 805 0 2021 KelseyCare Advantage Rx+Choice Retiree (HMO) www.kelseycareadvantage.com 11511 Shadow Creek Parkway Pearland TX 77584 8006637146 7134425646 711 711 8665340554 7134422273 711 711 H0332 806 0 2021 KelseyCare Advantage Essential Retiree (HMO) www.kelseycareadvantage.com 11511 Shadow Creek Parkway Pearland TX 77584 8778539075 7134425646 711 711 8778539075 7134422377 711 711 H0332 807 0 2021 KelseyCare Advantage Rx Retiree (HMO) www.kelseycareadvantage.com 11511 Shadow Creek Parkway Pearland TX 77584 8665340554 7134425646 711 711 8665340554 7134422273 711 711 H0332 808 0 2021 KelseyCare Advantage Essential+Choice Retiree (HMO) www.kelseycareadvantage.com 11511 Shadow Creek Parkway Pearland TX 77584 8778539075 7134427555 711 711 8665340556 7134427555 711 711 H0332 809 0 2021 KelseyCare Advantage Rx+Choice Retiree (HMO) www.kelseycareadvantage.com 11511 Shadow Creek Parkway Pearland TX 77584 8665340554 7134425646 711 711 8665340554 7134422273 711 711 H0332 810 0 2021 KelseyCare Advantage Rx Retiree (HMO) www.kelseycareadvantage.com 11511 Shadow Creek Parkway Pearland TX 77584 8665340554 7134425646 711 711 8665340554 7134422273 711 711 H0332 811 0 2021 KelseyCare Advantage Rx Retiree (HMO) www.kelseycareadvantage.com 11511 Shadow Creek Parkway Pearland TX 77584 8665358405 7134425646 711 711 8665358405 7134422273 711 711 H0332 812 0 2021 KelseyCare Advantage Rx Retiree (HMO) www.kelseycareadvantage.com 11511 Shadow Creek Parkway Pearland TX 77584 8665340554 7134425646 711 711 8665340554 7134422273 711 711 H0332 813 0 2021 KelseyCare Advantage RX Retiree (HMO) www.kelseycareadvantage.com 11511 Shadow Creek Parkway Pearland TX 77584 8665340554 7134425646 711 711 8665340554 7134422273 711 711 H0332 814 0 2021 KelseyCare Advantage Essential Retiree (HMO) www.kelseycareadvantage.com 11511 Shadow Creek Parkway Pearland TX 77584 8665340554 7134425646 711 711 8665340554 7134422273 711 711 H0336 001 0 2021 Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan) www.humana.com/medicare/medicaid-dual/illinois/ 500 West Main Street Louisville KY 40202 8556359561 8556359561 711 711 8007873311 8007873311 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H0342 001 0 2021 CarePartners Access (PPO) www.carepartnersct.com Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8444026874 8444026874 711 711 8883411507 8883411507 711 711 H0351 038 0 2021 Allwell CHF/Diabetes Medicare (HMO C-SNP) allwell.azcompletehealth.com AZ_InternetMemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8009777522 8009777522 711 711 H0351 052 0 2021 Allwell Medicare Premier II (HMO) allwell.azcompletehealth.com AZ_InternetMemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8009777522 8009777522 711 711 H0351 053 0 2021 Allwell Medicare Premier II (HMO) allwell.azcompletehealth.com AZ_InternetMemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8009777522 8009777522 711 711 H0351 054 0 2021 Allwell Medicare Boost (HMO) allwell.azcompletehealth.com AZ_InternetMemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8009777522 8009777522 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H0351 801 0 2021 Allwell CoCare (HMO) allwell.azcompletehealth.com AZ_InternetMemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8009777522 8009777522 711 711 H0351 803 0 2021 Allwell CoCare (HMO) allwell.azcompletehealth.com AZ_InternetMemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8009777522 8009777522 711 711 H0351 804 0 2021 Allwell CoCare (HMO) allwell.azcompletehealth.com AZ_InternetMemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8009777522 8009777522 711 711 H0354 001 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com P.O. Box 29030, Attention: Medicare Customer Service Phoenix AZ 85038 8555613811 8555613811 711 711 8006277534 8006277534 711 711 H0354 024 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com P.O. Box 29030, Attention: Medicare Customer Service Phoenix AZ 85038 8555613811 8555613811 711 711 8006277534 8006277534 711 711 H0354 027 0 2021 Cigna Achieve Medicare (HMO C-SNP) www.cignamedicare.com P.O. Box 29030, Attention: Medicare Customer Service Phoenix AZ 85038 8555613811 8555613811 711 711 8006277534 8006277534 711 711 H0354 028 0 2021 Cigna Alliance Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com P.O. Box 29030, Attention: Medicare Customer Service Phoenix AZ 85038 8555613811 8555613811 711 711 8006277534 8006277534 711 711 H0354 804 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com P.O. Box 29030, Attention: Medicare Customer Service Phoenix AZ 85038 8555613811 8555613811 711 711 8006277534 8006277534 711 711 H0354 805 0 2021 Cigna Preferred Medicare FY (HMO) www.cignamedicare.com P.O. Box 29030, Attention: Medicare Customer Service Phoenix AZ 85038 8555613811 8555613811 711 711 8006277534 8006277534 711 711 H0363 001 0 2021 Longevity Health Plan (HMO I-SNP) www.longevityhealthplan.com PO Box 5850 Glen Allen VA 23058 8883133609 8883133609 711 711 8883133609 8883133609 711 711 H0422 001 0 2021 Care Core: M Health Fairview & North Memorial (HMO-POS) https://home.ucare.org PO Box 52 Minneapolis MN 55440 8776711064 6126766645 8006882534 6126766810 8886182595 6126766520 8006882534 6126766810 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~ H0422 002 0 2021 Care Advantage: M Health Fairview & North Memorial (HMO-POS) https://home.ucare.org PO Box 52 Minneapolis MN 55440 8776711064 6126766645 8006882534 6126766810 8886182595 6126766520 8006882534 6126766810 H0423 001 0 2021 MetroPlus Advantage Plan (HMO D-SNP) www.metroplusmedicare.org 50 Water Street, 7th Floor New York NY 10004 8669860356 8669860356 711 711 8669860356 8669860356 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0423 004 0 2021 MetroPlus Platinum Plan (HMO) www.metroplusmedicare.org 50 Water Street, 7th Floor New York NY 10004 8669860356 8669860356 711 711 8669860356 8669860356 711 711 H0423 007 0 2021 MetroPlus UltraCare (HMO D-SNP) www.metroplusmedicare.org 50 Water Street, 7th Floor New York NY 10004 8669860356 8669860356 711 711 8669860356 8669860356 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0432 001 0 2021 AARP Medicare Advantage Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $55.00 annual deductible only applies to drugs on certain tiers.~ H0432 002 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H0432 003 0 2021 AARP Medicare Advantage Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $55.00 annual deductible only applies to drugs on certain tiers.~ H0432 004 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H0432 009 0 2021 UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8664801086 8664801086 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0432 010 0 2021 AARP Medicare Advantage Walgreens (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $55.00 annual deductible only applies to drugs on certain tiers.~ H0432 012 0 2021 AARP Medicare Advantage Patriot (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H0439 002 0 2021 Cigna TotalCare (HMO D-SNP) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826101 8559826101 711 711 8006683813 8006683813 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0439 003 1 2021 Cigna Preferred GA Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826101 8559826101 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H0439 003 2 2021 Cigna Preferred GA Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826101 8559826101 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H0439 006 0 2021 Cigna Premier Medicare (HMO-POS) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826101 8559826101 711 711 8006683813 8006683813 711 711 H0439 007 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826101 8559826101 711 711 8006683813 8006683813 711 711 H0439 008 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826101 8559826101 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H0439 009 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826101 8559826101 711 711 8006683813 8006683813 711 711 H0439 010 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826101 8559826101 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H0439 011 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826101 8559826101 711 711 8006683813 8006683813 711 711 H0439 801 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8882817867 8882817867 711 711 8666252494 8666252494 711 711 H0473 001 0 2021 HumanaChoice H0473-001 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $360.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H0473 003 0 2021 HumanaChoice H0473-003 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H0473 004 0 2021 HumanaChoice H0473-004 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H0473 005 0 2021 HumanaChoice H0473-005 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H0473 006 0 2021 HumanaChoice SNP-DE H0473-006 (PPO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~This plan's deductible only applies to out-of-network services.~ H0480 001 0 2021 MeridianComplete (Medicare-Medicaid Plan) https://corp.mhplan.com/ 1 Campus Martius, Suite 700 Detroit MI 48226 8553234578 8553234578 711 711 8553234578 8553234578 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H0482 001 0 2021 Ascension Complete Michigan Reward (HMO) ascensioncomplete.com PO Box 10420 Van Nuys CA 91410 8449420038 8449420038 711 711 8334311356 8334311356 711 711 This plan does not charge an annual deductible for all drugs. The $390.00 annual deductible only applies to drugs on certain tiers.~ H0482 002 0 2021 Ascension Complete Michigan Secure (HMO) ascensioncomplete.com PO Box 10420 Van Nuys CA 91410 8449420038 8449420038 711 711 8334311356 8334311356 711 711 H0504 015 0 2021 Blue Shield 65 Plus (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland HIlls CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 H0504 017 0 2021 Blue Shield 65 Plus (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland HIlls CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 H0504 021 0 2021 Blue Shield 65 Plus Plan 2 (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland HIlls CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 This plan is only offered in certain zip codes. Please ask the plan if it is available in your zip code.~ H0504 026 0 2021 Blue Shield 65 Plus (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland HIlls CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 H0504 028 0 2021 Blue Shield 65 Plus (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland HIlls CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 H0504 029 0 2021 Blue Shield 65 Plus (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland HIlls CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 H0504 031 0 2021 Blue Shield Inspire (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland HIlls CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 H0504 037 0 2021 Blue Shield Inspire (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland HIlls CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H0504 038 0 2021 Blue Shield 65 Plus (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland HIlls CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 H0504 039 0 2021 Blue Shield 65 Plus (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland HIlls CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 H0504 040 0 2021 Blue Shield 65 Plus Choice Plan (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland HIlls CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 H0504 041 0 2021 Blue Shield Inspire (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland HIlls CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 H0504 042 0 2021 Blue Shield Inspire (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland HIlls CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H0504 043 0 2021 Blue Shield Inspire (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland HIlls CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 H0504 044 0 2021 Blue Shield Vital (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland HIlls CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 H0504 045 0 2021 Blue Shield Vital (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland HIlls CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 H0504 046 0 2021 Blue Shield Inspire (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland HIlls CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 H0504 047 0 2021 Blue Shield Inspire (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland HIlls CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 H0504 803 0 2021 Blue Shield 65 Plus (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland HIlls CA 91367 8007764466 8007764466 711 711 8007764466 8007764466 711 711 H0504 804 0 2021 Blue Shield 65 Plus (HMO) blueshieldca.com/medicare 6300 Canoga Ave Woodland HIlls CA 91367 8007764466 8007764466 711 711 8007764466 8007764466 711 711 H0504 805 0 2021 Blue Shield 65 Plus (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland HIlls CA 91367 8007764466 8007764466 711 711 8007764466 8007764466 711 711 H0523 002 0 2021 Aetna Medicare Select Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H0523 022 0 2021 Aetna Medicare Select Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H0523 031 0 2021 Aetna Medicare Select Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H0523 052 0 2021 Aetna Medicare Select Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H0523 061 0 2021 Aetna Medicare Prime Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H0523 801 0 2021 Aetna Medicare Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H0523 805 0 2021 Aetna Medicare Plan w/Rx (HMO) www.aetnamedicare.com HicksJS@aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H0524 003 0 2021 Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 008 0 2021 Kaiser Permanente Senior Advantage Solano (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 013 0 2021 Kaiser Permanente Sr Adv Enhanced Sac., Sonoma (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 015 0 2021 Kaiser Permanente Senior Advantage Inland Empire (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 029 0 2021 Senior Advantage Medicare Medi-Cal Plan South (HMO D-SNP) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0524 030 0 2021 Senior Advantage Medicare Medi-Cal Plan North (HMO D-SNP) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0524 031 0 2021 Kaiser Permanente Senior Advantage Marin San Mateo (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 032 0 2021 Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 033 0 2021 Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 034 0 2021 Kaiser Permanente Senior Advantage Ventura (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 035 0 2021 Kaiser Permanente Senior Advantage Enhanced Kern (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 036 0 2021 Kaiser Permanente Senior Advantage Basic Kern (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 037 0 2021 Kaiser Permanente Senior Advantage San Diego (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 038 0 2021 Kaiser Permanente Senior Advantage Enhanced Fresno (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 039 0 2021 Kaiser Permanente Sr Adv Enhanced Santa Clara (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 040 0 2021 Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 041 0 2021 Kaiser Permanente Senior Advantage Basic Stanis (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 042 0 2021 Kaiser Permanente Senior Advantage Enhanced SnJoaq (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 043 0 2021 Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 046 0 2021 Kaiser Permanente Senior Advantage Basic Fresno (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 051 0 2021 Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 054 0 2021 Kaiser Permanente Senior Advantage Santa Cruz (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 059 0 2021 Kaiser Permanente Senior Advantage Basic Alameda (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 060 0 2021 Kaiser Permanente Senior Advantage Basic SF (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 061 0 2021 Kaiser Permanente Sr Adv Basic Contra Costa (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 062 0 2021 Kaiser Permanente Sr Adv Basic Santa Clara (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 801 0 2021 Kaiser Permanente Senior Advantage (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 802 0 2021 Kaiser Permanente Senior Advantage (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 805 0 2021 Kaiser Permanente Senior Advantage (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 806 0 2021 Kaiser Permanente Senior Advantage (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 809 0 2021 FEHB Part AB with D (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0524 810 0 2021 FEHB Part AB with D (HMO) kp.org/medicare 1800 Harrison Street Oakland CA 94612 8007771238 8007771238 711 711 8004430815 8004430815 711 711 H0543 001 0 2021 AARP Medicare Advantage SecureHorizons Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 013 0 2021 AARP Medicare Advantage SecureHorizons Value (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 019 0 2021 AARP Medicare Advantage SecureHorizons (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 022 0 2021 AARP Medicare Advantage SecureHorizons (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 028 0 2021 AARP Medicare Advantage SecureHorizons Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 This plan does not charge an annual deductible for all drugs. The $360.00 annual deductible only applies to drugs on certain tiers.~ H0543 029 0 2021 AARP Medicare Advantage SecureHorizons (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 This plan does not charge an annual deductible for all drugs. The $355.00 annual deductible only applies to drugs on certain tiers.~ H0543 032 0 2021 AARP Medicare Advantage SecureHorizons Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 This plan does not charge an annual deductible for all drugs. The $375.00 annual deductible only applies to drugs on certain tiers.~ H0543 035 0 2021 AARP Medicare Advantage SecureHorizons (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 036 0 2021 AARP Medicare Advantage SecureHorizons Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H0543 060 0 2021 AARP Medicare Advantage SecureHorizons Premier (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 070 0 2021 AARP Medicare Advantage SecureHorizons Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H0543 086 0 2021 AARP Medicare Advantage SecureHorizons (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H0543 089 0 2021 AARP Medicare Advantage SecureHorizons (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H0543 121 0 2021 AARP Medicare Advantage Patriot (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 138 0 2021 AARP Medicare Advantage SecureHorizons Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 140 0 2021 AARP Medicare Advantage SecureHorizons (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 144 0 2021 AARP Medicare Advantage SecureHorizons Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 145 0 2021 Sharp SecureHorizons Plan by UnitedHealthcare (HMO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 146 0 2021 AARP Medicare Advantage SecureHorizons Focus (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 147 0 2021 AARP Medicare Advantage SecureHorizons Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H0543 148 0 2021 AARP Medicare Advantage SecureHorizons (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 151 0 2021 AARP Medicare Advantage SecureHorizons Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 152 0 2021 AARP Medicare Advantage SecureHorizons Plan 4 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 This plan does not charge an annual deductible for all drugs. The $50.00 annual deductible only applies to drugs on certain tiers.~ H0543 153 0 2021 UnitedHealthcare Medicare Advantage Assure (HMO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 158 0 2021 AARP Medicare Advantage SecureHorizons Focus (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 This plan does not charge an annual deductible for all drugs. The $360.00 annual deductible only applies to drugs on certain tiers.~ H0543 163 0 2021 AARP Medicare Advantage SecureHorizons Focus (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H0543 164 0 2021 AARP Medicare Advantage SecureHorizons Premier (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 165 0 2021 AARP Medicare Advantage SecureHorizons Premier (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 166 0 2021 AARP Medicare Advantage SecureHorizons Premier (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 167 0 2021 AARP Medicare Advantage SecureHorizons Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 168 0 2021 AARP Medicare Advantage SecureHorizons Focus (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 169 0 2021 AARP Medicare Advantage SecureHorizons Focus (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 170 0 2021 AARP Medicare Advantage SecureHorizons Focus (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 172 0 2021 UnitedHealthcare Medicare Advantage Assure (HMO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 173 0 2021 UnitedHealthcare Medicare Advantage Assure (HMO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 175 0 2021 AARP Medicare Advantage SecureHorizons (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H0543 176 0 2021 AARP Medicare Advantage SecureHorizons (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 177 0 2021 AARP Medicare Advantage SecureHorizons (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H0543 178 0 2021 AARP Medicare Advantage SecureHorizons (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H0543 179 0 2021 AARP Medicare Advantage SecureHorizons (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H0543 183 0 2021 UnitedHealthcare Medicare Advantage Assure (HMO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 185 0 2021 UnitedHealthcare Medicare Advantage Assure (HMO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 188 0 2021 UnitedHealthcare Canopy Health Medicare Advantage (HMO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8668101498 8668101498 711 711 H0543 189 0 2021 UnitedHealthcare Canopy Health Medicare Advantage (HMO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8668101498 8668101498 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H0543 191 0 2021 UnitedHealthcare Canopy Health Medicare Advantage (HMO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8668101498 8668101498 711 711 H0543 193 0 2021 AARP Medicare Advantage SecureHorizons Focus (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H0543 194 0 2021 AARP Medicare Advantage SecureHorizons (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 195 0 2021 AARP Medicare Advantage SecureHorizons (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 196 0 2021 AARP Medicare Advantage SecureHorizons Focus (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 202 0 2021 UnitedHealthcare Medicare Advantage Assure (HMO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 204 0 2021 AARP Medicare Advantage Walgreens (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 205 0 2021 UnitedHealthcare Canopy Health Medicare Advantage (HMO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8668101498 8668101498 711 711 H0543 209 0 2021 UnitedHealthcare Canopy Health Medicare Advantage (HMO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8668101498 8668101498 711 711 H0543 210 0 2021 AARP Medicare Advantage Freedom Plus (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 214 0 2021 UnitedHealthcare Chronic Complete Focus (HMO C-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 215 0 2021 AARP Medicare Advantage Freedom Plus (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 216 0 2021 AARP Medicare Advantage Freedom Plus (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H0543 802 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0543 805 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0543 806 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0544 002 0 2021 Anthem MediBlue Value Plus (HMO) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930898 8555930898 711 711 8004992793 8004992793 711 711 H0544 003 0 2021 Anthem MediBlue Connect (HMO D-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930899 8555930899 711 711 8004992793 8004992793 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0544 004 0 2021 Anthem MediBlue Diabetes Care (HMO C-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930901 8555930901 711 711 8004992793 8004992793 711 711 H0544 005 0 2021 Anthem MediBlue Care On Site (HMO I-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930902 8555930902 711 711 8004992793 8004992793 711 711 H0544 007 0 2021 Anthem MediBlue StartSmart Plus (HMO) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930898 8555930898 711 711 8004992793 8004992793 711 711 H0544 008 0 2021 Anthem MediBlue Value Plus (HMO) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930898 8555930898 711 711 8004992793 8004992793 711 711 H0544 010 0 2021 Anthem MediBlue Diabetes Care (HMO C-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930901 8555930901 711 711 8004992793 8004992793 711 711 H0544 013 0 2021 Anthem MediBlue Heart Care (HMO C-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930901 8555930901 711 711 8004992793 8004992793 711 711 H0544 014 0 2021 Anthem MediBlue Lung Care (HMO C-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930901 8555930901 711 711 8004992793 8004992793 711 711 H0544 015 0 2021 Anthem MediBlue ESRD Care (HMO C-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930901 8555930901 711 711 8004992793 8004992793 711 711 H0544 019 0 2021 Anthem MediBlue Lung Care (HMO C-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930901 8555930901 711 711 8004992793 8004992793 711 711 H0544 020 0 2021 Anthem MediBlue ESRD Care (HMO C-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930901 8555930901 711 711 8004992793 8004992793 711 711 H0544 027 0 2021 Anthem MediBlue Value Plus (HMO) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930898 8555930898 711 711 8004992793 8004992793 711 711 H0544 031 0 2021 Anthem MediBlue Lung (HMO C-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930901 8555930901 711 711 8004992793 8004992793 711 711 H0544 032 0 2021 Anthem MediBlue Diabetes (HMO C-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930901 8555930901 711 711 8004992793 8004992793 711 711 H0544 036 0 2021 Anthem MediBlue Heart (HMO C-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930901 8555930901 711 711 8004992793 8004992793 711 711 H0544 038 0 2021 Anthem MediBlue Heart Care (HMO C-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930901 8555930901 711 711 8004992793 8004992793 711 711 H0544 050 0 2021 Anthem MediBlue Care On Site (HMO I-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930902 8555930902 711 711 8004992793 8004992793 711 711 H0544 052 0 2021 Anthem MediBlue Dual Advantage (HMO D-SNP) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930899 8555930899 711 711 8444696831 8444696831 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0544 053 0 2021 Anthem MediBlue Dual Advantage (HMO D-SNP) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930899 8555930899 711 711 8444696831 8444696831 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0544 054 0 2021 Anthem MediBlue Dual Advantage (HMO D-SNP) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930899 8555930899 711 711 8444696831 8444696831 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0544 055 0 2021 Anthem MediBlue Dual Advantage (HMO D-SNP) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930899 8555930899 711 711 8444696831 8444696831 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0544 056 0 2021 Anthem MediBlue Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930898 8555930898 711 711 8882307338 8882307338 711 711 H0544 057 0 2021 Anthem MediBlue Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930898 8555930898 711 711 8882307338 8882307338 711 711 H0544 058 0 2021 Anthem MediBlue Select (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930898 8555930898 711 711 8882307338 8882307338 711 711 H0544 059 0 2021 Anthem MediBlue Select (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930898 8555930898 711 711 8882307338 8882307338 711 711 H0544 060 3 2021 Anthem MediBlue Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930898 8555930898 711 711 8882307338 8882307338 711 711 H0544 060 4 2021 Anthem MediBlue Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930898 8555930898 711 711 8882307338 8882307338 711 711 H0544 061 0 2021 Anthem MediBlue Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930898 8555930898 711 711 8882307338 8882307338 711 711 H0544 062 0 2021 Anthem MediBlue Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930898 8555930898 711 711 8882307338 8882307338 711 711 H0544 063 0 2021 Anthem MediBlue Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930898 8555930898 711 711 8882307338 8882307338 711 711 H0544 064 0 2021 Anthem MediBlue Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930898 8555930898 711 711 8882307338 8882307338 711 711 H0544 065 0 2021 Anthem MediBlue Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930898 8555930898 711 711 8882307338 8882307338 711 711 H0544 066 0 2021 Anthem MediBlue Select (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930898 8555930898 711 711 8882307338 8882307338 711 711 H0544 067 0 2021 Anthem MediBlue Select (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930898 8555930898 711 711 8882307338 8882307338 711 711 H0544 069 0 2021 Anthem MediBlue Select (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930898 8555930898 711 711 8882307338 8882307338 711 711 H0544 070 0 2021 Anthem MediBlue Coordination Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930898 8555930898 711 711 8882307338 8882307338 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H0544 071 0 2021 Anthem MediBlue Coordination Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930898 8555930898 711 711 8882307338 8882307338 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H0544 072 0 2021 Anthem MediBlue Coordination Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930898 8555930898 711 711 8882307338 8882307338 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H0544 074 0 2021 Anthem MediBlue Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930898 8555930898 711 711 8882307338 8882307338 711 711 H0544 081 0 2021 Anthem MediBlue Extra (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930898 8555930898 711 711 8444879286 8444879286 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H0544 087 0 2021 Anthem MediBlue Dual Plus (HMO D-SNP) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930899 8555930899 711 711 8444696831 8444696831 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0544 088 0 2021 Anthem MediBlue Dual Plus (HMO D-SNP) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930899 8555930899 711 711 8444696831 8444696831 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0544 089 0 2021 Anthem MediBlue Dual Plus (HMO D-SNP) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930899 8555930899 711 711 8444696831 8444696831 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0544 090 0 2021 Anthem MediBlue Dual Plus (HMO D-SNP) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930899 8555930899 711 711 8444696831 8444696831 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0544 091 0 2021 Anthem MediBlue Select (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930898 8555930898 711 711 8882307338 8882307338 711 711 H0544 093 0 2021 Anthem MediBlue Care To You (HMO I-SNP) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930902 8555930902 711 711 8442095408 8442095408 711 711 H0544 094 0 2021 Anthem MediBlue Diabetes Care Plus (HMO C-SNP) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930901 8555930901 711 711 8442861322 8442861322 711 711 H0544 095 0 2021 Anthem MediBlue Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930898 8555930898 711 711 8882307338 8882307338 711 711 H0544 096 0 2021 Anthem MediBlue Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930898 8555930898 711 711 8882307338 8882307338 711 711 H0544 097 0 2021 Anthem MediBlue Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930898 8555930898 711 711 8882307338 8882307338 711 711 H0544 098 0 2021 Anthem MediBlue Select (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930898 8555930898 711 711 8882307338 8882307338 711 711 H0544 099 0 2021 Anthem MediBlue Coordination Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930898 8555930898 711 711 8882307338 8882307338 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H0544 100 0 2021 Anthem MediBlue Dual Advantage (HMO D-SNP) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930899 8555930899 711 711 8442861322 8442861322 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0544 101 0 2021 Anthem MediBlue Lung Care (HMO C-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930901 8555930901 711 711 8004992793 8004992793 711 711 H0544 102 0 2021 Anthem MediBlue Diabetes Care (HMO C-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930901 8555930901 711 711 8004992793 8004992793 711 711 H0544 103 0 2021 Anthem MediBlue Lung Care (HMO C-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930901 8555930901 711 711 8004992793 8004992793 711 711 H0544 104 0 2021 Anthem MediBlue Diabetes Care (HMO C-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930901 8555930901 711 711 8004992793 8004992793 711 711 H0544 105 0 2021 Anthem MediBlue Heart Care (HMO C-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930901 8555930901 711 711 8004992793 8004992793 711 711 H0544 106 0 2021 Anthem MediBlue Heart Care (HMO C-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930901 8555930901 711 711 8004992793 8004992793 711 711 H0544 107 0 2021 Anthem MediBlue Value (HMO) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930898 8555930898 711 711 8004992793 8004992793 711 711 H0544 108 0 2021 Anthem MediBlue Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930898 8555930898 711 711 8882307338 8882307338 711 711 H0544 110 0 2021 Anthem MediBlue Coordination Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8555930898 8555930898 711 711 8882307338 8882307338 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H0544 117 1 2021 Anthem MediBlue Lung (HMO C-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930901 8555930901 711 711 8004992793 8004992793 711 711 H0544 117 2 2021 Anthem MediBlue Lung (HMO C-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930901 8555930901 711 711 8004992793 8004992793 711 711 H0544 118 1 2021 Anthem MediBlue Diabetes (HMO C-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930901 8555930901 711 711 8004992793 8004992793 711 711 H0544 118 2 2021 Anthem MediBlue Diabetes (HMO C-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930901 8555930901 711 711 8004992793 8004992793 711 711 H0544 119 1 2021 Anthem MediBlue Heart (HMO C-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930901 8555930901 711 711 8004992793 8004992793 711 711 H0544 119 2 2021 Anthem MediBlue Heart (HMO C-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930901 8555930901 711 711 8004992793 8004992793 711 711 H0544 120 1 2021 Anthem MediBlue Value Plus (HMO) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930898 8555930898 711 711 8004992793 8004992793 711 711 H0544 120 2 2021 Anthem MediBlue Value Plus (HMO) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930898 8555930898 711 711 8004992793 8004992793 711 711 H0544 121 1 2021 Anthem MediBlue StartSmart Plus (HMO) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930898 8555930898 711 711 8004992793 8004992793 711 711 H0544 121 2 2021 Anthem MediBlue StartSmart Plus (HMO) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930898 8555930898 711 711 8004992793 8004992793 711 711 H0544 122 1 2021 Anthem MediBlue Connect Plus (HMO) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930898 8555930898 711 711 8004992793 8004992793 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H0544 122 2 2021 Anthem MediBlue Connect Plus (HMO) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930898 8555930898 711 711 8004992793 8004992793 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H0544 122 3 2021 Anthem MediBlue Connect Plus (HMO) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930898 8555930898 711 711 8004992793 8004992793 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H0544 801 0 2021 Anthem EGWP (HMO) www.anthem.com/ca/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8443096996 8443096996 711 711 8338488730 711 711 H0544 802 0 2021 Anthem EGWP MAPD (HMO) www.anthem.com/ca/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8443096996 8443096996 711 711 8338488730 8338488730 711 711 H0544 804 0 2021 Anthem EGWP MAPD (HMO) www.anthem.com/ca/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8443096996 8443096996 711 711 8338488730 8338488730 711 711 H0544 805 0 2021 Senior Secure (HMO) www.anthem.com/ca/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H0544 806 0 2021 Senior Secure (HMO) www.anthem.com/ca/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H0544 807 0 2021 Senior Secure (HMO) www.anthem.com/ca/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H0544 810 0 2021 Senior Secure (HMO) www.anthem.com/ca/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H0545 001 0 2021 Inter Valley Health Plan Service To Seniors (HMO) www.ivhp.com MemberServices@ivhp.com 300 S Park Avenue, PO Box 6002 Pomona CA 91769 8005007018 8005007018 711 711 8002518191 9096236333 711 711 H0545 012 0 2021 Inter Valley Health Plan Desert Preferred Choice (HMO) www.ivhp.com MemberServices@ivhp.com 300 S Park Avenue, PO Box 6002 Pomona CA 91769 8005007018 8005007018 711 711 8002518191 8002518191 711 711 H0545 015 0 2021 Inter Valley Health Plan Vitality Plus (HMO) www.ivhp.com MemberServices@ivhp.com 300 S Park Avenue, PO Box 6002 Pomona CA 91769 8005007018 8005007018 711 711 8002518191 9096236333 711 711 H0545 801 0 2021 Inter Valley Health Plan Active Plus I (HMO) www.ivhp.com MemberServices@ivhp.com 300 S Park Avenue, PO Box 6002 Pomona CA 91769 8005007018 8005007018 711 711 8002518191 9096236333 711 711 H0545 802 0 2021 Inter Valley Health Plan Active Plus II (HMO) www.ivhp.com MemberServices@ivhp.com 300 S Park Avenue, PO Box 6002 Pomona CA 91769 8005007018 8005007018 711 711 8002518191 9096236333 711 711 H0562 009 0 2021 Health Net Healthy Heart (HMO) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8002754737 8002754737 711 711 H0562 012 0 2021 Health Net Healthy Heart (HMO) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8002754737 8002754737 711 711 H0562 039 0 2021 Health Net Healthy Heart (HMO) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8002754737 8002754737 711 711 H0562 044 0 2021 Health Net Green (HMO) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8002754737 8002754737 711 711 H0562 055 0 2021 Health Net Amber I (HMO D-SNP) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8004319007 8004319007 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0562 068 0 2021 Health Net Healthy Heart (HMO) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8002754737 8002754737 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H0562 079 0 2021 Health Net Ruby (HMO) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8002754737 8002754737 711 711 H0562 084 0 2021 Health Net Healthy Heart (HMO) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8002754737 8002754737 711 711 H0562 090 0 2021 Health Net Healthy Heart (HMO) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8002754737 8002754737 711 711 H0562 092 0 2021 Health Net Jade (HMO C-SNP) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8004319007 8004319007 711 711 H0562 097 0 2021 Health Net Ruby Select (HMO) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8002754737 8002754737 711 711 H0562 103 0 2021 Health Net Ruby Select (HMO) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8002754737 8002754737 711 711 H0562 112 0 2021 Health Net Ruby Select (HMO) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8002754737 8002754737 711 711 H0562 113 0 2021 Health Net Ruby Select (HMO) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8002754737 8002754737 711 711 H0562 114 0 2021 Health Net Jade (HMO C-SNP) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8004319007 8004319007 711 711 H0562 118 0 2021 Health Net Jade (HMO C-SNP) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8004319007 8004319007 711 711 H0562 119 0 2021 Health Net Healthy Heart (HMO) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8002754737 8002754737 711 711 H0562 120 0 2021 Health Net Ruby (HMO) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8002754737 8002754737 711 711 H0562 121 0 2021 Health Net Amber II (HMO D-SNP) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8004319007 8004319007 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0562 122 0 2021 Health Net Sapphire (HMO) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8004319007 8004319007 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H0562 123 0 2021 Health Net Healthy Heart (HMO) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8002754737 8002754737 711 711 H0562 124 0 2021 Health Net Ruby Select (HMO) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8002754737 8002754737 711 711 H0562 125 0 2021 Health Net Gold Select (HMO) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8002754737 8002754737 711 711 H0562 126 0 2021 Health Net Gold Select (HMO) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8002754737 8002754737 711 711 H0562 801 0 2021 Health Net Seniority Plus Employer (HMO) healthnet.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8002754737 8002754737 711 711 H0562 803 0 2021 Health Net Seniority Plus Employer (HMO) healthnet.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8002754737 8002754737 711 711 H0562 804 0 2021 Health Net Seniority Plus Employer (HMO) healthnet.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8002754737 8002754737 711 711 H0571 001 0 2021 CCHP Senior Program (HMO) www.cchphealthplan.com/medicare memberservices@cchphealthplan.com 445 Grant Avenue, Suite 700 San Francisco CA 94108 8886813888 4159558831 8776818898 8776818898 8887757888 4158342118 8776818898 8776818898 H0571 005 0 2021 CCHP Senior Select Program (HMO D-SNP) www.cchphealthplan.com/medicare memberservices@cchphealthplan.com 445 Grant Avenue, Suite 700 San Francisco CA 94108 8886813888 4159558831 8776818898 8776818898 8887757888 4158342118 8776818898 8776818898 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0571 007 0 2021 CCHP Senior Value Program (HMO) www.cchphealthplan.com/medicare memberservices@cchphealthplan.com 445 Grant Avenue, Suite 700 San Francisco CA 94108 8886813888 4159558831 8776818898 8776818898 8887757888 4158342118 8776818898 8776818898 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H0609 007 0 2021 AARP Medicare Advantage SecureHorizons Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 H0609 012 0 2021 AARP Medicare Advantage SecureHorizons Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 H0609 018 0 2021 AARP Medicare Advantage Patriot (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 H0609 025 0 2021 AARP Medicare Advantage (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 H0609 026 0 2021 AARP Medicare Advantage Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8773702843 8773702843 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H0609 027 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 H0609 028 0 2021 AARP Medicare Advantage (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8885252086 8885252086 711 711 H0609 031 0 2021 AARP Medicare Advantage Premier (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8885252086 8885252086 711 711 H0609 032 0 2021 UnitedHealthcare Medicare Advantage Focus (HMO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448766176 8448766176 711 711 H0609 033 0 2021 AARP Medicare Advantage Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448766176 8448766176 711 711 This plan does not charge an annual deductible for all drugs. The $290.00 annual deductible only applies to drugs on certain tiers.~ H0609 034 1 2021 AARP Medicare Advantage SecureHorizons Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 This plan does not charge an annual deductible for all drugs. The $75.00 annual deductible only applies to drugs on certain tiers.~ H0609 034 2 2021 AARP Medicare Advantage SecureHorizons Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 This plan does not charge an annual deductible for all drugs. The $75.00 annual deductible only applies to drugs on certain tiers.~ H0609 036 1 2021 AARP Medicare Advantage SecureHorizons Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 This plan does not charge an annual deductible for all drugs. The $75.00 annual deductible only applies to drugs on certain tiers.~ H0609 036 2 2021 AARP Medicare Advantage SecureHorizons Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 This plan does not charge an annual deductible for all drugs. The $75.00 annual deductible only applies to drugs on certain tiers.~ H0609 037 0 2021 UnitedHealthcare Medicare Advantage Assist (HMO C-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 H0609 038 0 2021 AARP Medicare Advantage Walgreens Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 H0609 040 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448766176 8448766176 711 711 This plan does not charge an annual deductible for all drugs. The $290.00 annual deductible only applies to drugs on certain tiers.~ H0609 041 0 2021 AARP Medicare Advantage Patriot (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 H0609 801 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0609 804 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0609 805 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0609 807 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0609 808 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0609 809 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0609 810 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0609 811 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0609 812 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0609 813 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com UHCNV-Member-HPN@uhc.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0609 814 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com UHCNV-Member-HPN@uhc.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0609 815 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com UHCNV-Member-HPN@uhc.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0609 816 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com UHCNV-Member-HPN@uhc.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0609 817 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0609 818 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0609 819 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0609 820 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0609 821 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0624 001 0 2021 UnitedHealthcare Dual Complete (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8664801086 8664801086 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0628 001 0 2021 Aetna Medicare Premier (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H0628 003 0 2021 Aetna Medicare Premier (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H0628 005 0 2021 Aetna Medicare Premier (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H0628 006 0 2021 Aetna Medicare Premier (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H0628 007 0 2021 Aetna Medicare Premier (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H0628 008 0 2021 Aetna Medicare Premier (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H0628 009 0 2021 Aetna Medicare Premier (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H0628 010 0 2021 Aetna Medicare Premier (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H0628 011 0 2021 Aetna Medicare Premier (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H0628 012 0 2021 Aetna Medicare Assure 1 (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0628 013 0 2021 Aetna Medicare Assure 1 (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $220.00 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0628 014 0 2021 Aetna Medicare Eagle (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H0628 015 0 2021 Aetna Medicare Eagle (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H0628 016 0 2021 Aetna Medicare Eagle (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H0628 017 0 2021 Aetna Medicare Premier (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H0628 801 0 2021 Aetna Medicare Plan (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H0628 802 0 2021 Aetna Medicare Plan w/Rx (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H0630 013 0 2021 Kaiser Permanente Senior Advantage Core (HMO) kp.org/medicare 2500 S. Havana St. Aurora CO 80014 8774083492 8774083492 711 711 8004762167 3033383800 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H0630 014 0 2021 Senior Advantage Medicare Medicaid (HMO D-SNP) kp.org/medicare 2500 S. Havana St. Aurora CO 80014 8774083492 8774083492 711 711 8004762167 3033383800 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0630 015 0 2021 Kaiser Permanente Senior Advantage Silver (HMO) kp.org/medicare 2500 S. Havana St. Aurora CO 80014 8774083492 8774083492 711 711 8004762167 3033383800 711 711 This plan does not charge an annual deductible for all drugs. The $50.00 annual deductible only applies to drugs on certain tiers.~ H0630 016 0 2021 Kaiser Permanente Senior Advantage Gold (HMO) kp.org/medicare 2500 S. Havana St. Aurora CO 80014 8774083492 8774083492 711 711 8004762167 3033383800 711 711 H0630 017 0 2021 Kaiser Permanente Senior Advantage Core (HMO) kp.org/medicare 2500 S. Havana St. Aurora CO 80014 8774083492 8774083492 711 711 8004762167 3033383800 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H0630 020 0 2021 Kaiser Permanente Senior Advantage Core (HMO) kp.org/medicare 2500 S. Havana St. Aurora CO 80014 8774083492 8774083492 711 711 8004762167 3033383800 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H0630 021 0 2021 Kaiser Permanente Senior Advantage Silver (HMO) kp.org/medicare 2500 S. Havana St. Aurora CO 80014 8774083492 8774083492 711 711 8004762167 3033383800 711 711 H0630 023 0 2021 Kaiser Permanente Senior Advantage Enhanced (HMO) kp.org/medicare 2500 S Havana St. Aurora CO 80014 8774083492 8774083492 711 711 8004762167 3033383800 711 711 This plan does not charge an annual deductible for all drugs. The $75.00 annual deductible only applies to drugs on certain tiers.~ H0630 807 0 2021 Senior Advantage Group MA-PD (HMO) kp.org/medicare 2500 S. Havana St. Aurora CO 80014 8774083492 8774083492 711 711 8004762167 3033383800 711 711 H0630 808 0 2021 Senior Adv_Group_MA only (HMO) kp.org/medicare 2500 S. Havana St. Aurora CO 80014 8774083492 8774083492 711 711 8004762167 3033383800 711 711 H0630 810 0 2021 FEHB AB with D (HMO) kp.org/medicare 2500 S. Havana St. Aurora CO 80014 8774083492 8774083492 711 711 8004762167 3033383800 711 711 H0630 813 0 2021 Senior Advantage Group MA-PD (HMO) kp.org/medicare 2500 S. Havana St. Aurora CO 80014 8774083492 8774083492 711 711 8004762167 3033383800 711 711 H0630 814 0 2021 Senior Adv Group_MA only (HMO) kp.org/medicare 2500 S. Havana St. Aurora CO 80014 8774083492 8774083492 711 711 8004762167 3033383800 711 711 H0630 816 0 2021 FEHB AB with D (HMO) kp.org/medicare 2500 S. Havana St. Aurora CO 80014 8774083492 8774083492 711 711 8004762167 3033383800 711 711 H0630 819 0 2021 Senior Advantage Group MAPD (HMO) kp.org/medicare 2500 S. Havana St. Aurora CO 80014 8774083492 8774083492 711 711 8004762167 3033383800 711 711 H0630 820 0 2021 Senior Advantage Group MA Only (HMO) kp.org/medicare 2500 S. Havana St. Aurora CO 80014 8774083492 8774083492 711 711 8004762167 3033383800 711 711 H0630 822 0 2021 FEHB AB with D (HMO) kp.org/medicare 2500 S. Havana St. Aurora CO 80014 8774083492 8774083492 711 711 8004762167 3033383800 711 711 H0657 005 0 2021 Friday Health Plans Silver SV Plan (Cost) www.fridayhealthplans.com dessa.pottberg@fridayhealthplans.com 700 Main Street #100 Alamosa CO 81101 8004758466 7195893696 8006592656 8006592656 8004758466 7195893696 8006592656 8006592656 H0657 006 0 2021 Friday Health Plans Gold SV Plan (Cost) www.fridayhealthplans.com dessa.pottberg@fridayhealthplans.com 700 Main Street #100 Alamosa CO 81101 8004758466 7195893696 8006592656 8006592656 8004758466 7195893696 8006592656 8006592656 H0657 008 0 2021 Friday Health Plans Silver Plan (Cost) www.fridayhealthplans.com dessa.pottberg@fridayhealthplans.com 700 Main Street #100 Alamosa CO 81101 8004758466 7195893696 8006592656 8006592656 8004758466 7195893696 8006592656 8006592656 H0657 009 0 2021 Friday Health Plans Gold Plan (Cost) www.fridayhealthplans.com dessa.pottberg@fridayhealthplans.com 700 Main Street #100 Alamosa CO 81101 8004758466 7195893696 8006592656 8006592656 8004758466 7195893696 8006592656 8006592656 H0672 001 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559520786 8559520786 711 711 8006683813 8006683813 711 711 H0672 002 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559520786 8559520786 711 711 8006683813 8006683813 711 711 H0672 003 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559520786 8559520786 711 711 8006683813 8006683813 711 711 H0672 004 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559520786 8559520786 711 711 8006683813 8006683813 711 711 H0672 005 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8553438992 8553438992 711 711 8006683813 8006683813 711 711 H0672 006 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8553940157 8553940157 711 711 8006683813 8006683813 711 711 H0672 801 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H0710 004 0 2021 UnitedHealthcare Nursing Home Plan (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H0710 005 0 2021 UnitedHealthcare Nursing Home Plan (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H0710 007 0 2021 UnitedHealthcare Nursing Home Plan (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H0710 008 0 2021 UnitedHealthcare Assisted Living Plan (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H0710 009 0 2021 UnitedHealthcare Assisted Living Plan (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H0710 010 0 2021 UnitedHealthcare Nursing Home Plan (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8668184270 8668184270 711 711 H0710 012 0 2021 UnitedHealthcare Assisted Living Plan (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H0710 013 0 2021 UnitedHealthcare Nursing Home Plan (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H0710 015 0 2021 UnitedHealthcare Nursing Home Plan (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H0710 016 0 2021 UnitedHealthcare Nursing Home Plan (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H0710 017 0 2021 UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H0710 020 0 2021 UnitedHealthcare Nursing Home Plan (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H0710 026 0 2021 UnitedHealthcare Nursing Home Plan (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H0710 027 0 2021 UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H0710 030 0 2021 UnitedHealthcare Assisted Living Plan (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H0710 031 0 2021 UnitedHealthcare Nursing Home Plan (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H0710 032 0 2021 UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H0710 033 0 2021 UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H0710 034 0 2021 UnitedHealthcare Nursing Home Plan (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H0710 035 0 2021 UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H0710 036 0 2021 UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H0710 037 0 2021 UnitedHealthcare Assisted Living Plan 2 (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H0710 038 0 2021 UnitedHealthcare Nursing Home Plan (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H0710 039 0 2021 UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H0710 041 0 2021 UnitedHealthcare Nursing Home Plan (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H0710 042 0 2021 UnitedHealthcare Assisted Living Plan (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H0710 043 0 2021 UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H0710 046 0 2021 UnitedHealthcare Nursing Home Plan (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H0710 047 0 2021 UnitedHealthcare Assisted Living Plan (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H0710 049 0 2021 UnitedHealthcare Assisted Living Plan (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H0710 050 0 2021 UnitedHealthcare Assisted Living Plan 2 (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H0710 051 0 2021 UnitedHealthcare Nursing Home Plan (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H0710 052 0 2021 UnitedHealthcare Nursing Home Plan (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H0710 053 0 2021 UnitedHealthcare Nursing Home Plan (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H0710 801 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0710 802 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0710 803 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0710 807 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0710 808 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0710 809 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0710 810 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0710 811 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0710 815 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0710 816 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0710 817 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0710 818 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0710 819 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0710 820 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0710 821 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0710 822 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0710 823 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0710 825 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0710 826 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0710 827 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0710 829 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0710 830 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0710 831 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0712 005 0 2021 WellCare Access (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0712 019 0 2021 WellCare Value (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H0712 020 0 2021 WellCare Compass (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H0712 022 0 2021 WellCare Value (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H0712 023 0 2021 WellCare Value (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H0712 025 0 2021 WellCare Access (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0712 029 0 2021 WellCare Freedom (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0724 001 0 2021 Allwell Medicare (HMO) allwell.buckeyehealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661851 8557661851 711 711 This plan does not charge an annual deductible for all drugs. The $75.00 annual deductible only applies to drugs on certain tiers.~ H0724 005 0 2021 Allwell Medicare Essentials (HMO) allwell.buckeyehealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661851 8557661851 711 711 H0724 006 0 2021 Allwell Medicare Complement (HMO) allwell.buckeyehealthplan.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661851 8557661851 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H0724 007 0 2021 Allwell Medicare Boost (HMO) allwell.buckeyehealthplan.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661851 8557661851 711 711 This plan does not charge an annual deductible for all drugs. The $75.00 annual deductible only applies to drugs on certain tiers.~ H0724 801 0 2021 Allwell Group (HMO) allwell.buckeyehealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661851 8557661851 711 711 H0724 802 0 2021 Allwell Group (HMO) allwell.buckeyehealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661851 8557661851 711 711 H0724 803 0 2021 Allwell Group (HMO) allwell.buckeyehealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661851 8557661851 711 711 H0755 030 0 2021 UnitedHealthcare Medicare Advantage Plan 1 (HMO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8007110646 8007110646 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H0755 031 0 2021 UnitedHealthcare Medicare Advantage Plan 2 (HMO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8007110646 8007110646 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H0755 032 0 2021 UnitedHealthcare Medicare Advantage Patriot (HMO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8007110646 8007110646 711 711 H0755 033 0 2021 UnitedHealthcare Medicare Advantage Plan 3 (HMO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8007110646 8007110646 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~ H0755 037 0 2021 AARP Medicare Advantage Patriot (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H0755 038 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H0755 040 1 2021 AARP Medicare Advantage Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $240.00 annual deductible only applies to drugs on certain tiers.~ H0755 040 2 2021 AARP Medicare Advantage Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $240.00 annual deductible only applies to drugs on certain tiers.~ H0755 041 1 2021 AARP Medicare Advantage Plan 3 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H0755 041 2 2021 AARP Medicare Advantage Plan 3 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H0755 042 1 2021 AARP Medicare Advantage Plan 4 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H0755 042 2 2021 AARP Medicare Advantage Plan 4 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H0755 810 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0755 811 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0755 812 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0755 813 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0755 814 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0755 815 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H0783 001 0 2021 Humana Gold Plus SNP-DE H0783-001 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0798 001 0 2021 Medica Advantage Solution with CHI Health (HMO) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8663987374 9529922134 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H0838 020 0 2021 Brand New Day Harmony Choice Plan (HMO C-SNP) www.bndhmo.com compliance@universalcare.com 5455 Garden Grove Blvd, Suite 500 Westminster CA 92683 8662554795 8662554795 711 711 8662554795 8662554795 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H0838 024 0 2021 Brand New Day Dual Access Plan (HMO D-SNP) www.bndhmo.com compliance@universalcare.com 5455 Garden Grove Blvd, Suite 500 Westminster CA 92683 8662554795 8662554795 711 711 8662554795 8662554795 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0838 025 0 2021 Brand New Day Classic Care I Plan (HMO) www.bndhmo.com compliance@universalcare.com 5455 Garden Grove Blvd, Suite 500 Westminster CA 92683 8662554795 8662554795 711 711 8662554795 8662554795 711 711 H0838 028 0 2021 Brand New Day Bridges Care Plan (HMO C-SNP) www.bndhmo.com compliance@universalcare.com 5455 Garden Grove Blvd, Suite 500 Westminster CA 92683 8662554795 8662554795 711 711 8662554795 8662554795 711 711 H0838 029 0 2021 Brand New Day Bridges Choice Plan (HMO C-SNP) www.bndhmo.com compliance@universalcare.com 5455 Garden Grove Blvd, Suite 500 Westminster CA 92683 8662554795 8662554795 711 711 8662554795 8662554795 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H0838 032 0 2021 Brand New Day Harmony Care Plan (HMO C-SNP) www.bndhmo.com compliance@universalcare.com 5455 Garden Grove Blvd, Suite 500 Westminster CA 92683 8662554795 8662554795 711 711 8662554795 8662554795 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H0838 033 0 2021 Brand New Day Classic Choice Plan (HMO) www.bndhmo.com compliance@universalcare.com 5455 Garden Grove Blvd, Suite 500 Westminster CA 92683 8662554795 8662554795 711 711 8662554795 8662554795 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H0838 037 0 2021 Brand New Day Classic Care II Plan (HMO) www.bndhmo.com compliance@universalcare.com 5455 Garden Grove Blvd, Suite 500 Westminster CA 92683 8662554795 8662554795 711 711 8662554795 8662554795 711 711 This plan does not charge an annual deductible for all drugs. The $50.00 annual deductible only applies to drugs on certain tiers.~ H0838 039 1 2021 Brand New Day Embrace Care Plan (HMO C-SNP) www.bndhmo.com compliance@universalcare.com 5455 Garden Grove Blvd, Suite 500 Westminster CA 92683 8662554795 8662554795 711 711 8662554795 8662554795 711 711 H0838 039 2 2021 Brand New Day Embrace Care Plan (HMO C-SNP) www.bndhmo.com compliance@universalcare.com 5455 Garden Grove Blvd, Suite 500 Westminster CA 92683 8662554795 8662554795 711 711 8662554795 8662554795 711 711 H0838 040 1 2021 Brand New Day Embrace Choice Plan (HMO C-SNP) www.bndhmo.com compliance@universalcare.com 5455 Garden Grove Blvd, Suite 500 Westminster CA 92683 8662554795 8662554795 711 711 8662554795 8662554795 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H0838 040 2 2021 Brand New Day Embrace Choice Plan (HMO C-SNP) www.bndhmo.com compliance@universalcare.com 5455 Garden Grove Blvd, Suite 500 Westminster CA 92683 8662554795 8662554795 711 711 8662554795 8662554795 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H0838 042 0 2021 Brand New Day Select Care I Plan (HMO I-SNP) www.bndhmo.com compliance@universalcare.com 5455 Garden Grove Blvd, Suite 500 Westminster CA 92683 8662554795 8662554795 711 711 8662554795 8662554795 711 711 H0838 043 0 2021 Brand New Day Select Care II Plan (HMO I-SNP) www.bndhmo.com compliance@universalcare.com 5455 Garden Grove Blvd, Suite 500 Westminster CA 92683 8662554795 8662554795 711 711 8662554795 8662554795 711 711 H0838 044 0 2021 Brand New Day Select Choice I Plan (HMO I-SNP) www.bndhmo.com compliance@universalcare.com 5455 Garden Grove Blvd, Suite 500 Westminster CA 92683 8662554795 8662554795 711 711 8662554795 8662554795 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H0838 045 0 2021 Brand New Day Select Choice II Plan (HMO I-SNP) www.bndhmo.com compliance@universalcare.com 5455 Garden Grove Blvd, Suite 500 Westminster CA 92683 8662554795 8662554795 711 711 8662554795 8662554795 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H0885 001 0 2021 Braven Medicare Choice (PPO) www.bravenhealth.com 3 Penn Plaza East, PP- 12F Newark NJ 07105 8337131313 8337131313 711 711 8332728360 8332728360 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H0885 002 0 2021 Braven Medicare Freedom (PPO) www.bravenhealth.com 3 Penn Plaza East, PP- 12F Newark NJ 07105 8337131313 8337131313 711 711 8332728360 8332728360 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H0885 801 0 2021 Braven Medicare Group (PPO) www.bravenhealth.com 3 Penn Plaza East, PP- 12F Newark NJ 07105 8332728360 8332728360 711 711 8332728360 8332728360 711 711 H0885 802 0 2021 Braven Medicare Group w/Rx (PPO) www.bravenhealth.com 3 Penn Plaza East, PP- 12F Newark NJ 07105 8332728360 8332728360 711 711 8332728360 8332728360 711 711 H0885 803 0 2021 Braven Medicare Group w/Rx Ideal (PPO) www.bravenhealth.com 3 Penn Plaza East, PP- 12F Newark NJ 07105 8332728360 8332728360 711 711 8332728360 8332728360 711 711 H0885 804 0 2021 Braven Medicare Group w/Rx Complete (PPO) www.bravenhealth.com 3 Penn Plaza East, PP- 12F Newark NJ 07105 8332728360 8332728360 711 711 8332728360 8332728360 711 711 H0907 001 0 2021 Amerivantage Dual Coordination (HMO D-SNP) https://shop.amerigroup.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8555930903 8555930903 711 711 8335570950 8335570950 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0908 001 0 2021 Allwell Dual Medicare (HMO D-SNP) allwell.buckeyehealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8663897690 8663897690 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0908 801 0 2021 Allwell Group (HMO) allwell.buckeyehealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661851 8557661851 711 711 H0908 802 0 2021 Allwell Group (HMO) allwell.buckeyehealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661851 8557661851 711 711 H0908 803 0 2021 Allwell Group (HMO) allwell.buckeyehealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661851 8557661851 711 711 H0913 002 0 2021 WellCare Value (HMO-POS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H0913 013 0 2021 WellCare Liberty (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0913 015 0 2021 WellCare Compass (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H0913 017 0 2021 WellCare Focus (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H0927 001 0 2021 Blue Cross Community MMAI (Medicare-Medicaid Plan) www.bcbsil.com/mmai PO Box 3836 Scranton PA 18505 8777237702 8777237702 711 711 8777237702 8777237702 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H0969 001 0 2021 WellCare Premier (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $160.00 annual deductible only applies to drugs on certain tiers.~ H0969 002 0 2021 WellCare Prime (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H0982 001 0 2021 SOLIS SPF 001 (HMO) https://solishealthplans.com info@solishealthplans.com 9250 NW 36th Street, Suite 400 Miami FL 33178 8444476547 3054203079 711 711 8444476547 3054203079 711 711 H0982 002 0 2021 SOLIS SPF 002 (HMO D-SNP) https://solishealthplans.com info@solishealthplans.com 9250 NW 36th Street, Suite 400 Miami FL 33178 8444476547 3054203079 711 711 8444476547 3054203079 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0982 005 0 2021 SOLIS SPF 005 (HMO) https://solishealthplans.com info@solishealthplans.com 9250 NW 36th Street, Suite 400 Miami FL 33178 8444476547 3054203079 711 711 8444476547 3054203079 711 711 H0982 006 0 2021 SOLIS SPF 006 (HMO D-SNP) https://solishealthplans.com info@solishealthplans.com 9250 NW 36th Street, Suite 400 Miami FL 33178 8444476547 3054203079 711 711 8444476547 3054203079 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0982 007 0 2021 SOLIS SPF 007 (HMO) https://solishealthplans.com info@solishealthplans.com 9250 NW 36th Street, Suite 400 Miami FL 33178 8444476547 3054203079 711 711 8444476547 3054203079 711 711 H0982 008 0 2021 SOLIS SPF 008 (HMO) https://solishealthplans.com info@solishealthplans.com 9250 NW 36th Street, Suite 400 Miami FL 33178 8444476547 3054203079 711 711 8444476547 3054203079 711 711 H0982 009 0 2021 SOLIS SPF 009 (HMO) https://solishealthplans.com info@solishealthplans.com 9250 NW 36th Street, Suite 400 Miami FL 33178 8444476547 3054203079 711 711 8444476547 3054203079 711 711 H0982 010 0 2021 SOLIS SPF 010 (HMO D-SNP) https://solishealthplans.com info@solishealthplans.com 9250 NW 36th Street, Suite 400 Miami FL 33178 8444476547 3054203079 711 711 8444476547 3054203079 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0982 011 0 2021 SOLIS SPF 011 (HMO C-SNP) https://solishealthplans.com info@solishealthplans.com 9250 NW 36th Street, Suite 400 Miami FL 33178 8444476547 3054203079 711 711 8444476547 3054203079 711 711 H0982 012 0 2021 SOLIS SPF 012 (HMO D-SNP) https://solishealthplans.com info@solishealthplans.com 9250 NW 36th Street, Suite 400 Miami FL 33178 8444476547 3054203079 711 711 8444476547 3054203079 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H0982 013 0 2021 SOLIS SPF 013 (HMO D-SNP) https://solishealthplans.com info@solishealthplans.com 9250 NW 36th Street, Suite 400 Miami FL 33178 8444476547 3054203079 711 711 8444476547 3054203079 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1016 001 0 2021 AvMed Medicare Choice (HMO) www.avmed.org regulatory.correspondence@avmed.org 9400 S Dadeland Blvd, Suite 315 Miami FL 33156 8005359355 3056715437 21003 711 711 8007828633 3056715437 22147 711 711 H1016 021 0 2021 AvMed Medicare Choice (HMO) www.avmed.org regulatory.correspondence@avmed.org 9400 S Dadeland Blvd, Suite 315 Miami FL 33156 8005359355 3056715437 21003 711 711 8007828633 3056715437 22147 711 711 H1016 023 0 2021 AvMed Medicare Circle (HMO) www.avmed.org regulatory.correspondence@avmed.org 9400 S Dadeland Blvd, Suite 315 Miami FL 33156 8005359355 3056715437 21003 711 711 8007828633 3056715437 22147 711 711 H1016 024 0 2021 AvMed Medicare Circle (HMO) www.avmed.org regulatory.correspondence@avmed.org 9400 S Dadeland Blvd, Suite 315 Miami FL 33156 8005359355 3056715437 21003 711 711 8007828633 3056715437 22147 711 711 H1016 025 0 2021 AvMed Medicare Access (HMO-POS) www.avmed.org regulatory.correspondence@avmed.org 9400 S Dadeland Blvd, Suite 315 Miami FL 33156 8005359355 3056715437 21003 711 711 8007828633 3056715437 22147 711 711 H1016 026 0 2021 AvMed Medicare Access (HMO-POS) www.avmed.org regulatory.correspondence@avmed.org 9400 S Dadeland Blvd, Suite 315 Miami FL 33156 8005359355 3056715437 21003 711 711 8007828633 3056715437 22147 711 711 H1016 028 0 2021 AvMed Medicare Premium Saver (HMO) www.avmed.org regulatory.correspondence@avmed.org 9400 S Dadeland Blvd, Suite 315 Miami FL 33156 8005359355 3056715437 21003 711 711 8007828633 3056715437 22147 711 711 H1016 801 0 2021 AvMed Employer Group MAPD Plan (HMO) www.avmed.org regulatory.correspondence@avmed.org 9400 S Dadeland Blvd, Suite 315 Miami FL 33156 8005359355 3056715437 21003 711 711 8007828633 3056715437 22147 711 711 H1016 802 0 2021 AvMed Employer Group MA Only Plan (HMO) www.avmed.org regulatory.correspondence@avmed.org 9400 S Dadeland Blvd, Suite 315 Miami FL 33156 8005359355 3056715437 21003 711 711 8007828633 3056715437 22147 711 711 H1016 803 0 2021 AvMed Employer Group MAPD Non-CY Plan (HMO) www.avmed.org regulatory.correspondence@avmed.org 9400 S Dadeland Blvd, Suite 315 Miami FL 33156 8005359355 3056715437 21003 711 711 8007828633 3056715437 22147 711 711 H1016 804 0 2021 AvMed Employer Group MA Only Non-CY Plan (HMO) www.avmed.org regulatory.correspondence@avmed.org 9400 S Dadeland Blvd, Suite 315 Miami FL 33156 8005359355 3056715437 21003 711 711 8007828633 3056715437 22147 711 711 H1019 001 0 2021 CareOne (HMO) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 H1019 006 0 2021 CareOne PLUS (HMO) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 H1019 023 0 2021 CareNeeds PLUS (HMO D-SNP) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1019 026 0 2021 CareNeeds PLUS (HMO D-SNP) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1019 043 0 2021 CareOne (HMO) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 H1019 057 0 2021 CareOne PLUS (HMO-POS) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 H1019 065 0 2021 CareFree (HMO) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H1019 069 0 2021 CareOne (HMO) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 H1019 073 0 2021 CareNeeds PLUS (HMO D-SNP) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $355.00 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1019 076 0 2021 CareFree PLUS (HMO) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 H1019 089 0 2021 CareExtra (HMO) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 H1019 092 0 2021 CareFree (HMO) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 H1019 094 0 2021 CareFree (HMO) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H1019 098 0 2021 CareOne PLUS (HMO) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 H1019 099 0 2021 CareFree (HMO) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 H1019 102 0 2021 CareOne (HMO) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 H1019 103 1 2021 CareOne PLUS (HMO) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 H1019 103 2 2021 CareOne PLUS (HMO) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 H1019 104 1 2021 CareFree (HMO) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 H1019 104 2 2021 CareFree (HMO) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 H1019 105 0 2021 CareComplete (HMO C-SNP) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 H1019 106 0 2021 CareComplete (HMO C-SNP) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 H1019 107 0 2021 CareComplete (HMO C-SNP) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 H1019 108 0 2021 CareComplete (HMO C-SNP) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 H1019 109 0 2021 CareComplete (HMO C-SNP) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 H1019 110 0 2021 CareOne PLATINUM (HMO-POS) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 H1019 111 0 2021 CareOne PLATINUM (HMO) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 H1019 112 0 2021 CareOne PLATINUM (HMO) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 H1019 113 0 2021 CareOne PLATINUM (HMO) www.careplushealthplans.com cphp_memberservices@careplus-hp.com 11430 NW 20th St., Ste. 300 Miami FL 33172 8007944105 8007944105 711 711 8007945907 8007945907 711 711 H1032 040 0 2021 WellCare Dividend (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 124 0 2021 WellCare Access (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1032 170 0 2021 WellCare Access (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1032 175 0 2021 WellCare Liberty (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1032 176 0 2021 WellCare Liberty (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1032 182 0 2021 WellCare Select (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1032 184 0 2021 WellCare Guardian (HMO C-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 186 0 2021 WellCare Guardian (HMO C-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 189 0 2021 WellCare Dividend Prime (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 190 0 2021 WellCare Elite (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 191 0 2021 WellCare Dividend Prime (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 192 0 2021 WellCare Elite (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 193 0 2021 WellCare Dividend Prime (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 194 0 2021 WellCare Elite (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 195 0 2021 WellCare Dividend Prime (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 196 0 2021 WellCare Elite (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 197 0 2021 WellCare Reserve (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1032 198 0 2021 WellCare Dividend Prime (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 199 0 2021 WellCare Elite (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 200 0 2021 WellCare Dividend Prime (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 201 0 2021 WellCare Elite (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 202 0 2021 WellCare Reserve (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1032 203 0 2021 WellCare Champion (HMO C-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 204 0 2021 WellCare Dividend Prime (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 205 0 2021 WellCare Elite (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 206 0 2021 WellCare Reserve (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1032 209 0 2021 WellCare Dividend Prime (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 210 0 2021 WellCare Dividend Prime (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 211 0 2021 WellCare Elite (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 212 0 2021 WellCare Dividend Prime (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 213 0 2021 WellCare Elite (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 214 0 2021 WellCare Reserve (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1032 215 0 2021 WellCare Dividend Prime (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 216 0 2021 WellCare Elite (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 217 0 2021 WellCare Reserve (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1032 218 0 2021 WellCare Elite (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 224 0 2021 WellCare Guardian (HMO C-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 225 0 2021 WellCare Guardian (HMO C-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 226 0 2021 WellCare Guardian (HMO C-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 227 0 2021 WellCare Champion (HMO C-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 228 0 2021 WellCare Champion (HMO C-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 229 1 2021 WellCare Select (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1032 229 2 2021 WellCare Select (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1032 229 3 2021 WellCare Select (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1032 230 0 2021 WellCare Guardian (HMO C-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 231 0 2021 WellCare Champion (HMO C-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 232 0 2021 WellCare Guardian (HMO C-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1032 233 0 2021 WellCare Champion (HMO C-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1035 002 0 2021 FHCP Medicare Rx Plus (HMO-POS) www.fhcpmedicare.com MemberServices@fhcp.com 1510 Ridgewood Avenue Holly Hill FL 32117 8554623427 3866767110 8009558770 8009558770 8338666559 3866154022 8009558770 8009558770 H1035 006 0 2021 FHCP Medicare Rx (HMO) www.fhcpmedicare.com MemberServices@fhcp.com 1510 Ridgewood Avenue Holly Hill FL 32117 8554623427 3866767110 8009558770 8009558770 8338666559 3866154022 8009558770 8009558770 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H1035 011 0 2021 FHCP Medicare Premier Plus (HMO) www.fhcpmedicare.com MemberServices@fhcp.com 1510 Ridgewood Avenue Holly Hill FL 32117 8554623427 3866767110 8009558770 8009558770 8338666559 3866154022 8009558770 8009558770 H1035 014 0 2021 FHCP Medicare Rx Savings (HMO) www.fhcpmedicare.com MemberServices@fhcp.com 1510 Ridgewood Avenue Holly Hill FL 32117 8554623427 3866767110 8009558770 8009558770 8338666559 3866154022 8009558770 8009558770 This plan does not charge an annual deductible for all drugs. The $395.00 annual deductible only applies to drugs on certain tiers.~ H1035 016 0 2021 FHCP Medicare Flagler Advantage (HMO) www.fhcpmedicare.com MemberServices@fhcp.com 1510 Ridgewood Avenue Holly Hill FL 32117 8554623427 3866767110 8009558770 8009558770 8338666559 3866154022 8009558770 8009558770 H1035 017 0 2021 BlueMedicare Classic (HMO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 H1035 018 0 2021 BlueMedicare Classic (HMO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 H1035 019 0 2021 BlueMedicare Classic (HMO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 H1035 020 0 2021 BlueMedicare Classic (HMO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 H1035 021 0 2021 BlueMedicare Classic (HMO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 H1035 022 0 2021 BlueMedicare Premier (HMO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 H1035 023 0 2021 BlueMedicare Premier (HMO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 H1035 024 0 2021 BlueMedicare Premier (HMO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 H1035 025 0 2021 BlueMedicare Premier (HMO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 H1035 026 0 2021 BlueMedicare Premier (HMO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 H1035 027 0 2021 BlueMedicare Complete (HMO D-SNP) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1035 028 0 2021 BlueMedicare Complete (HMO D-SNP) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1035 029 0 2021 BlueMedicare Complete (HMO D-SNP) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1035 030 0 2021 BlueMedicare Complete (HMO D-SNP) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1035 031 0 2021 BlueMedicare Complete (HMO D-SNP) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1035 032 0 2021 BlueMedicare Complete (HMO D-SNP) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1035 033 0 2021 BlueMedicare Premier (HMO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 H1035 034 0 2021 BlueMedicare Premier (HMO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 H1035 035 0 2021 BlueMedicare Saver (HMO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 This plan does not charge an annual deductible for all drugs. The $50.00 annual deductible only applies to drugs on certain tiers.~ H1035 037 0 2021 BlueMedicare Saver (HMO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 This plan does not charge an annual deductible for all drugs. The $50.00 annual deductible only applies to drugs on certain tiers.~ H1035 038 0 2021 BlueMedicare Saver (HMO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 This plan does not charge an annual deductible for all drugs. The $50.00 annual deductible only applies to drugs on certain tiers.~ H1035 039 0 2021 BlueMedicare Saver (HMO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 H1035 040 0 2021 FHCP Medicare Premier Advantage (HMO) www.fhcpmedicare.com MemberServices@fhcp.com 1510 Ridgewood Avenue Holly Hill FL 32117 8554623427 3866767110 8009558770 8009558770 8338666559 3866154022 8009558770 8009558770 H1035 043 0 2021 BlueMedicare Premier (HMO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 H1035 044 0 2021 FHCP Medicare Choice (HMO-POS) www.fhcpmedicare.com MemberServices@fhcp.com 1510 Ridgewood Avenue Holly Hill FL 32117 8554623427 3866767110 8009558770 8009558770 8338666559 3866154022 8009558770 8009558770 This plan does not charge an annual deductible for all drugs. The $395.00 annual deductible only applies to drugs on certain tiers.~ H1035 045 0 2021 BlueMedicare Premier (HMO) FloridaBlue.com/medicare 4800 Deerwood Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 H1035 801 0 2021 BlueMedicare Group HMO (HMO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 200 / 4th Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 H1035 802 0 2021 BlueMedicare Group HMO (HMO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 200 / 4th Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 H1036 025 0 2021 Humana Gold Plus H1036-025 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 044 0 2021 Humana Gold Plus H1036-044 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 054 0 2021 Humana Gold Plus H1036-054C (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 056 0 2021 Humana Honor (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 062 0 2021 Humana Gold Plus H1036-062C (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 065 0 2021 Humana Gold Plus H1036-065C (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 068 0 2021 Humana Gold Plus H1036-068 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 074 0 2021 Humana Gold Plus H1036-074 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 077 0 2021 Humana Gold Plus SNP-DE H1036-077A (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1036 081 0 2021 Humana Gold Plus H1036-081D (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 102 0 2021 Humana Gold Plus SNP-DE H1036-102 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1036 103 0 2021 Humana Gold Plus SNP-DE H1036-103A (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1036 104 0 2021 Humana Gold Plus SNP-DE H1036-104A (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1036 119 0 2021 Humana Honor (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 121 0 2021 Humana Gold Plus - Diabetes (HMO C-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 137 0 2021 Humana Gold Plus H1036-137 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 140 0 2021 Humana Gold Plus H1036-140 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 143 0 2021 Humana Gold Plus H1036-143 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 146 0 2021 Humana Gold Plus H1036-146 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 151 0 2021 Humana Gold Plus H1036-151 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~ H1036 153 0 2021 Humana Gold Plus H1036-153 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H1036 156 0 2021 Humana Gold Plus - Diabetes (HMO C-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 157 0 2021 Humana Gold Plus H1036-157 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 160 0 2021 Humana Gold Plus - Diabetes (HMO C-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 167 0 2021 Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1036 168 0 2021 Humana Gold Plus SNP-DE H1036-168 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1036 171 0 2021 Humana Gold Plus H1036-171 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H1036 175 0 2021 Humana Gold Plus - Diabetes (HMO C-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 199 0 2021 Humana Gold Plus H1036-199 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H1036 209 0 2021 Humana Gold Plus SNP-DE H1036-209 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1036 210 0 2021 Humana Gold Plus SNP-DE H1036-210 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1036 213 0 2021 Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1036 214 0 2021 Humana Gold Plus SNP-DE H1036-214 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1036 217 0 2021 Humana Gold Plus H1036-217 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 219 0 2021 Humana Gold Plus H1036-219 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H1036 222 0 2021 Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1036 223 0 2021 Humana Gold Plus H1036-223 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $320.00 annual deductible only applies to drugs on certain tiers.~ H1036 226 0 2021 Humana Gold Plus SNP-DE H1036-226 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1036 229 0 2021 Humana Gold Plus H1036-229 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 230 0 2021 Humana Gold Plus H1036-230 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 231 0 2021 Humana Gold Plus SNP-DE H1036-231 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1036 233 0 2021 Humana Gold Plus H1036-233 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 234 0 2021 Humana Community HMO Diabetes and Heart (HMO C-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 235 0 2021 Humana Community HMO SNP-DE (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1036 236 0 2021 Humana Community (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 237 1 2021 Humana Gold Plus H1036-237 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 237 2 2021 Humana Gold Plus H1036-237 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 243 0 2021 Humana Gold Plus SNP-DE H1036-243 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1036 245 0 2021 Humana Gold Plus SNP-DE H1036-245 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1036 249 0 2021 Humana Gold Plus SNP-DE H1036-249 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1036 261 0 2021 Humana Gold Plus SNP-DE H1036-261 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1036 262 0 2021 Humana Gold Plus SNP-DE H1036-262 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1036 265 1 2021 Humana Gold Plus H1036-265 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 265 2 2021 Humana Gold Plus H1036-265 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 266 0 2021 Humana Gold Plus H1036-266 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 268 0 2021 Humana Gold Plus H1036-268 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 269 0 2021 Humana Gold Plus H1036-269 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 270 0 2021 Humana Gold Plus H1036-270 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 271 0 2021 Humana Gold Plus H1036-271 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 276 0 2021 Humana Gold Plus SNP-DE H1036-276 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1036 277 0 2021 Humana Gold Plus H1036-277 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 278 0 2021 Humana Gold Plus H1036-278 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 279 0 2021 Humana Honor (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 280 0 2021 Humana Fully Integrated H1036-280 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1036 281 0 2021 Humana Fully Integrated H1036-281 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1036 282 0 2021 Humana Fully Integrated H1036-282 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1036 283 0 2021 Humana Fully Integrated H1036-283 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1036 284 0 2021 Humana Gold Plus SNP-DE H1036-284 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1036 285 0 2021 Humana Gold Plus SNP-DE H1036-285 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1036 286 0 2021 Humana Gold Plus H1036-286-000 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 287 0 2021 Humana Honor (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 288 0 2021 Humana Honor (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 289 0 2021 Humana Honor (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 290 0 2021 Humana Honor (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 291 0 2021 Humana Gold Plus H1036-291 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1036 801 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H1036 806 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H1036 810 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H1036 811 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H1036 814 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H1036 815 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H1036 816 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H1036 817 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H1036 818 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H1036 819 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H1036 820 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H1036 821 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H1036 822 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H1036 823 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H1036 824 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H1036 825 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H1036 826 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H1036 827 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H1045 001 0 2021 Preferred Choice Dade (HMO) www.myPreferredCare.com P.O. Box 30770 Salt Lake City UT 84130 8774855595 8774855595 711 711 8662317201 8662317201 711 711 H1045 005 0 2021 Preferred Choice Broward (HMO) www.myPreferredCare.com P.O. Box 30770 Salt Lake City UT 84130 8774855595 8774855595 711 711 8662317201 8662317201 711 711 H1045 012 0 2021 Preferred Medicare Assist Plan 1 (HMO D-SNP) www.myPreferredCare.com P.O. Box 30769 Salt Lake City UT 84130 8774855595 8774855595 711 711 8662317201 8662317201 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1045 018 0 2021 Preferred Special Care Miami-Dade (HMO C-SNP) www.myPreferredCare.com P.O. Box 30770 Salt Lake City UT 84130 8774855595 8774855595 711 711 8662317201 8662317201 711 711 H1045 025 0 2021 UnitedHealthcare The Villages Medicare Advantage (HMO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8666277806 8666277806 711 711 H1045 026 0 2021 AARP Medicare Advantage (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8666277806 8666277806 711 711 H1045 028 0 2021 AARP Medicare Advantage (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H1045 030 0 2021 AARP Medicare Advantage (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H1045 031 0 2021 AARP Medicare Advantage (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8666277806 8666277806 711 711 H1045 032 0 2021 AARP Medicare Advantage (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8666277806 8666277806 711 711 H1045 033 0 2021 AARP Medicare Advantage (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8666277806 8666277806 711 711 H1045 034 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8666277806 8666277806 711 711 H1045 036 0 2021 AARP Medicare Advantage Focus (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8666277806 8666277806 711 711 H1045 037 0 2021 Preferred Choice Palm Beach (HMO) www.myPreferredCare.com P.O. Box 30770 Salt Lake City UT 84130 8774855595 8774855595 711 711 8662317201 8662317201 711 711 H1045 038 0 2021 Preferred Medicare Assist Palm Beach (HMO D-SNP) www.myPreferredCare.com P.O. Box 30769 Salt Lake City UT 84130 8774855595 8774855595 711 711 8662317201 8662317201 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1045 039 0 2021 UnitedHealthcare Dual Complete LP (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30769 Salt Lake City UT 84130 8888343721 8888343721 711 711 8668424968 8668424968 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1045 041 0 2021 AARP Medicare Advantage (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8666277806 8666277806 711 711 H1045 042 0 2021 AARP Medicare Advantage (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8666277806 8666277806 711 711 H1045 043 0 2021 AARP Medicare Advantage (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8666277806 8666277806 711 711 H1045 045 0 2021 AARP Medicare Advantage Focus (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8666277806 8666277806 711 711 H1045 046 0 2021 Preferred Complete Care (HMO) www.myPreferredCare.com P.O. Box 30770 Salt Lake City UT 84130 8774855595 8774855595 711 711 8662317201 8662317201 711 711 H1045 048 1 2021 UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H1045 048 2 2021 UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H1045 048 3 2021 UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H1045 048 4 2021 UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H1045 053 0 2021 Preferred Medicare Assist Plan 2 (HMO D-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8774855595 8774855595 711 711 8662317201 8662317201 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1045 801 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1045 802 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1045 803 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1099 001 0 2021 Health First Classic Plan (HMO-POS) myHFHP.org HFHPInfo@HF.org Health First Health Plans, 6450 US Highway 1 Rockledge FL 32955 8007167737 8007167737 8009558771 8009558771 8007167737 8007167737 8009558771 8009558771 H1099 006 0 2021 Health First Value Plan (HMO) myHFHP.org HFHPInfo@HF.org Health First Health Plans, 6450 US Highway 1 Rockledge FL 32955 8007167737 8007167737 8009558771 8009558771 8007167737 8007167737 8009558771 8009558771 H1099 009 0 2021 Health First Secure Plan (HMO) myHFHP.org HFHPInfo@HF.org Health First Health Plans, 6450 US Highway 1 Rockledge FL 32955 8007167737 8007167737 8009558771 8009558771 8007167737 8007167737 8009558771 8009558771 H1099 014 0 2021 Health First Rewards Plan (HMO) myHFHP.org HFHPInfo@HF.org Health First Health Plans, 6450 US Highway 1 Rockledge FL 32955 8007167737 8007167737 8009558771 8009558771 8007167737 8007167737 8009558771 8009558771 H1099 016 0 2021 AdventHealth SunSaver Plan (HMO) myAHplan.com HFHPInfo@HF.org AdventHealth Advantage Plans, 6450 US Highway 1 Rockledge FL 32955 8775358278 8775358278 8009558771 8009558771 8775358278 8775358278 8009558771 8009558771 H1099 802 0 2021 Employer Group Plus (HMO) myHFHP.org HFHPInfo@HF.org Health First Health Plans, 6450 US Highway 1 Rockledge FL 32955 8007167737 8007167737 8009558771 8009558771 8007167737 8007167737 8009558771 8009558771 H1099 804 0 2021 Employer Group POS (HMO-POS) myHFHP.org HFHPInfo@HF.org Health First Health Plans, 6450 US Highway 1 Rockledge FL 32955 8007167737 8007167737 8009558771 8009558771 8007167737 8007167737 8009558771 8009558771 H1100 001 0 2021 Innovation Health-Aetna Medicare Voyager (PPO) www.innovationhealthmedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8556055295 8556055295 711 711 8552491282 8552491282 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H1100 002 0 2021 Innovation Health-Aetna Medicare Premier (PPO) www.innovationhealthmedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8556055295 8556055295 711 711 8552491282 8552491282 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H1109 005 0 2021 Aetna Medicare Select Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H1109 006 0 2021 Aetna Medicare Select Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H1109 801 0 2021 Aetna Medicare Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H1109 802 0 2021 Aetna Medicare Plan w/Rx (HMO) www.aetnamedicare.com HicksJS@aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H1111 009 1 2021 AARP Medicare Advantage Walgreens (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H1111 009 2 2021 AARP Medicare Advantage Walgreens (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H1111 801 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1111 804 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1111 805 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1112 006 0 2021 WellCare Access (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1112 033 0 2021 WellCare Liberty (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1112 034 0 2021 WellCare Patriot (HMO-POS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H1112 035 0 2021 WellCare Choice (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H1112 037 0 2021 WellCare Guardian (HMO C-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H1112 038 0 2021 WellCare Value (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H1112 039 0 2021 WellCare Value (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H1112 040 0 2021 WellCare Focus (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H1112 042 0 2021 WellCare Dividend (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H1112 043 0 2021 WellCare Compass (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H1112 044 0 2021 WellCare Value (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H1119 001 0 2021 Valor Health Plan (HMO I-SNP) www.valorhealthplan.com info@valorhealthplan.com One Riverfront Place, Suite 525 Little Rock AR 72114 8004853793 5012550109 711 711 8004853793 5012550109 711 711 H1142 001 0 2021 Bright Advantage (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H1142 002 0 2021 Bright Advantage Plus (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H1142 003 0 2021 Bright Advantage University Hospitals (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H1142 013 0 2021 Bright Advantage (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H1142 801 0 2021 Bright Advantage University Hospitals Group (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H1170 002 0 2021 Kaiser Permanente Senior Advantage Enhanced (HMO) kp.org/medicare 3495 Piedmont Road Northeast, Building 9 Atlanta GA 30305 8774083493 8774083493 711 711 8002324404 8002324404 711 711 H1170 008 0 2021 Senior Advantage Medicare Medicaid Plan (HMO D-SNP) kp.org/medicare 3495 Piedmont Road Northeast, Building 9 Atlanta GA 30305 8774083493 8774083493 711 711 8002324404 8002324404 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1170 009 0 2021 Kaiser Permanente Senior Advantage Basic (HMO) kp.org/medicare 3495 Piedmont Road Northeast, Building 9 Atlanta GA 30305 8774083493 8774083493 711 711 8002324404 8002324404 711 711 H1170 801 0 2021 Kaiser Permanente Employer Group Plan (HMO) kp.org/medicare 3495 Piedmont Road Northeast, Building 9 Atlanta GA 30305 8774083493 8774083493 711 711 8002324404 8002324404 711 711 H1170 802 0 2021 Kaiser Employer Group With Part D (HMO) kp.org/medicare 3495 Piedmont Road Northeast, Building 9 Atlanta GA 30305 8774083493 8774083493 711 711 8002324404 8002324404 711 711 H1170 805 0 2021 FEHB Part AB with D (HMO) kp.org/medicare 3495 Piedmont Road, Building 10 Atlanta GA 30305 8774083493 8774083493 711 711 8002324404 8002324404 711 711 H1189 001 0 2021 CHRISTUS Health Plan Generations (HMO) http://www.christushealthplan.org P.O. Box 169009 Irving TX 75016 8442823026 8442823026 711 711 8442823026 8442823026 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H1189 002 0 2021 CHRISTUS Health Plan Generations Plus (HMO) http://www.christushealthplan.org P.O. Box 169009 Irving TX 75016 8442823026 8442823026 711 711 8442823026 8442823026 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H1189 003 0 2021 CHRISTUS Health Plan Generations (HMO) http://www.christushealthplan.org/ P.O. Box 169009 Irving TX 75016 8442823026 8442823026 711 711 8442823026 8442823026 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H1189 004 0 2021 CHRISTUS Health Plan Generations Plus (HMO) http://www.christushealthplan.org/ P.O. Box 169009 Irving TX 75016 8442823026 8442823026 711 711 8442823026 8442823026 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H1205 001 0 2021 Integra Harmony (HMO D-SNP) www.integramanagedcare.com 1981 Marcus Avenue, Suite 100 Lake Success NY 11042 8773885190 8773885190 711 711 8773885195 8773885195 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1205 002 0 2021 Integra Synergy Medicaid Advantage Plus (MAP) (HMO D-SNP) www.integramanagedcare.com 1981 Marcus Avenue, Suite 100 Lake Success NY 11042 8773885190 8773885190 711 711 8773885195 8773885195 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1205 005 0 2021 Integra Harmony (HMO D-SNP) www.integramanagedcare.com 1981 Marcus Avenue, Suite 100 Lake Success NY 11042 8773885190 8773885190 711 711 8773885195 8773885195 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1205 006 0 2021 Integra Synergy Medicaid Advantage Plus (MAP) (HMO D-SNP) www.integramanagedcare.com 1981 Marcus Avenue, Suite 100 Lake Success NY 11042 8773885190 8773885190 711 711 8773885195 8773885195 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1205 007 0 2021 Integra Balanced Medicaid Advantage (HMO D-SNP) www.integramanagedcare.com 1981 Marcus Avenue, Suite 100 Lake Success NY 11042 8773885190 8773885190 711 711 8773885195 8773885195 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1205 008 0 2021 Integra Balanced Medicaid Advantage (HMO D-SNP) www.integramanagedcare.com 1981 Marcus Avenue, Suite 100 Lake Success NY 11042 8773885190 8773885190 711 711 8773885195 8773885195 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1225 001 0 2021 Johns Hopkins Advantage MD (HMO) www.hopkinsmedicare.com/ P.O. Box 3538 Scranton PA 18505 8884037682 8884037682 711 711 8772934998 8772934998 711 711 H1225 002 0 2021 Johns Hopkins Advantage MD (HMO) www.hopkinsmedicare.com/ P.O. Box 3538 Scranton PA 18505 8884037682 8884037682 711 711 8772934998 8772934998 711 711 H1230 001 0 2021 Kaiser Permanente Senior Advantage Enhanced (HMO) kp.org/medicare 711 Kapiolani Blvd Honolulu HI 96813 8774083494 8774083494 711 711 8008052739 8008052739 711 711 H1230 003 0 2021 Kaiser Permanente Senior Advantage Basic (HMO) kp.org/medicare 711 Kapiolani Blvd Honolulu HI 96813 8774083494 8774083494 711 711 8008052739 8008052739 711 711 H1230 008 0 2021 Senior Advantage Medicare Medicaid (HMO D-SNP) kp.org/medicare 711 Kapiolani Blvd Honolulu HI 96813 8774083494 8774083494 711 711 8008052739 8008052739 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1230 013 0 2021 Kaiser Permanente Senior Advantage Maui (HMO) kp.org/medicare 711 Kapiolani Blvd Honolulu HI 96813 8774083494 8774083494 711 711 8008052739 8008052739 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H1230 014 0 2021 Kaiser Permanente Senior Advantage Hawaii Island (HMO) kp.org/medicare 711 Kapiolani Blvd Honolulu HI 96813 8774083494 8774083494 711 711 8008052739 8008052739 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H1230 801 0 2021 Kaiser Permanente Employer Group MA only (HMO) kp.org/medicare 711 Kapiolani Blvd Honolulu HI 96813 8774083494 8774083494 711 711 8008052739 8008052739 711 711 H1230 803 0 2021 Kaiser Permanente Employer Group MA-PD (HMO) kp.org/medicare 711 Kapiolani Blvd Honolulu HI 96813 8774083494 8774083494 711 711 8008052739 8008052739 711 711 H1230 805 0 2021 FEHB AB with D (HMO) kp.org/medicare 711 Kapiolani Blvd Honolulu HI 96813 8774083494 8774083494 711 711 8008052739 8008052739 711 711 H1248 001 0 2021 Blue Advantage (PPO) www.bcbsla.com/blueadvantage customerservice@blueadvantage.bcbsla.com 5525 Reitz Ave Baton Rouge LA 70809 8003639152 8003639152 711 711 8665087145 8665087145 711 711 This plan's deductible only applies to out-of-network services.~ H1248 002 0 2021 Blue Advantage (PPO) www.bcbsla.com/blueadvantage customerservice@blueadvantage.bcbsla.com 5525 Reitz Ave Baton Rouge LA 70809 8003639152 8003639152 711 711 8665087145 8665087145 711 711 This plan's deductible only applies to out-of-network services.~ H1248 003 0 2021 Blue Advantage (PPO) www.bcbsla.com/blueadvantage customerservice@blueadvantage.bcbsla.com 5525 Reitz Ave Baton Rouge LA 70809 8003639152 8003639152 711 711 8665087145 8665087145 711 711 This plan's deductible only applies to out-of-network services.~ H1248 004 0 2021 Blue Advantage (PPO) www.bcbsla.com/blueadvantage customerservice@blueadvantage.bcbsla.com 5525 Reitz Ave Baton Rouge LA 70809 8003639152 8003639152 711 711 8665087145 8665087145 711 711 This plan's deductible only applies to out-of-network services.~ H1248 005 0 2021 Blue Advantage (PPO) www.bcbsla.com/blueadvantage customerservice@blueadvantage.bcbsla.com 5525 Reitz Ave Baton Rouge LA 70809 8003639152 8003639152 711 711 8665087145 8665087145 711 711 This plan's deductible only applies to out-of-network services.~ H1248 006 0 2021 Blue Advantage (PPO) www.bcbsla.com/blueadvantage customerservice@blueadvantage.bcbsla.com 5525 Reitz Ave Baton Rouge LA 70809 8003639152 8003639152 711 711 8665087145 8665087145 711 711 This plan's deductible only applies to out-of-network services.~ H1248 801 0 2021 Blue Advantage (PPO) www.bcbsla.com/blueadvantage customerservice@blueadvantage.bcbsla.com 5525 Reitz Ave Baton Rouge LA 70809 8003639152 8003639152 711 711 8665087145 8665087145 711 711 H1248 802 0 2021 Blue Advantage (PPO) www.bcbsla.com/blueadvantage customerservice@blueadvantage.bcbsla.com 5525 Reitz Ave Baton Rouge LA 70809 8003639152 8003639152 711 711 8665087145 8665087145 711 711 H1248 803 0 2021 Blue Advantage (PPO) www.bcbsla.com/blueadvantage customerservice@blueadvantage.bcbsla.com 5525 Reitz Ave Baton Rouge LA 70809 8003639152 8003639152 711 711 8665087145 8665087145 711 711 H1277 001 0 2021 Align Thrive (HMO I-SNP) www.alignseniorcare.com 10900 Nuckols Road, Suite 110 Glen Allen VA 23060 8442057244 8442057244 711 711 8442057244 8442057244 711 711 H1277 002 0 2021 Align Connect (HMO C-SNP) www.alignseniorcare.com 10900 Nuckols Road, Suite 110 Glen Allen VA 23060 8442057244 8442057244 711 711 8442057244 8442057244 711 711 H1278 001 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H1278 003 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $255.00 annual deductible only applies to drugs on certain tiers.~ H1278 004 0 2021 AARP Medicare Advantage Walgreens (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $345.00 annual deductible only applies to drugs on certain tiers.~ H1278 005 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $345.00 annual deductible only applies to drugs on certain tiers.~ H1278 007 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H1278 009 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H1278 010 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $255.00 annual deductible only applies to drugs on certain tiers.~ H1278 013 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $345.00 annual deductible only applies to drugs on certain tiers.~ H1278 014 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $245.00 annual deductible only applies to drugs on certain tiers.~ H1278 015 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $345.00 annual deductible only applies to drugs on certain tiers.~ H1278 016 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $245.00 annual deductible only applies to drugs on certain tiers.~ H1278 018 0 2021 AARP Medicare Advantage Patriot (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H1278 019 0 2021 AARP Medicare Advantage Patriot (PPO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H1290 001 0 2021 Devoted Health Core Miami-Dade (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 H1290 002 0 2021 Devoted Health Core Broward (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 H1290 003 0 2021 Devoted Health Core Palm Beach (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 H1290 004 0 2021 Devoted Health Core Greater Tampa Bay (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 H1290 005 0 2021 Devoted Health Core Greater Orlando (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 H1290 006 0 2021 Devoted Health Prime Miami-Dade (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H1290 007 0 2021 Devoted Health Prime Broward (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H1290 008 0 2021 Devoted Health Prime Palm Beach (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H1290 009 0 2021 Devoted Health Prime Greater Tampa Bay (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H1290 010 0 2021 Devoted Health Prime Greater Orlando (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H1290 013 0 2021 Devoted Health Essentials Miami-Dade (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 H1290 014 0 2021 Devoted Health Essentials Broward (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 H1290 015 0 2021 Devoted Health Essentials Palm Beach (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 H1290 016 0 2021 Devoted Health Essentials Greater Tampa Bay (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 H1290 017 0 2021 Devoted Health Essentials Polk (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 H1290 018 0 2021 Devoted Health Essentials Greater Orlando (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 H1290 019 0 2021 Devoted Health Dual Miami-Dade (HMO D-SNP) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1290 020 0 2021 Devoted Health Dual Broward (HMO D-SNP) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1290 021 0 2021 Devoted Health Dual Palm Beach (HMO D-SNP) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1290 022 0 2021 Devoted Health Dual Greater Orlando (HMO D-SNP) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1290 023 0 2021 Devoted Health Dual Greater Jacksonville (HMO D-SNP) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1290 024 0 2021 Devoted Health Dual Greater Tampa Bay (HMO D-SNP) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1290 025 0 2021 Devoted Health Core Manatee (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 H1290 026 0 2021 Devoted Health Prime Manatee (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 H1290 027 0 2021 Devoted Health Core (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 H1290 028 0 2021 Devoted Health Prime (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 H1290 029 0 2021 Devoted Health Core Greater Jacksonville (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 H1290 030 0 2021 Devoted Health Prime Greater Jacksonville (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 H1290 031 0 2021 Devoted Health Essentials Greater Jacksonville (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 H1290 032 0 2021 Devoted Health Essentials Manatee (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 H1302 004 0 2021 Secure Blue no Rx (PPO) medicare.bcidaho.com MACS@bcidaho.com P.O. Box 8406 Boise ID 83707 8884922583 2082863673 711 711 8884942583 2083958200 711 711 H1302 802 0 2021 Secure Blue Employer (PPO) www.bcidaho.com/medicare MACS@bcidaho.com P.O. Box 8406 Boise ID 83707 8884922583 2082863673 711 711 8884942583 2083958200 711 711 H1304 001 0 2021 Regence Valiance (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8005418981 8005418981 711 711 H1304 004 0 2021 Regence MedAdvantage + Rx Enhanced (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8005418981 8005418981 711 711 H1304 011 1 2021 Regence MedAdvantage + Rx Primary (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8005418981 8005418981 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H1304 011 2 2021 Regence MedAdvantage + Rx Primary (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8005418981 8005418981 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H1304 012 1 2021 Regence MedAdvantage + Rx Classic (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8005418981 8005418981 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H1304 012 2 2021 Regence MedAdvantage + Rx Classic (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8005418981 8005418981 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H1304 803 0 2021 Regence MedAdvantage (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883198904 8883198904 711 711 8883198904 8883198904 711 711 H1304 804 0 2021 Regence MedAdvantage + Rx (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883198904 8883198904 711 711 8883198904 8883198904 711 711 H1304 805 0 2021 Regence MedAdvantage + Rx 02 (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883198904 8883198904 711 711 8883198904 8883198904 711 711 H1304 806 0 2021 Regence MedAdvantage + Rx 03 (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883198904 8883198904 711 711 8883198904 8883198904 711 711 H1350 006 0 2021 True Blue no Rx (HMO) medicare.bcidaho.com MACS@bcidaho.com P.O. Box 8406 Boise ID 83707 8884922583 2082863673 711 711 8884942583 2083958200 711 711 H1350 009 0 2021 True Blue Special Needs Plan (HMO D-SNP) idahotruebluesnp.com MACS@bcidaho.com P.O. Box 8406 Boise ID 83707 8884952583 2082863675 711 711 8884952583 2082863675 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1350 015 1 2021 True Blue Rx Option I (HMO) medicare.bcidaho.com MACS@bcidaho.com P.O. Box 8406 Boise ID 83707 8884922583 2082863673 711 711 8884942583 2083958200 711 711 H1350 015 2 2021 True Blue Rx Option I (HMO) medicare.bcidaho.com MACS@bcidaho.com P.O. Box 8406 Boise ID 83707 8884922583 2082863673 711 711 8884942583 2083958200 711 711 H1350 016 1 2021 True Blue Rx Option II (HMO) medicare.bcidaho.com MACS@bcidaho.com P.O. Box 8406 Boise ID 83707 8884922583 2082863673 711 711 8884942583 2083958200 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H1350 016 2 2021 True Blue Rx Option II (HMO) medicare.bcidaho.com MACS@bcidaho.com P.O. Box 8406 Boise ID 83707 8884922583 2082863673 711 711 8884942583 2083958200 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H1350 019 1 2021 True Blue Rx (HMO) medicare.bcidaho.com MACS@bcidaho.com P.O. Box 8406 Boise ID 83707 8884922583 2082863673 711 711 8884942583 2083958200 711 711 This plan does not charge an annual deductible for all drugs. The $125.00 annual deductible only applies to drugs on certain tiers.~ H1350 019 2 2021 True Blue Rx (HMO) medicare.bcidaho.com MACS@bcidaho.com P.O. Box 8406 Boise ID 83707 8884922583 2082863673 711 711 8884942583 2083958200 711 711 This plan does not charge an annual deductible for all drugs. The $125.00 annual deductible only applies to drugs on certain tiers.~ H1350 021 0 2021 True Blue Rx Preferred (HMO) medicare.bcidaho.com MACS@bcidaho.com P.O. Box 8406 Boise ID 83707 8884922583 2082863673 711 711 8884942583 2083958200 711 711 This plan does not charge an annual deductible for all drugs. The $185.00 annual deductible only applies to drugs on certain tiers.~ H1350 023 1 2021 True Blue Rx | St. Luke's Health Partners (HMO) medicare.bcidaho.com MACS@bcidaho.com P.O. Box 8406 Boise ID 83707 8884922583 2082863673 711 711 8884942583 2083958200 711 711 This plan does not charge an annual deductible for all drugs. The $125.00 annual deductible only applies to drugs on certain tiers.~ H1350 023 2 2021 True Blue Rx | St. Luke's Health Partners (HMO) medicare.bcidaho.com MACS@bcidaho.com P.O. Box 8406 Boise ID 83707 8884922583 2082863673 711 711 8884942583 2083958200 711 711 This plan does not charge an annual deductible for all drugs. The $125.00 annual deductible only applies to drugs on certain tiers.~ H1350 024 1 2021 True Blue Rx Gem (HMO) medicare.bcidaho.com MACS@bcidaho.com P.O. Box 8406 Boise ID 83707 8884922583 2082863673 711 711 8884942583 2083958200 711 711 This plan does not charge an annual deductible for all drugs. The $190.00 annual deductible only applies to drugs on certain tiers.~ H1350 024 2 2021 True Blue Rx Gem (HMO) medicare.bcidaho.com MACS@bcidaho.com P.O. Box 8406 Boise ID 83707 8884922583 2082863673 711 711 8884942583 2083958200 711 711 This plan does not charge an annual deductible for all drugs. The $190.00 annual deductible only applies to drugs on certain tiers.~ H1350 024 3 2021 True Blue Rx Gem (HMO) medicare.bcidaho.com MACS@bcidaho.com P.O. Box 8406 Boise ID 83707 8884922583 2082863673 711 711 8884942583 2083958200 711 711 This plan does not charge an annual deductible for all drugs. The $190.00 annual deductible only applies to drugs on certain tiers.~ H1350 025 0 2021 True Blue Special Needs Plan (HMO D-SNP) idahotruebluesnp.com MACS@bcidaho.com P.O. Box 8406 Boise ID 83707 8884952583 2082863675 711 711 8884952583 2082863675 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1350 026 0 2021 True Blue Rx Essentials (HMO) medicare.bcidaho.com MACS@bcidaho.com P.O. Box 8406 Boise ID 83707 8884922583 2082863673 711 711 8884942583 2083958200 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H1350 803 0 2021 True Blue Employer (HMO) medicare.bcidaho.com MACS@bcidaho.com P.O. Box 8406 Boise ID 83707 8884922583 2082863673 711 711 8884942583 2083958200 711 711 H1350 804 0 2021 True Blue Employer (HMO) medicare.bcidaho.com MACS@bcidaho.com P.O. Box 8406 Boise ID 83707 8884922583 2082863673 711 711 8884942583 2083958200 711 711 H1350 805 0 2021 True Blue Employer (HMO) medicare.bcidaho.com MACS@bcidaho.com P.O. Box 8406 Boise ID 83707 8884922583 2082863673 711 711 8884942583 2083958200 711 711 H1350 806 0 2021 True Blue Employer (HMO-POS) medicare.bcidaho.com MACS@bcidaho.com P.O. Box 8406 Boise ID 83707 8884922583 2082863673 711 711 8884942583 2083958200 711 711 H1350 807 0 2021 True Blue Employer (HMO-POS) medicare.bcidaho.com MACS@bcidaho.com P.O. Box 8406 Boise ID 83707 8884922583 2082863673 711 711 8884942583 2083958200 711 711 H1350 808 0 2021 True Blue Employer (HMO) medicare.bcidaho.com MACS@bcidaho.com P.O. Box 8406 Boise ID 83707 8884922583 2082863673 711 711 8884942583 2083958200 711 711 H1350 809 0 2021 True Blue Employer (HMO) medicare.bcidaho.com MACS@bcidaho.com P.O. Box 8406 Boise ID 83707 8884922583 2082863673 711 711 8884942583 2083958200 711 711 H1350 810 0 2021 True Blue Employer (HMO-POS) medicare.bcidaho.com MACS@bcidaho.com P.O. Box 8406 Boise ID 83707 8884922583 2082863673 711 711 8884942583 2083958200 711 711 H1350 811 0 2021 True Blue Employer (HMO-POS) medicare.bcidaho.com MACS@bcidaho.com P.O. Box 8406 Boise ID 83707 8884922583 2082863673 711 711 8884942583 2083958200 711 711 H1352 001 0 2021 Blue Medicare Advantage Complete (HMO) www.MedicareBlueKC.com Blue Medicare Advantage, 2301 Main Street Kansas City MO 64108 8552088246 8163953152 711 711 8665087140 8665087140 711 711 H1352 002 0 2021 Blue Medicare Advantage Plus (HMO) www.MedicareBlueKC.com Blue Medicare Advantage, 2301 Main Street Kansas City MO 64108 8552088246 8163953152 711 711 8665087140 8665087140 711 711 H1352 003 0 2021 Blue Medicare Advantage Spira Care (HMO) www.MedicareBlueKC.com Blue Medicare Advantage, 2301 Main Street Kansas City MO 64108 8552088246 8163953152 711 711 8777747265 8777747265 711 711 H1352 801 0 2021 Blue Medicare Advantage Employer Group Plan MA-CY (HMO) www.MedicareBlueKC.com Blue Medicare Advantage, 2301 Main Street Kansas City MO 64108 8552088246 8163953152 711 711 8665087140 8665087140 711 711 H1352 803 0 2021 Blue Medicare Advantage Employer Group Plan MAPDCY (HMO) www.MedicareBlueKC.com Blue Medicare Advantage, 2301 Main Street Kansas City MO 64108 8552088246 8163953152 711 711 8665087140 8665087140 711 711 H1352 804 0 2021 Blue Medicare Advantage Employer Group Plan MAPDBY (HMO) www.MedicareBlueKC.com Blue Medicare Advantage, 2301 Main Street Kansas City MO 64108 8552088246 8163953152 711 711 8665087140 8665087140 711 711 H1353 001 0 2021 WellCare Value (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1353 002 0 2021 WellCare Access (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1353 004 0 2021 WellCare Liberty (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1353 005 0 2021 WellCare Value (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1353 006 0 2021 WellCare Dividend (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H1360 001 0 2021 UnitedHealthcare Dual Complete (HMO D-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8664801086 8664801086 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1365 001 0 2021 Martin's Point Generations Advantage Select (PPO) MartinsPoint.org/Advantage gamemberservices@martinspoint.org P.O. Box 9746, 331 Veranda Street Portland ME 04104 8886404423 8886404423 711 711 8665447504 8665447504 711 711 H1365 002 0 2021 Martin's Point Generations Advantage Select (PPO) MartinsPoint.org/Advantage gamemberservices@martinspoint.org P.O. Box 9746, 331 Veranda Street Portland ME 04104 8886404423 8886404423 711 711 8665447504 8665447504 711 711 H1365 802 0 2021 Martin's Point Generations Advantage Premier Group (PPO) MartinsPoint.org/Advantage P.O. Box 9746, 331 Veranda Street Portland ME 04104 8886404423 8886404423 711 711 8665447504 8665447504 711 711 H1365 803 0 2021 Martin's Point Generations Advantage Premier Group (PPO) MartinsPoint.org/Advantage P.O. Box 9746, 331 Veranda Street Portland ME 04104 8886404423 8886404423 711 711 8665447504 8665447504 711 711 H1372 001 0 2021 AgeRight Advantage Health Plan (HMO I-SNP) www.agerightadvantage.com PO Box 4440 Glen Allen VA 23058 8448546885 8448546885 711 711 8448546885 8448546885 711 711 H1375 001 0 2021 UnitedHealthcare Dual Complete (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8009334017 8009334017 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1375 002 0 2021 UnitedHealthcare Dual Complete (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8009334017 8009334017 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1393 001 0 2021 Bright Advantage Choice (PPO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H1393 002 0 2021 Bright Advantage Choice Plus (PPO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H1393 003 0 2021 Bright Advantage Choice (PPO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H1393 004 0 2021 Bright Advantage Assist (PPO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H1415 013 0 2021 Cigna Fundamental Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8888861993 8888861993 711 711 8006683813 8006683813 711 711 H1415 021 0 2021 Cigna Premier Medicare (HMO-POS) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8888861993 8888861993 711 711 8006683813 8006683813 711 711 H1415 024 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8888861993 8888861993 711 711 8006683813 8006683813 711 711 H1416 009 0 2021 WellCare Value (HMO-POS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1416 023 0 2021 WellCare Compass (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H1416 026 0 2021 WellCare Essential (HMO-POS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1416 033 0 2021 WellCare Access (HMO-POS D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1416 034 0 2021 WellCare Access (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1416 035 0 2021 WellCare Access (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1416 036 0 2021 WellCare Access (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1416 039 0 2021 WellCare Dividend (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1416 041 0 2021 WellCare Compass (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H1416 042 0 2021 WellCare Compass (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H1416 043 0 2021 WellCare Liberty (HMO-POS D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1416 044 0 2021 WellCare Liberty (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1416 048 0 2021 WellCare Plus (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H1416 053 0 2021 WellCare Patriot (HMO-POS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1416 055 0 2021 WellCare Preferred (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1416 056 0 2021 WellCare Value (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H1416 057 0 2021 WellCare Value (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H1416 058 0 2021 WellCare Patriot (HMO-POS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1416 059 0 2021 WellCare Patriot (HMO-POS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H1416 060 0 2021 WellCare Patriot (HMO-POS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1416 061 0 2021 WellCare Patriot (HMO-POS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1416 064 0 2021 WellCare Dividend (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1416 065 0 2021 WellCare Dividend (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H1416 066 0 2021 WellCare Guardian (HMO C-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1416 067 1 2021 WellCare Value (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H1416 067 2 2021 WellCare Value (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H1416 068 0 2021 WellCare Compass (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H1416 069 1 2021 WellCare Value (HMO-POS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1416 069 2 2021 WellCare Value (HMO-POS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1416 069 3 2021 WellCare Value (HMO-POS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1423 001 0 2021 Amerivantage Lung Care Plus (HMO C-SNP) https://shop.amerigroup.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930904 8555930904 711 711 8888162790 8888162790 711 711 H1423 002 0 2021 Amerivantage Diabetes Care Plus (HMO C-SNP) https://shop.amerigroup.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930904 8555930904 711 711 8888162790 8888162790 711 711 H1423 003 0 2021 Amerivantage Heart Care Plus (HMO C-SNP) https://shop.amerigroup.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930904 8555930904 711 711 8888162790 8888162790 711 711 H1423 004 0 2021 Amerivantage Classic Plus (HMO) https://shop.amerigroup.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930905 8555930905 711 711 8888162790 8888162790 711 711 H1423 005 0 2021 Amerivantage Smart Value Plus (HMO) https://shop.amerigroup.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930905 8555930905 711 711 8888162790 8888162790 711 711 H1423 007 0 2021 Amerivantage CareMore Care To You Plus (HMO I-SNP) https://shop.amerigroup.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930906 8555930906 711 711 8888162790 8888162790 711 711 H1423 008 0 2021 Amerivantage CareMore Care To You Plus (HMO I-SNP) https://shop.amerigroup.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930906 8555930906 711 711 8888162790 8888162790 711 711 H1426 001 0 2021 Choice (HMO) www.VitalityHP.net 18000 Studebaker Road, Suite 960 Cerritos CA 90703 8663333530 8663333530 711 711 8663333530 8663333530 711 711 Available to current members only.~ H1426 002 0 2021 Choice (HMO) www.VitalityHP.net 18000 Studebaker Road, Suite 960 Cerritos CA 90703 8663333530 8663333530 711 711 8663333530 8663333530 711 711 Available to current members only.~ H1426 003 0 2021 Plus (HMO) www.VitalityHP.net 18000 Studebaker Road, Suite 960 Cerritos CA 90703 8663333530 8663333530 711 711 8663333530 8663333530 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Available to current members only.~ H1436 002 0 2021 Allwell Medicare (HMO) allwell.absolutetotalcare.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661497 8557661497 711 711 H1436 004 0 2021 Allwell Medicare (HMO) allwell.absolutetotalcare.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661497 8557661497 711 711 H1436 005 0 2021 Allwell Dual Medicare (HMO D-SNP) allwell.absolutetotalcare.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661497 8557661497 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1436 801 0 2021 Allwell Group (HMO) allwell.absolutetotalcare.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661497 8557661497 711 711 H1436 802 0 2021 Allwell Group (HMO) allwell.absolutetotalcare.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661497 8557661497 711 711 H1436 803 0 2021 Allwell Group (HMO) allwell.absolutetotalcare.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661497 8557661497 711 711 H1463 003 0 2021 Health Alliance Medicare HMO 20 Rx (HMO) www.healthalliancemedicare.org MemberServices@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8883829771 8883829771 711 711 8009654022 8009654022 711 711 H1463 008 0 2021 Health Alliance Medicare HMO Basic (HMO) www.healthalliancemedicare.org MemberServices@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8883829771 8883829771 711 711 8009654022 8009654022 711 711 H1463 009 0 2021 Health Alliance Medicare HMO Basic Rx (HMO) www.healthalliancemedicare.org MemberServices@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8883829771 8883829771 711 711 8009654022 8009654022 711 711 H1463 010 0 2021 Health Alliance Medicare HMO 40 Rx (HMO) www.healthalliancemedicare.org MemberServices@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8883829771 8883829771 711 711 8009654022 8009654022 711 711 H1463 012 0 2021 Reid Health Alliance Medicare HMO Rx Plus (HMO) www.healthalliancemedicare.org memberservices@healthalliance.org 600 E Main Street Richmond IN 47374 8777493002 8777493002 711 711 8777493253 8777493253 711 711 H1463 013 0 2021 Reid Health Alliance Medicare HMO Rx (HMO) www.healthalliancemedicare.org memberservices@healthalliance.org 600 E Main Street Richmond IN 47374 8777493002 8777493002 711 711 8777493253 8777493253 711 711 H1463 014 0 2021 Health Alliance Medicare POS Basic (HMO-POS) www.healthalliancemedicare.org memberservices@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8883829771 2179028744 711 711 8009654022 8009654022 711 711 H1463 015 0 2021 Health Alliance Medicare POS Basic Rx (HMO-POS) www.healthalliancemedicare.org memberservices@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8883829771 2179028744 711 711 8009654022 8009654022 711 711 H1463 017 0 2021 Health Alliance Medicare POS 30 Rx (HMO-POS) www.healthalliancemedicare.org memberservices@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8883829771 2179028744 711 711 8009654022 8009654022 711 711 H1463 019 0 2021 Health Alliance Medicare POS 10 Rx (HMO-POS) healthalliancemedicare.org memberservices@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8883829771 2179028744 711 711 8009654022 8009654022 711 711 H1463 020 0 2021 Reid Health Alliance Medicare HMO (HMO) www.healthalliancemedicare.org memberservices@healthalliance.org 600 E Main Street Richmond IN 47374 8777493002 8777493002 711 711 8777493253 8777493253 711 711 H1463 021 0 2021 Health Alliance Medicare Guide HMO Rx 2 (HMO) healthalliancemedicare.org Memberservices@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8779338454 8779338454 711 711 8009654022 8009654022 711 711 H1463 022 0 2021 Reid Health Alliance Medicare POS Rx (HMO-POS) healthalliancemedicare.org Memberservices@healthalliance.org 600 E Main Street Richmond IN 47374 8777493002 8777493002 711 711 8777493253 8777493253 711 711 H1463 023 0 2021 Simplete 1 (HMO) healthalliancemedicare.org Memberservices@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8776343390 8776343390 711 711 8779338475 8779338475 711 711 H1463 024 0 2021 Simplete 2 (HMO) healthalliancemedicare.org Memberservices@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8776343390 8776343390 711 711 8779338475 8779338475 711 711 H1463 025 0 2021 Simplete 3 (HMO-POS) healthalliancemedicare.org Memberservices@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8776343390 8776343390 711 711 8779338475 8779338475 711 711 H1463 032 0 2021 Simplete Riverside 1 (HMO) healthalliancemedicare.org Memberservices@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8776424753 8776424753 711 711 8779338481 8779338481 711 711 H1463 033 0 2021 Simplete Riverside 2 (HMO) healthalliancemedicare.org Memberservices@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8776424753 8776424753 711 711 8779338481 8779338481 711 711 H1463 034 0 2021 Simplete Riverside 3 (HMO-POS) healthalliancemedicare.org Memberservices@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8776424753 8776424753 711 711 8779338481 8779338481 711 711 H1463 035 0 2021 OSF MedAdvantage Core (HMO) www.healthalliancemedicare.org MemberServices@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8776332531 8776332531 711 711 8779338480 8779338480 711 711 H1463 036 0 2021 OSF MedAdvantage Open (HMO-POS) www.healthalliancemedicare.org MemberServices@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8776332531 8776332531 711 711 8779338480 8779338480 711 711 H1463 037 0 2021 OSF MedAdvantage Plus (HMO-POS) www.healthalliancemedicare.org MemberServices@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8776332531 8776332531 711 711 8779338480 8779338480 711 711 H1463 038 0 2021 OSF MedAdvantage Select (HMO) www.healthalliancemedicare.org MemberServices@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8776332531 8776332531 711 711 8779338480 8779338480 711 711 H1463 039 0 2021 Simplete Richland 1 (HMO) healthalliancemedicare.org memberservices@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8775618307 8775618307 711 711 8777956118 8777956118 711 711 H1463 040 0 2021 Reid Health Alliance Medicare POS Rx Basic (HMO-POS) healthalliancemedicare.org memberservices@healthalliance.org 600 E Main Street Richmond IN 47474 8777493002 8777493002 711 711 8777493253 8777493253 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H1463 041 0 2021 Reid Health Alliance Medicare HMO Basic Rx 2 (HMO) healthalliancemedicare.org memberservices@healthalliance.org 600 E Main Street Richmond IN 47474 8777493002 8777493002 711 711 8777493253 8777493253 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H1463 801 0 2021 Medicare Employer HMO (HMO) www.healthalliancemedicare.org MemberServices@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8883829771 8883829771 711 711 8009654022 8009654022 711 711 H1463 802 0 2021 Medicare Employer HMO Rx (HMO) www.healthalliancemedicare.org MemberServices@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8883829771 8883829771 711 711 8009654022 8009654022 711 711 H1463 810 0 2021 Medicare Employer HMO Rx - non calendar year (HMO) www.healthalliancemedicare.org MemberServices@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8883829771 8883829771 711 711 8009654022 8009654022 711 711 H1463 811 0 2021 Medicare Employer HMO-POS (HMO-POS) www.healthalliancemedicare.org memberservices@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8883829771 8883829771 711 711 8009654022 8009654022 711 711 H1463 812 0 2021 Medicare Employer HMO-POS with Rx (HMO-POS) www.healthalliancemedicare.org memberservices@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8883829771 8883829771 711 711 8009654022 8009654022 711 711 H1463 813 0 2021 Medicare Employer HMO-POS with Rx (HMO-POS) www.healthalliancemedicare.org memberservices@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8883829771 8883829771 711 711 8009654022 8009654022 711 711 H1468 007 0 2021 Humana Gold Plus H1468-007 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1468 013 0 2021 Humana Gold Plus H1468-013 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1468 014 0 2021 Humana Gold Plus H1468-014 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1468 017 0 2021 Humana Community HMO Diabetes and Heart (HMO C-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1468 018 0 2021 Humana Community Select HMO H1468-018 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1468 019 0 2021 Humana Together in Health (HMO I-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1468 802 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H1468 803 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H1468 805 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H1468 806 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H1537 005 0 2021 UnitedHealthcare Medicare Advantage Choice (PPO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8007116088 8007116088 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H1537 801 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1537 802 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1537 803 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1537 807 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1537 808 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1537 809 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1537 816 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1537 817 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1537 823 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1537 824 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1537 825 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1537 826 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1537 830 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1537 831 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1537 832 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1537 833 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1537 834 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1537 836 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1537 837 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1537 838 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1537 839 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1537 840 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1537 841 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1537 842 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1587 001 0 2021 Tribute Advantage (HMO-POS D-SNP) www.superiorselectmedicare.com info@superiorselectinc.com 1 Riverfront Place, Suite 615 North Little Rock AR 72114 8773721033 8773721033 711 711 8773721033 8773721033 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1587 003 0 2021 Tribute Select (HMO-POS I-SNP) www.superiorselectmedicare.com info@superiorselectinc.com 1 Riverfront Place, Suite 615 North Little Rock AR 72114 8773721033 8773721033 711 711 8773721033 8773721033 711 711 H1607 012 0 2021 Anthem MediBlue Access Plus (PPO) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8555930907 8555930907 711 711 8555581438 8555581438 711 711 This plan does not charge an annual deductible for all drugs. The $60.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H1607 014 0 2021 Anthem MediBlue Access (PPO) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8555930907 8555930907 711 711 8555581438 8555581438 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H1607 015 0 2021 Anthem MediBlue Access Preferred (PPO) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8555930907 8555930907 711 711 8555581438 8555581438 711 711 This plan does not charge an annual deductible for all drugs. The $125.00 annual deductible only applies to drugs on certain tiers.~ H1607 809 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H1607 810 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H1607 811 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H1607 812 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H1607 813 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H1607 814 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H1607 815 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H1607 816 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H1608 001 0 2021 Aetna Medicare Premier (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1608 004 0 2021 Aetna Medicare Prime (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1608 007 0 2021 Aetna Medicare Prime (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1608 008 0 2021 Aetna Medicare Prime (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1608 012 0 2021 Aetna Medicare Premier (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1608 013 0 2021 Aetna Medicare Premier Advantra (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H1608 016 0 2021 Aetna Medicare Premier Plus (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1608 017 0 2021 Aetna Medicare Premier Plus (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1608 018 0 2021 Aetna Medicare Premier Plus (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1608 021 0 2021 Aetna Medicare Premier Plus (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1608 024 0 2021 Aetna Medicare Premier Plus 2 (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1608 026 0 2021 Aetna Medicare Advantra Gold (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan's deductible only applies to out-of-network services.~ H1608 027 0 2021 Aetna Medicare Advantra Gold (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan's deductible only applies to out-of-network services.~ H1608 028 0 2021 Aetna Medicare Advantra Preferred Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H1608 029 0 2021 Aetna Medicare Advantra Silver (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H1608 031 0 2021 Aetna Medicare Advantra Credit Value (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H1608 035 0 2021 Aetna Medicare Premier Advantra (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H1608 037 0 2021 Aetna Medicare Elite (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1608 038 0 2021 Aetna Medicare Elite (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1608 039 0 2021 Aetna Medicare Elite (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1608 040 0 2021 Aetna Medicare Advantra Value (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan's deductible only applies to out-of-network services.~ H1608 041 0 2021 Aetna Medicare Advantra Value (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan's deductible only applies to out-of-network services.~ H1608 043 0 2021 Aetna Medicare Elite (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1608 047 0 2021 Aetna Medicare Elite (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1608 048 0 2021 Aetna Medicare Premier Plus (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1608 050 0 2021 Aetna Medicare Elite (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1608 051 0 2021 Aetna Medicare Premier Plus (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H1608 052 0 2021 Aetna Medicare Elite (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1608 053 0 2021 Aetna Medicare Elite (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1608 054 0 2021 Aetna Medicare Elite (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1608 055 0 2021 Aetna Medicare Elite (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1608 056 0 2021 Aetna Medicare Premier Plus (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H1608 059 0 2021 Aetna Medicare Elite (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1608 060 0 2021 Aetna Medicare Eagle (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1608 801 0 2021 Aetna Medicare Plan (PPO) www.aetnamedicare.com 151 Farmington Ave Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H1608 802 0 2021 Aetna Medicare Plan w/Rx (PPO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H1609 001 0 2021 Aetna Medicare Premier (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1609 009 0 2021 Aetna Medicare Prime (HMO) www.aetnamedicare.com HicksJS@Aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1609 016 0 2021 Aetna Medicare Select (HMO) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1609 017 0 2021 Aetna Medicare Assure (HMO D-SNP) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1609 018 0 2021 Aetna Medicare Select (HMO) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1609 019 0 2021 Aetna Medicare Assure (HMO D-SNP) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1609 020 0 2021 Aetna Medicare Select (HMO) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1609 021 0 2021 Aetna Medicare Select (HMO) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1609 022 0 2021 Aetna Medicare Select (HMO) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1609 023 0 2021 Aetna Medicare Assure (HMO D-SNP) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1609 025 0 2021 Aetna Medicare Select (HMO) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1609 026 0 2021 Aetna Medicare Value (HMO) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1609 027 0 2021 Aetna Medicare Select (HMO) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1609 028 0 2021 Aetna Medicare Choice (HMO-POS) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H1609 034 0 2021 Aetna Medicare Select (HMO) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1609 035 0 2021 Aetna Medicare Select (HMO) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1609 037 0 2021 Aetna Medicare Select (HMO) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1609 038 0 2021 Aetna Medicare Select (HMO) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1609 039 0 2021 Aetna Medicare Assure (HMO D-SNP) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1609 040 0 2021 Aetna Medicare Assure (HMO D-SNP) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1609 041 0 2021 Aetna Medicare Select (HMO) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1609 042 0 2021 Aetna Medicare Select (HMO) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1609 043 0 2021 Aetna Medicare Assure Plus (HMO D-SNP) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1609 044 0 2021 Aetna Medicare Assure Plus (HMO D-SNP) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1609 045 0 2021 Aetna Medicare Assure Plus (HMO D-SNP) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1609 046 0 2021 Aetna Medicare Assure Plus (HMO D-SNP) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596037 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1609 047 0 2021 Aetna Medicare Assure Plus (HMO D-SNP) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1609 048 0 2021 Aetna Medicare Assure Plus (HMO D-SNP) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1609 049 0 2021 Aetna Medicare Assure Plus (HMO D-SNP) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1609 052 0 2021 Aetna Medicare Eagle (HMO) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1609 053 0 2021 Aetna Medicare Credit (HMO) www.aetnamedicare.com hicksjs@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1609 801 0 2021 Aetna Medicare Plan (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H1609 807 0 2021 Aetna Medicare w/Rx Plan (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H1610 001 0 2021 Aetna Better Health of Virginia (HMO D-SNP) www.aetnabetterhealth.com/virginia-hmosnp VA_DSNP_MemberServices@aetna.com 7400 W Campus Rd New Albany OH 43054 8338596031 8338596031 711 711 8554630933 8554630933 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1644 001 0 2021 Longevity Health Plan (HMO I-SNP) www.longevityhealthplan.com PO Box 5850 Glen Allen VA 23058 8662249499 8662249499 711 711 8662249499 8662249499 711 711 H1651 001 0 2021 Medical Associates SmartPlan (Cost) www.mahealthplans.com memberservices@mahealthcare.com 1605 Associates Drive Dubuque IA 52002 8668211365 5635568070 8007352942 8007352942 8668211365 5635568070 8007352942 8007352942 H1651 002 0 2021 Medical Associates Basic Plan (Cost) www.mahealthplans.com memberservices@mahealthcare.com 1605 Associates Drive Dubuque IA 52002 8007478900 5635568070 8007352942 8007352942 8668211365 5635844885 8007352942 8007352942 H1651 003 0 2021 Medical Associates SmartPlan (Cost) www.mahealthplans.com memberservices@mahealthcare.com 1605 Associates Drive Dubuque IA 52002 8007478900 5635568070 8007352942 8007352942 8668211365 5635844885 8007352942 8007352942 H1651 004 0 2021 Medical Associates Community Plan (Cost) www.mahealthplans.com memberservices@mahealthcare.com 1605 Associates Drive Dubuque IA 52002 8007478900 5635568070 8007352942 8007352942 8668211365 5635844885 8007352942 8007352942 H1651 005 0 2021 Medical Associates Community Plan (Cost) www.mahealthplans.com memberservices@mahealthcare.com 1605 Associates Drive Dubuque IA 52002 8007478900 5635568070 8007352942 8007352942 8668211365 5635844885 8007352942 8007352942 H1651 008 0 2021 Medical Associates Freedom Plan (Cost) www.mahealthplans.com memberservices@mahealthcare.com 1605 Associates Drive Dubuque IA 52002 8007478900 5635568070 8007352942 8007352942 8668211365 5635844885 8007352942 8007352942 H1651 009 0 2021 Medical Associates Freedom Plan (Cost) www.mahealthplans.com memberservices@mahealthcare.com 1605 Associates Drive Dubuque IA 52002 8007478900 5635568070 8007352942 8007352942 8668211365 5635844885 8007352942 8007352942 H1651 010 0 2021 MercyOne Cedar Valley Senior Plan (Cost) www.mahealthplans.com memberservices@mahealthcare.com 1605 Associates Drive Dubuque IA 52002 8007478900 5635568070 8007352942 8007352942 8668211365 5635844885 8007352942 8007352942 H1651 011 0 2021 Central Iowa Health Senior Plan (Cost) www.mahealthplans.com memberservices@mahealthcare.com 1605 Associates Drive Dubuque IA 52002 8007478900 5635568070 8007352942 8007352942 8668211365 5635844885 8007352942 8007352942 H1651 012 0 2021 MercyOne Clinton Community Senior Plan (Cost) www.mahealthplans.com memberservices@mahealthcare.com 1605 Associates Drive Dubuque IA 52002 8007478900 5635568070 8007352942 8007352942 8668211365 5635844885 8007352942 8007352942 H1651 013 0 2021 Quad Cities Community Health Senior Plan (Cost) www.mahealthplans.com memberservices@mahealthcare.com 1605 Associates Drive Dubuque IA 52002 8007478900 5635568070 8007352942 8007352942 8668211365 5635844885 8007352942 8007352942 H1651 014 0 2021 Mercy Cedar Rapids Senior Plan (Cost) www.mahealthplans.com memberservices@mahealthcare.com 1605 Associates Drive Dubuque IA 52002 8007478900 5635568070 8007352942 8007352942 8668211365 5635844885 8007352942 8007352942 H1651 015 0 2021 MercyOne North Iowa Senior Plan (Cost) www.mahealthplans.com memberservices@mahealthcare.com 1605 Associates Drive Dubuque IA 52002 8007478900 5635568070 8007352942 8007352942 8668211365 5635844885 8007352942 8007352942 H1651 016 0 2021 Mercy Iowa City Senior Plan (Cost) www.mahealthplans.com memberservices@mahealthcare.com 1605 Associates Drive Dubuque IA 52002 8007478900 5635568070 8007352942 8007352942 8668211365 5635844885 8007352942 8007352942 H1651 017 0 2021 Quad Cities Community Health Senior Plan (Cost) www.mahealthplans.com memberservices@mahealthcare.com 1605 Associates Drive Dubuque IA 52002 8007478900 5635568070 8007352942 8007352942 8668211365 5635844885 8007352942 8007352942 H1651 025 0 2021 Live360 Health Plan (Cost) www.live360healthplan.com live360healthplan@mahealthcare.com 1605 Associates Drive Dubuque IA 52002 8337280538 2172065050 8007352942 8007352942 8337280538 2172065050 8007352942 8007352942 H1651 026 0 2021 Medical Associates Nebraska Senior Plan (Cost) www.mahealthplans.com 1605 Associates Drive Dubuque IA 52002 8007478900 5635568070 8007352942 8007352942 8668211365 5635844885 8007352942 8007352942 H1659 002 0 2021 UnitedHealthcare Medicare Advantage Choice Plan 1 (PPO) myUHCPiedmont.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8662721967 8662721967 711 711 This plan does not charge an annual deductible for all drugs. The $405.00 annual deductible only applies to drugs on certain tiers.~ H1659 003 0 2021 UnitedHealthcare Medicare Advantage Choice Plan 2 (PPO) myUHCPiedmont.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8662721967 8662721967 711 711 This plan does not charge an annual deductible for all drugs. The $405.00 annual deductible only applies to drugs on certain tiers.~ H1660 013 0 2021 Harvard Pilgrim Stride Value Rx (HMO) www.hpforlife.org 1600 Crown Colony Drive Quincy MA 02169 8774314742 8774314742 711 711 8886090692 8886090692 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H1660 014 0 2021 Harvard Pilgrim Stride Basic Rx (HMO) www.hpforlife.org 1600 Crown Colony Drive Quincy MA 02169 8774314742 8774314742 711 711 8886090692 8886090692 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H1660 015 0 2021 Harvard Pilgrim Stride Basic Rx (HMO) www.hpforlife.org 1600 Crown Colony Drive Quincy MA 02169 8774314742 8774314742 711 711 8886090692 8886090692 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H1660 016 1 2021 Harvard Pilgrim Stride Value Rx (HMO) www.hpforlife.org 1600 Crown Colony Drive Quincy MA 02169 8774314742 8774314742 711 711 8886090692 8886090692 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H1660 016 2 2021 Harvard Pilgrim Stride Value Rx (HMO) www.hpforlife.org 1600 Crown Colony Drive Quincy MA 02169 8774314742 8774314742 711 711 8886090692 8886090692 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H1660 017 1 2021 Harvard Pilgrim Stride Value Rx Plus (HMO) www.hpforlife.org 1600 Crown Colony Drive Quincy MA 02169 8774314742 8774314742 711 711 8886090692 8886090692 711 711 H1660 017 2 2021 Harvard Pilgrim Stride Value Rx Plus (HMO) www.hpforlife.org 1600 Crown Colony Drive Quincy MA 02169 8774314742 8774314742 711 711 8886090692 8886090692 711 711 H1660 018 0 2021 Harvard Pilgrim Stride Choice Rx (HMO-POS) www.hpforlife.org 1600 Crown Colony Drive Quincy MA 02169 8774314742 8774314742 711 711 8886090692 8886090692 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H1660 802 0 2021 Harvard Pilgrim Stride Choice Rx (HMO-POS) www.hpforlife.org 1600 Crown Colony Drive Quincy MA 02169 8774314742 8774314742 711 711 8886090692 8886090692 711 711 H1660 803 0 2021 Harvard Pilgrim Stride Value Rx (HMO) www.hpforlife.org 1600 Crown Colony Drive Quincy MA 02169 8774314742 8774314742 711 711 8886090692 8886090692 711 711 H1660 804 0 2021 Harvard Pilgrim Stride Value Rx (HMO) www.hpforlife.org 1600 Crown Colony Drive Quincy MA 02169 8774314742 8774314742 711 711 8886090692 8886090692 711 711 H1664 001 0 2021 Allwell Medicare (HMO) allwell.homestatehealth.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661452 8557661452 711 711 H1664 002 0 2021 Allwell Medicare (HMO) allwell.homestatehealth.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661452 8557661452 711 711 H1664 004 0 2021 Allwell Medicare (HMO) allwell.homestatehealth.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661452 8557661452 711 711 H1664 005 0 2021 Allwell Dual Medicare (HMO D-SNP) allwell.homestatehealth.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8332983361 8332983361 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1664 006 0 2021 Allwell Medicare Boost (HMO) allwell.homestatehealth.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661452 8557661452 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H1664 007 0 2021 Allwell Medicare Complement (HMO) allwell.homestatehealth.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661452 8557661452 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H1664 008 0 2021 Allwell Medicare Boost (HMO) allwell.homestatehealth.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661452 8557661452 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H1664 009 0 2021 Allwell Medicare Complement (HMO) allwell.homestatehealth.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661452 8557661452 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H1664 010 0 2021 Allwell Medicare Boost (HMO) allwell.homestatehealth.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661452 8557661452 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H1664 011 0 2021 Allwell Medicare Complement (HMO) allwell.homestatehealth.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661452 8557661452 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H1664 801 0 2021 Allwell Group (HMO) allwell.homestatehealth.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661452 8557661452 711 711 H1664 802 0 2021 Allwell Group (HMO) allwell.homestatehealth.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661452 8557661452 711 711 H1664 803 0 2021 Allwell Group (HMO) allwell.homestatehealth.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661452 8557661452 711 711 H1666 001 0 2021 Blue Cross Medicare Advantage Choice Premier (PPO) www.getbluetx.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H1666 002 0 2021 Blue Cross Medicare Advantage Choice Premier (PPO) www.getbluetx.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H1666 003 0 2021 Blue Cross Medicare Advantage Choice Premier (PPO) www.getbluetx.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H1666 004 0 2021 Blue Cross Medicare Advantage Choice Plus (PPO) www.getbluetx.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H1666 005 0 2021 Blue Cross Medicare Advantage Choice Plus (PPO) www.getbluetx.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H1666 006 0 2021 Blue Cross Medicare Advantage Choice Plus (PPO) www.getbluetx.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H1666 008 0 2021 Blue Cross Medicare Advantage Choice Plus (PPO) www.getbluetx.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H1666 010 0 2021 Blue Cross Medicare Advantage Choice Plus (PPO) www.getbluetx.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H1666 801 0 2021 Blue Cross Group Medicare Advantage Plan (PPO) getbluetx.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H1666 803 0 2021 Blue Cross Group Medicare Advantage Plan (PPO) getbluetx.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H1666 805 0 2021 Blue Cross Group Medicare Advantage Plan (PPO) getbluetx.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H1666 807 0 2021 Blue Cross Group Medicare Advantage Plan (PPO) getbluetx.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H1666 808 0 2021 Blue Cross Group Medicare Advantage Plan (PPO) getbluetx.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H1692 002 0 2021 Aetna Medicare Advantra Silver (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1692 003 0 2021 Aetna Medicare Advantra Elite (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1692 004 0 2021 Aetna Medicare Advantra Elite (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H1692 005 0 2021 Aetna Medicare Advantra Cares (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1692 801 0 2021 Aetna Medicare Plan (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H1692 802 0 2021 Aetna Medicare Plan w/Rx (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H1722 002 0 2021 Healthfirst Signature (HMO) www.healthfirst.org/medicare Healthfirst Medicare Plan, PO Box 5165 New York NY 10274 8772371303 8772371303 8885423821 8885423821 8557711081 8557711081 8885423821 8885423821 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H1723 001 0 2021 Absolute Total Care (Medicare-Medicaid Plan) mmp.absolutetotalcare.com PO Box 2020 Farmington MO 63640 8557354398 8557354398 711 711 8557354398 8557354398 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H1732 001 0 2021 Empire MediBlue HealthPlus Dual Plus (HMO D-SNP) www.empireblue.com mediblue@empireblue.com P.O. Box 659404 San Antonio TX 78265 8555930908 8555930908 711 711 8337131080 8337131080 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1732 002 0 2021 Empire MediBlue HealthPlus Dual Advantage (HMO D-SNP) www.empireblue.com mediblue@empireblue.com P.O. Box 659404 San Antonio TX 78265 8555930908 8555930908 711 711 8337131080 8337131080 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1732 003 0 2021 Empire MediBlue HealthPlus Dual Connect (HMO D-SNP) www.empireblue.com mediblue@empireblue.com P.O. Box 659404 San Antonio TX 78265 8555930908 8555930908 711 711 8337131080 8337131080 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1732 004 0 2021 Empire MediBlue HealthPlus (HMO) https://shop.anthem.com/medicare mediblue@empireblue.com P.O. Box 659404 San Antonio TX 78265 8555930909 8555930909 711 711 8337131079 8337131079 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H1732 005 0 2021 Empire MediBlue HealthPlus (HMO) https://shop.anthem.com/medicare mediblue@empireblue.com P.O. Box 659404 San Antonio TX 78265 8555930909 8555930909 711 711 8337131079 8337131079 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H1732 006 0 2021 Empire MediBlue HealthPlus (HMO) https://shop.anthem.com/medicare mediblue@empireblue.com P.O. Box 659404 San Antonio TX 78265 8555930909 8555930909 711 711 8337131079 8337131079 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H1737 001 0 2021 Health Alliance Medicare Guide HMO Rx (HMO) www.healthalliancemedicare.org healthalliancemedicare@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8779250424 8779250424 711 711 8779178550 8779178550 711 711 H1737 801 0 2021 Medicare Employer HMO (HMO) www.healthalliancemedicare.org healthalliancemedicare@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8779250424 8779250424 711 711 8779178550 8779178550 711 711 H1737 802 0 2021 Medicare Employer HMO Rx (HMO) www.healthalliancemedicare.org healthalliancemedicare@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8779250424 8779250424 711 711 8779178550 8779178550 711 711 H1737 803 0 2021 Medicare Employer HMO Rx - non calendar year (HMO) www.healthalliancemedicare.org healthalliancemedicare@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8779250424 8779250424 711 711 8779178550 8779178550 711 711 H1748 001 0 2021 Sonder Health Plans, Inc. (HMO) www.sonderhealthplans.com memberservices@sonderhealthplans.com 100 Hartsfield Centre Pkwy, Suite 500 Atlanta GA 30354 8884284440 8884284440 711 711 8884284440 8884284440 711 711 H1748 003 0 2021 Sonder Health Plans, Inc. (HMO C-SNP) www.sonderhealthplans.com memberservices@sonderhealthplans.com 100 Hartsfield Centre Pkwy, Suite 500 Atlanta GA 30354 8884284440 8884284440 711 711 8884284440 8884284440 711 711 H1748 004 0 2021 Sonder Health Plans, Inc. (HMO C-SNP) www.sonderhealthplans.com memberservices@sonderhealthplans.com 100 Hartsfield Centre Pkwy, Suite 500 Atlanta GA 30354 8884284440 8884284440 711 711 8884284440 8884284440 711 711 H1774 001 0 2021 Ascension Complete St. Vincent Access (PPO) www.ascensioncomplete.com PO Box 10420 Van Nuys CA 91410 8449420038 8449420038 711 711 8335250824 8335250824 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H1777 007 0 2021 ArchCare Advantage (HMO I-SNP) www.archcareadvantage.org 205 Lexington Avenue, 2nd Floor NEW YORK NY 10016 8003733177 8003733177 711 711 8003733177 8003733177 711 711 H1787 001 0 2021 Great Plains Medicare Advantage (HMO I-SNP) www.greatplainsmedicareadvantage.com PO Box 2190 Glen Allen VA 23058 8446374760 8446374760 711 711 8446374760 8446374760 711 711 H1787 002 0 2021 Great Plain Medicare Advantage Gold (HMO I-SNP) www.greatplainsmedicareadvantage.com PO Box 2190 Glen Allen VA 23058 8446374760 8446374760 711 711 8446374760 8446374760 711 711 H1821 001 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H1821 002 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H1821 003 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H1846 004 0 2021 MediGold Flexible Choice (PPO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H1846 801 0 2021 EGWP MediGold Network Choice (PPO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H1846 802 0 2021 EGWP MediGold Network Choice Medical Only (PPO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H1848 001 0 2021 WellCare Absolute (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H1848 002 0 2021 WellCare Premier (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1862 001 0 2021 WellCare Value (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1889 002 1 2021 UnitedHealthcare Dual Complete Choice (PPO D-SNP) www.UHCCommunityPlan.com P.O. Box 30769 Salt Lake City UT 84130 8888343721 8888343721 711 711 8668424968 8668424968 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1889 002 2 2021 UnitedHealthcare Dual Complete Choice (PPO D-SNP) www.UHCCommunityPlan.com P.O. Box 30769 Salt Lake City UT 84130 8888343721 8888343721 711 711 8668424968 8668424968 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1894 001 0 2021 Amerivantage Classic (HMO) https://shop.amerigroup.com/medicare/ Amerigroup Washington, 705 Union Station, Suite 300 - 705 Fifth Avenue South Seattle WA 98104 8555930910 8555930910 711 711 8668054589 8668054589 711 711 H1894 002 0 2021 Amerivantage Dual Coordination (HMO D-SNP) https://shop.amerigroup.com/medicare/ Amerigroup Washington, 705 Union Station, Suite 300 - 705 Fifth Avenue South Seattle WA 98104 8555930911 8555930911 711 711 8442095407 8442095407 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1914 001 0 2021 WellCare Premier (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H1914 002 0 2021 WellCare Absolute (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1914 003 0 2021 WellCare Endurance (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H1944 001 0 2021 AARP Medicare Advantage Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H1944 004 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H1944 005 0 2021 AARP Medicare Advantage Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H1944 006 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H1944 009 0 2021 AARP Medicare Advantage (HMO) www.AARPMedicarePlans.com memberservices@mypreferredcare.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H1944 010 0 2021 AARP Medicare Advantage Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H1944 011 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H1944 014 0 2021 AARP Medicare Advantage Plan 2 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $75.00 annual deductible only applies to drugs on certain tiers.~ H1944 015 0 2021 AARP Medicare Advantage Patriot (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H1944 016 0 2021 AARP Medicare Advantage Plan 1 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H1944 017 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H1944 018 0 2021 AARP Medicare Advantage Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H1944 024 0 2021 AARP Medicare Advantage (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $130.00 annual deductible only applies to drugs on certain tiers.~ H1944 028 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H1944 030 0 2021 AARP Medicare Advantage Patriot (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H1944 031 0 2021 AARP Medicare Advantage Plan 4 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H1944 032 0 2021 AARP Medicare Advantage Plan 3 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H1944 805 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1944 806 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 29675 Hot Springs AR 71903 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1944 807 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 29675 Hot Springs AR 71903 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H1947 001 0 2021 Healthy Blue Dual Advantage (HMO D-SNP) shop.healthybluela.com/medicare 1351 William Howard Taft, CN14B-818 Cincinnati OH 45206 8555930912 8555930912 711 711 8442095406 8442095406 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1951 013 0 2021 Humana Gold Plus H1951-013 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1951 024 0 2021 Humana Gold Plus H1951-024 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1951 028 0 2021 Humana Gold Plus H1951-028 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1951 032 0 2021 Humana Gold Plus SNP-DE H1951-032 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1951 033 0 2021 Humana Gold Plus SNP-DE H1951-033 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1951 034 0 2021 Humana Gold Plus SNP-DE H1951-034 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1951 038 0 2021 Humana-Ochsner Network H1951-038 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1951 039 0 2021 Humana-Ochsner Network H1951-039 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1951 041 0 2021 Humana Gold Plus SNP-DE H1951-041 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1951 044 0 2021 Humana Gold Plus - Diabetes and Heart H1951-044 (HMO C-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1951 047 1 2021 Humana Gold Plus H1951-047 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1951 047 2 2021 Humana Gold Plus H1951-047 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1951 048 1 2021 Humana Gold Plus H1951-048 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1951 048 2 2021 Humana Gold Plus H1951-048 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1951 049 1 2021 Humana Gold Plus H1951-049 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1951 049 2 2021 Humana Gold Plus H1951-049 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1951 049 3 2021 Humana Gold Plus H1951-049 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1951 051 0 2021 Humana LCMC Advantage H1951-051 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1951 052 0 2021 Humana Gold Plus H1951-052 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H1951 801 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H1951 804 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H1951 807 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H1951 808 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H1961 003 0 2021 Peoples Health Secure Health (HMO D-SNP) www.peopleshealth.com PHN.member@peopleshealth.com Three Lakeway Center, 3838 N Causeway Blvd, Suite 2200 Metairie LA 70002 8888343721 8888343721 711 711 8002228600 8002228600 8008465277 8008465277 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1961 011 0 2021 Peoples Health Secure Choice (HMO D-SNP) www.peopleshealth.com PHN.member@peopleshealth.com Three Lakeway Center, 3838 N Causeway Blvd, Suite 2200 Metairie LA 70002 8888343721 8888343721 711 711 8002228600 8002228600 8008465277 8008465277 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1961 014 1 2021 Peoples Health Choices 65 (HMO) www.peopleshealth.com PHN.member@peopleshealth.com Three Lakeway Center, 3838 N Causeway Blvd, Suite 2200 Metairie LA 70002 8005555757 8005555757 711 711 8002228600 8002228600 8008465277 8008465277 H1961 014 2 2021 Peoples Health Choices 65 (HMO) www.peopleshealth.com PHN.member@peopleshealth.com Three Lakeway Center, 3838 N Causeway Blvd, Suite 2200 Metairie LA 70002 8005555757 8005555757 711 711 8002228600 8002228600 8008465277 8008465277 H1961 014 3 2021 Peoples Health Choices 65 (HMO) www.peopleshealth.com PHN.member@peopleshealth.com Three Lakeway Center, 3838 N Causeway Blvd, Suite 2200 Metairie LA 70002 8005555757 8005555757 711 711 8002228600 8002228600 8008465277 8008465277 H1961 014 4 2021 Peoples Health Choices 65 (HMO) www.peopleshealth.com PHN.member@peopleshealth.com Three Lakeway Center, 3838 N Causeway Blvd, Suite 2200 Metairie LA 70002 8005555757 8005555757 711 711 8002228600 8002228600 8008465277 8008465277 H1961 017 0 2021 Peoples Health Choices Gold (HMO) www.peopleshealth.com PHN.member@peopleshealth.com Three Lakeway Center, 3838 N Causeway Blvd, Suite 2200 Metairie LA 70002 8005555757 8005555757 711 711 8002228600 8002228600 8008465277 8008465277 H1961 018 0 2021 Peoples Health Choices Value (HMO) www.peopleshealth.com PHN.member@peopleshealth.com Three Lakeway Center, 3838 N Causeway Blvd, Suite 2200 Metairie LA 70002 8005555757 8005555757 711 711 8002228600 8002228600 8008465277 8008465277 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H1961 019 0 2021 Peoples Health Secure Complete (HMO D-SNP) www.peopleshealth.com PHN.member@peopleshealth.com Three Lakeway Center, 3838 N Causeway Blvd, Suite 2200 Metairie LA 70002 8888343721 8888343721 711 711 8002228600 8002228600 8008465277 8008465277 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H1961 801 0 2021 Peoples Health Group Medicare (HMO-POS) www.peopleshealth.com PHN.member@peopleshealth.com Three Lakeway Center, 3838 N Causeway Blvd, Suite 2200 Metairie LA 70002 8663018865 5047127504 8008465277 8008465277 8002228600 5048494685 8008465277 8008465277 H1961 802 0 2021 Peoples Health Group Medicare (HMO-POS) www.peopleshealth.com PHN.member@peopleshealth.com Three Lakeway Center, 3838 N Causeway Blvd, Suite 2200 Metairie LA 70002 8663018865 5047127504 8008465277 8008465277 8002228600 5048494685 8008465277 8008465277 H1961 803 0 2021 Peoples Health Group Medicare (HMO) www.peopleshealth.com PHN.member@peopleshealth.com Three Lakeway Center, 3838 N Causeway Blvd, Suite 2200 Metairie LA 70002 8663018865 5047127504 8008465277 8008465277 8002228600 5048494685 8008465277 8008465277 H1961 804 0 2021 Peoples Health Group Medicare (HMO) www.peopleshealth.com PHN.member@peopleshealth.com Three Lakeway Center, 3838 N Causeway Blvd, Suite 2200 Metairie LA 70002 8663018865 5047127504 8008465277 8008465277 8002228600 5048494685 8008465277 8008465277 H1969 002 0 2021 Regence Blue MedAdvantage HMO (HMO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8555228896 8555228896 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H1969 004 0 2021 Regence Blue MedAdvantage HMO Plus (HMO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8555228896 8555228896 711 711 This plan does not charge an annual deductible for all drugs. The $110.00 annual deductible only applies to drugs on certain tiers.~ H1969 006 0 2021 Regence | St. Luke's Health Partners Align No Rx (HMO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8555228896 8555228896 711 711 H1969 007 3 2021 Regence | St. Luke's Health Partners Align (HMO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8555228896 8555228896 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H1969 007 4 2021 Regence | St. Luke's Health Partners Align (HMO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8555228896 8555228896 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H1969 008 1 2021 Regence | St. Luke's Health Partners Align Plus (HMO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8555228896 8555228896 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H1969 008 2 2021 Regence | St. Luke's Health Partners Align Plus (HMO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8555228896 8555228896 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H1977 001 0 2021 Upper Peninsula Health Plan MI Health Link (Medicare-Medicaid Plan) www.uphp.com/medicare 853 W. Washington Street Marquette MI 49855 8773499324 8773499324 711 711 8773499324 8773499324 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H1993 001 0 2021 Astiva Health Advantage (HMO) https://astivahealth.com/ memberservices@astivahealth.com 3200 Bristol St., Suite 600 Costa Mesa CA 92626 8666889021 9493938839 711 711 8666889021 9493938839 711 711 H1993 002 0 2021 Astiva Health Value (HMO) https://astivahealth.com/ memberservices@astivahealth.com 3200 Bristol St., Suite 600 Costa Mesa CA 92626 8666889021 9493938839 711 711 8666889021 9493938839 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H1993 003 0 2021 Astiva Health Advantage (HMO) https://astivahealth.com/ memberservices@astivahealth.com 3200 Bristol St., Suite 600 Costa Mesa CA 92626 8666889021 9493938839 711 711 8666889021 9493938839 711 711 H1993 004 0 2021 Astiva Health Value (HMO) https://astivahealth.com/ memberservices@astivahealth.com 3200 Bristol St., Suite 600 Costa Mesa CA 92626 8666889021 9493938839 711 711 8666889021 9493938839 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H1994 001 0 2021 SelectHealth Advantage Essential (HMO) www.selecthealth.org/medicare PO Box 30196 Salt Lake City UT 84130 8554429940 8554429940 8003464128 711 8554429900 8014429900 8003464128 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H1994 002 0 2021 SelectHealth Advantage (HMO) www.selecthealth.org/medicare PO Box 30196 Salt Lake City UT 84130 8554429940 8554429940 8003464128 711 8554429900 8554429900 8003464128 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H1994 003 0 2021 SelectHealth Advantage Essential (HMO) www.selecthealth.org/medicare PO Box 30196 Salt Lake City UT 84130 8554429940 8554429940 8003773529 711 8554429900 2084299900 8003773529 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H1994 004 0 2021 SelectHealth Advantage (HMO) www.selecthealth.org/medicare PO Box 30196 Salt Lake City UT 84130 8554429940 8554429940 8003773529 711 8554429900 8554429900 8003773529 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H1994 007 0 2021 SelectHealth Advantage Enhanced (HMO) www.selecthealth.org/medicare PO Box 30196 Salt Lake City UT 84130 8554429940 8554429940 8003464128 711 8554429900 8014429900 8003464128 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H1994 008 0 2021 SelectHealth Advantage Enhanced (HMO) www.selecthealth.org/medicare PO Box 30196 Salt Lake City UT 84130 8554429940 8554429940 8003773529 711 8554429900 8014429900 8003773529 711 H1994 012 0 2021 SelectHealth Advantage (HMO) www.selecthealth.org/medicare PO Box 30196 Salt Lake City UT 84130 8554429940 8554429940 8003464128 711 8554429900 8554429900 8003464128 711 H1994 013 0 2021 SelectHealth Advantage (HMO) www.selecthealth.org/medicare PO Box 30196 Salt Lake City UT 84130 8554429940 8554429940 8003773529 711 8554429900 2084299900 8003773529 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H1994 014 0 2021 SelectHealth Advantage (HMO) www.selecthealth.org/medicare PO Box 30196 Salt Lake City UT 84130 8554429940 8554429940 8003773529 711 8554429900 2084299900 8003773529 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H1994 801 0 2021 SelectHealth Advantage (HMO) www.selecthealth.org/medicare PO Box 30196 Salt Lake City UT 84130 8554429940 8554429940 711 711 8554429900 8554429900 711 711 H1994 802 0 2021 SelectHealth Advantage (HMO) www.selecthealth.org/medicare PO Box 30196 Salt Lake City UT 84130 8554429940 8554429940 711 711 8554429900 8554429900 711 711 H1994 803 0 2021 SelectHealth Advantage (HMO) www.selecthealth.org/medicare PO Box 30196 Salt Lake City UT 84130 8554429940 8554429940 711 711 8554429900 8554429900 711 711 H1997 002 0 2021 Regence BlueAdvantage HMO Plus (HMO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8555228896 8555228896 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H1997 008 0 2021 Regence Valiance (HMO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8555228896 8555228896 711 711 H1997 009 0 2021 Regence BlueAdvantage HMO (HMO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8555228896 8555228896 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H1997 010 0 2021 Regence Align (HMO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8555228896 8555228896 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H1997 011 0 2021 Regence Align Plus (HMO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8555228896 8555228896 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H2001 001 0 2021 AARP Medicare Advantage Choice Plan 1 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H2001 010 0 2021 AARP Medicare Advantage Choice Plan 2 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2001 017 0 2021 UnitedHealthcare Medicare Advantage Choice (PPO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~ H2001 018 0 2021 AARP Medicare Advantage Choice Plan 1 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H2001 019 0 2021 AARP Medicare Advantage Choice Plan 3 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2001 816 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 817 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 818 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 822 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 823 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 824 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 825 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 826 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 827 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 828 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 829 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 830 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 831 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 835 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com memberservices@mypreferredcare.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 836 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 837 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 838 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 839 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 840 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 841 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 842 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 843 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 844 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 845 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 846 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 847 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 848 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 849 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 850 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 851 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 852 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 853 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 854 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 855 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 856 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 857 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 858 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2001 859 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2011 001 0 2021 Bright Advantage (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H2011 002 0 2021 Bright Advantage Plus (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H2011 003 0 2021 Bright Advantage (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H2011 004 0 2021 Bright Advantage Plus (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H2020 001 0 2021 Clear Spring Health Essential (PPO) www.clearspringhealthcare.com PO Box 278530 Miramar FL 33027 8773644566 8773644566 711 711 8773644566 8773644566 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H2020 002 0 2021 Clear Spring Health Essential (PPO) www.clearspringhealthcare.com P.O. Box 278530 Miramar FL 33027 8773644566 8773644566 711 711 8773644566 8773644566 711 711 H2020 003 0 2021 Clear Spring Health Essential (PPO) www.clearspringhealthcare.com P.O. Box 278530 Miramar FL 33027 8773644566 8773644566 711 711 8773644566 8773644566 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H2020 004 0 2021 Clear Spring Health Essential Plus (PPO) www.clearspringhealthcare.com P.O. Box 278530 Miramar FL 33027 8773644566 8773644566 711 711 8773644566 8773644566 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H2020 005 0 2021 Clear Spring Health Essential Plus (PPO) www.clearspringhealthcare.com P.O. Box 278530 Miramar FL 33027 8773644566 8773644566 711 711 8773644566 8773644566 711 711 H2029 001 0 2021 HumanaChoice Value H2029-001 (PPO) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8006813625 8006813625 711 711 8667735959 8667735959 711 711 H2029 801 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8667735959 8667735959 711 711 8667735959 8667735959 711 711 H2029 802 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8667735959 8667735959 711 711 8667735959 8667735959 711 711 H2029 809 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8667735959 8667735959 711 711 8667735959 8667735959 711 711 H2029 810 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8667735959 8667735959 711 711 8667735959 8667735959 711 711 H2029 811 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8667735959 8667735959 711 711 8667735959 8667735959 711 711 H2029 812 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8667735959 8667735959 711 711 8667735959 8667735959 711 711 H2029 813 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8667735959 8667735959 711 711 8667735959 8667735959 711 711 H2029 814 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8667735959 8667735959 711 711 8667735959 8667735959 711 711 H2032 001 0 2021 BSW SeniorCare Advantage (PPO) advantage.swhp.org 1206 West Campus Drive Temple TX 76502 8663343141 8663343141 711 711 8663343141 8663343141 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H2032 002 0 2021 BSW SeniorCare Advantage Basic (PPO) advantage.swhp.org 1206 West Campus Drive Temple TX 76502 8663343141 8663343141 711 711 8663343141 8663343141 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H2032 003 0 2021 BSW SeniorCare Advantage Platinum (PPO) advantage.swhp.org 1206 West Campus Drive Temple TX 76502 8663343141 8663343141 711 711 8663343141 8663343141 711 711 This plan does not charge an annual deductible for all drugs. The $50.00 annual deductible only applies to drugs on certain tiers.~ H2032 801 0 2021 BSW SeniorCare Advantage EGWP CY Rx (PPO) advantage.swhp.org 1206 West Campus Drive Temple TX 76502 8663343141 8663343141 711 711 8663343141 8663343141 711 711 H2032 802 0 2021 BSW SeniorCare Advantage EGWP CY (PPO) advantage.swhp.org 1206 West Campus Drive Temple TX 76502 8663343141 8663343141 711 711 8663343141 8663343141 711 711 H2032 803 0 2021 BSW SeniorCare Advantage EGWP FY Rx (PPO) advantage.swhp.org 1206 West Campus Drive Temple TX 76502 8663343141 8663343141 711 711 8663343141 8663343141 711 711 H2032 804 0 2021 BSW SeniorCare Advantage EGWP FY (PPO) advantage.swhp.org 1206 West Campus Drive Temple TX 76502 8663343141 8663343141 711 711 8663343141 8663343141 711 711 H2034 001 0 2021 Community Care's Partnership Program (HMO D-SNP) www.communitycareinc.org 205 Bishops Way Brookfield WI 53005 8669926600 4142314000 711 711 8669926600 4142314000 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2056 001 0 2021 Aetna Medicare Elite Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H2056 002 0 2021 Aetna Medicare Value Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H2056 003 0 2021 Aetna Medicare Elite Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H2056 004 0 2021 Aetna Medicare Value Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H2056 005 0 2021 Aetna Medicare Elite Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H2056 007 0 2021 Aetna Medicare Elite Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H2056 801 0 2021 Aetna Medicare Plan (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H2056 802 0 2021 Aetna Medicare Plan w/Rx (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H2108 001 0 2021 Cigna TotalCare (HMO D-SNP) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8008567657 8008567657 711 711 8006683813 8006683813 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2108 020 0 2021 Cigna Traditions Medicare (HMO I-SNP) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8008567657 8008567657 711 711 8006683813 8006683813 711 711 H2108 022 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8008567657 8008567657 711 711 8006683813 8006683813 711 711 H2108 028 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8008567657 8008567657 711 711 8006683813 8006683813 711 711 H2108 029 0 2021 Cigna Achieve Medicare (HMO C-SNP) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8008567657 8008567657 711 711 8006683813 8006683813 711 711 H2108 030 0 2021 Cigna Achieve Medicare (HMO C-SNP) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8008567657 8008567657 711 711 8006683813 8006683813 711 711 H2108 034 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8008567657 8008567657 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $280.00 annual deductible only applies to drugs on certain tiers.~ H2108 036 0 2021 Cigna Alliance Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8008567657 8008567657 711 711 8006683813 8006683813 711 711 H2108 801 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8882817867 8882817867 711 711 8882817867 8882817867 711 711 H2120 001 0 2021 BlueEssential (HMO C-SNP) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8886655678 8886655678 711 711 8888512583 8888512583 711 711 H2120 002 0 2021 BlueEssential (HMO C-SNP) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8886655678 8886655678 711 711 8888512583 8888512583 711 711 H2120 003 0 2021 BlueEssential (HMO C-SNP) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8886655678 8886655678 711 711 8888512583 8888512583 711 711 H2120 004 0 2021 BlueEssential (HMO C-SNP) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8886655678 8886655678 711 711 8888512583 8888512583 711 711 H2134 001 0 2021 Allwell Dual Medicare (HMO D-SNP) allwell.westernskycommunitycare.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8448107965 8448107965 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2134 002 0 2021 Allwell Medicare Boost (HMO) allwell.westernskycommunitycare.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8335430246 8335430246 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2134 003 0 2021 Allwell Dual Medicare Harmony (HMO D-SNP) allwell.westernskycommunitycare.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8448107965 8448107965 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $410.00 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2134 004 0 2021 Allwell Medicare Complement (HMO) allwell.westernskycommunitycare.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8335430246 8335430246 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H2134 005 0 2021 Allwell Medicare (HMO) allwell.westernskycommunitycare.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8335430246 8335430246 711 711 This plan does not charge an annual deductible for all drugs. The $125.00 annual deductible only applies to drugs on certain tiers.~ H2134 006 0 2021 Allwell Medicare Simple (HMO) allwell.westernskycommunitycare.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8335430246 8335430246 711 711 H2134 801 0 2021 Allwell Group (HMO) allwell.westernskycommunity.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8448107965 8448107965 711 711 H2134 802 0 2021 Allwell Group (HMO) allwell.westernskycommunity.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8448107965 8448107965 711 711 H2134 803 0 2021 Allwell Group (HMO) allwell.westernskycommunity.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8448107965 8448107965 711 711 H2161 002 0 2021 Upper Peninsula Health Plan Advantage (HMO-POS) www.uphp.com/medicare 853 W. Washington Street Marquette MI 49855 8773499324 8773499324 711 711 8773499324 8773499324 711 711 H2161 003 0 2021 Upper Peninsula Health Plan Choice (HMO) www.uphp.com/medicare 853 W. Washington Street Marquette MI 49855 8773499324 8773499324 711 711 8773499324 8773499324 711 711 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~ H2162 001 0 2021 WellCare Value (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $160.00 annual deductible only applies to drugs on certain tiers.~ H2162 002 0 2021 WellCare Plus (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H2168 001 0 2021 VillageCareMAX Medicare Health Advantage (HMO D-SNP) www.villagecaremax.org 112 Charles Street New York NY 12570 8004696292 8004696292 711 711 8004696292 8004696292 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2168 002 0 2021 VillageCareMAX Medicare Total Advantage (HMO D-SNP) www.villagecaremax.org 112 Charles Street New York NY 10014 8004696292 8004696292 711 711 8004696292 8004696292 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2171 001 0 2021 Care N' Care Classic (HMO) www.cnchealthplan.com yourteam@cnchealthplan.com 1701 River Run, Suite 402 Fort Worth TX 76107 8776652622 8776652622 711 711 8773747993 8773747993 711 711 H2171 801 0 2021 Care N' Care Classic CY - MAPD (HMO) www.cnchealthplan.com concierge@cnchealthplan.com 1701 River Run, Suite 402 Fort Worth TX 76107 8776652622 8776652622 711 711 8773747993 8773747993 711 711 H2171 802 0 2021 Care N' Care Classic NCY - MAPD (HMO) www.cnchealthplan.com concierge@cnchealthplan.com 1701 River Run, Suite 402 Fort Worth TX 76107 8776652622 8776652622 711 711 8773747993 8773747993 711 711 H2171 803 0 2021 Care N' Care Classic CY - MA-Only (HMO) www.cnchealthplan.com concierge@cnchealthplan.com 1701 River Run, Suite 402 Fort Worth TX 76107 8776652622 8776652622 711 711 8773747993 8773747993 711 711 H2171 804 0 2021 Care N' Care Classic NCY - MA-Only (HMO) www.cnchealthplan.com concierge@cnchealthplan.com 1701 River Run, Suite 402 Fort Worth TX 76107 8776652622 8776652622 711 711 8773747993 8773747993 711 711 H2172 001 0 2021 Kaiser Permanente Medicare Advantage High DC (HMO) kp.org/medicare 2101 East Jefferson Street, 2nd Floor West Rockville MD 20852 8774088607 8774088607 711 711 8887775536 8887775536 711 711 H2172 002 0 2021 Kaiser Permanente Medicare Advantage High MD (HMO) kp.org/medicare 2101 East Jefferson Street, 2nd Floor West Rockville MD 20852 8774088607 8774088607 711 711 8887775536 8887775536 711 711 H2172 003 0 2021 Kaiser Permanente Medicare Advantage Standard DC (HMO) kp.org/medicare 2101 East Jefferson Street, 2nd Floor West Rockville MD 20852 8774088607 8774088607 711 711 8887775536 8887775536 711 711 H2172 004 0 2021 Kaiser Permanente Medicare Advantage Standard MD (HMO) kp.org/medicare 2101 East Jefferson Street, 2nd Floor West Rockville MD 20852 8774088607 8774088607 711 711 8887775536 8887775536 711 711 H2172 005 0 2021 Kaiser Permanente Medicare Advantage w/o Part D (HMO) kp.org/medicare 2101 East Jefferson Street, 2nd Floor West Rockville MD 20852 8774088607 8774088607 711 711 8887775536 8887775536 711 711 H2172 006 0 2021 Kaiser Permanente Medicare Advantage Value Balt (HMO) kp.org/medicare 2101 East Jefferson Street, 2nd Floor West Rockville MD 20852 8774088607 8774088607 711 711 8887775536 8887775536 711 711 H2172 008 0 2021 Kaiser Permanente Medicare Advantage High VA (HMO) kp.org/medicare 2101 East Jefferson Street, 2nd Floor West Rockville MD 20852 8774088607 8774088607 711 711 8887775536 8887775536 711 711 H2172 009 0 2021 Kaiser Permanente Medicare Advantage Standard VA (HMO) kp.org/medicare 2101 East Jefferson Street, 2nd Floor West Rockville MD 20852 8774088607 8774088607 711 711 8887775536 8887775536 711 711 H2172 010 0 2021 Kaiser Permanente Medicare Advantage Value VA (HMO) kp.org/medicare 2101 East Jefferson Street, 2nd Floor West Rockville MD 20852 8774088607 8774088607 711 711 8887775536 8887775536 711 711 H2172 011 0 2021 Kaiser Permanente Medicare Advantage Value MD (HMO) kp.org/medicare 2101 East Jefferson Street, 2nd Floor West Rockville MD 20852 8774088607 8774088607 711 711 8887775536 8887775536 711 711 H2172 012 0 2021 Kaiser Permanente Medicare Advantage Value DC (HMO) kp.org/medicare 2101 East Jefferson Street, 2nd Floor West Rockville MD 20852 8774088607 8774088607 711 711 8887775536 8887775536 711 711 H2172 801 0 2021 Kaiser Permanente Medicare Advantage for Groups (HMO) kp.org/medicare 2101 East Jefferson Street, 2nd Floor West Rockville MD 20852 8774088607 8774088607 711 711 8887775536 8887775536 711 711 H2172 803 0 2021 Kaiser Permanente Medicare Advantage Fed w/Part D (HMO) kp.org/medicare 2101 East Jefferson Street, 2nd Floor West Rockville MD 20852 8774088607 8774088607 711 711 8887775536 8887775536 711 711 H2172 805 0 2021 Kaiser Permanente Medicare Advantage GRP w/o D (HMO) kp.org/medicare 2101 East Jefferson Street, 2nd Floor West Rockville MD 20852 8774088607 8774088607 711 711 8887775536 8887775536 711 711 H2174 001 0 2021 Trillium Advantage Dual (HMO D-SNP) trilliumadvantage.com cs@trilliumchp.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8448671156 8448671156 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $310.00 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2185 001 0 2021 LifeWorks Advantage I-SNP (HMO I-SNP) www.lifeworksadvantage.com PO Box 2190 Glen Allen VA 23058 8448546883 8448546883 711 711 8448546883 8448546883 711 711 H2196 001 0 2021 AARP Medicare Advantage (HMO) www.UHCMedicareSolutions.com PHN.member@peopleshealth.com P.O. Box 30770, 3838 N Causeway Blvd, Suite 2200 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H2196 002 0 2021 AARP Medicare Advantage (HMO) www.UHCMedicareSolutions.com PHN.member@peopleshealth.com P.O. Box 30770, 3838 N Causeway Blvd, Suite 2200 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H2224 001 0 2021 Senior Whole Health (HMO D-SNP) www.seniorwholehealthMA.com info@seniorwholehealth.com 58 Charles Street Cambridge MA 02141 8885663526 8885663526 711 711 8887947268 8887947268 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2224 003 0 2021 Senior Whole Health NHC (HMO D-SNP) www.seniorwholehealthMA.com info@seniorwholehealth.com 58 Charles Street Cambridge MA 02141 8885663526 8885663526 711 711 8887947268 8887947268 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2225 001 0 2021 Senior Care Options Program (HMO D-SNP) www.commonwealthcaresco.org 30 Winter Street Boston MA 02108 8662751222 8662751222 711 711 8666102273 8666102273 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2226 001 0 2021 UnitedHealthcare Senior Care Options (HMO D-SNP) www.UHCCommunityPlan.com 950 Winter ST STE 3800 Waltham MA 02451 8005555757 8005555757 711 711 8888675511 8888675511 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2226 003 0 2021 UnitedHealthcare Senior Care Options NHC (HMO D-SNP) www.UHCCommunityPlan.com 950 Winter ST STE 3800 Waltham MA 02451 8005555757 8005555757 711 711 8888675511 8888675511 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2228 002 0 2021 UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H2228 010 0 2021 UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H2228 011 0 2021 UnitedHealthcare Assisted Living Plan (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H2228 013 0 2021 UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H2228 016 0 2021 UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H2228 017 0 2021 UnitedHealthcare Assisted Living Plan 1 (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H2228 018 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $50.00 annual deductible only applies to drugs on certain tiers.~ H2228 019 0 2021 AARP Medicare Advantage Choice Plan 1 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2228 020 0 2021 AARP Medicare Advantage Focus (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2228 021 0 2021 AARP Medicare Advantage Choice Plan 1 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $185.00 annual deductible only applies to drugs on certain tiers.~ H2228 022 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $50.00 annual deductible only applies to drugs on certain tiers.~ H2228 023 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H2228 024 0 2021 AARP Medicare Advantage Choice Plan 1 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8668681534 8668681534 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H2228 025 0 2021 AARP Medicare Advantage Patriot (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8668681534 8668681534 711 711 H2228 029 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H2228 030 0 2021 AARP Medicare Advantage Choice Plan 1 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2228 031 0 2021 AARP Medicare Advantage Choice Plan 1 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $190.00 annual deductible only applies to drugs on certain tiers.~ H2228 032 0 2021 AARP Medicare Advantage Choice Plan 2 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~ H2228 035 0 2021 AARP Medicare Advantage Choice Plan 1 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8007116088 8007116088 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H2228 036 0 2021 AARP Medicare Advantage Choice Plan 2 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2228 037 0 2021 AARP Medicare Advantage Choice Plan 1 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8003930993 8003930993 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H2228 039 0 2021 UnitedHealthcare Assisted Living Plan 1 (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H2228 041 0 2021 UnitedHealthcare Dual Complete Choice Premier (PPO D-SNP) www.UHCCommunityPlan.com P.O. Box 30769 Salt Lake City UT 84130 8888343721 8888343721 711 711 8669444983 8669444983 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2228 043 0 2021 UnitedHealthcare Dual Complete (PPO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8666228054 8666228054 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2228 044 0 2021 UnitedHealthcare Dual Complete (PPO D-SNP) www.UHCCommunityPlan.com P.O. Box 30769 Salt Lake City UT 84130 8888343721 8888343721 711 711 8664801086 8664801086 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2228 045 0 2021 UnitedHealthcare Dual Complete (PPO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8664801086 8664801086 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2228 047 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2228 049 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2228 064 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2228 065 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2228 066 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H2228 067 0 2021 AARP Medicare Advantage Choice Plan 2 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8668681534 8668681534 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2228 068 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8668681534 8668681534 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H2228 071 0 2021 AARP Medicare Advantage Choice Plan 1 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2228 074 0 2021 AARP Medicare Advantage Walgreens Plan 1 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H2228 075 0 2021 AARP Medicare Advantage Walgreens Plan 1 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H2228 076 0 2021 AARP Medicare Advantage Choice Plan 1 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H2228 077 0 2021 AARP Medicare Advantage Walgreens Plan 2 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H2228 079 0 2021 AARP Medicare Advantage Walgreens (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H2228 080 0 2021 AARP Medicare Advantage Choice Plan 2 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H2228 081 0 2021 AARP Medicare Advantage Choice Plan 2 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $185.00 annual deductible only applies to drugs on certain tiers.~ H2228 082 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2228 083 0 2021 AARP Medicare Advantage Walgreens (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2228 084 0 2021 AARP Medicare Advantage Walgreens (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H2228 085 0 2021 AARP Medicare Advantage Choice Plan 2 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2228 086 0 2021 AARP Medicare Advantage Choice Plan 3 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2228 088 0 2021 AARP Medicare Advantage Patriot (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2228 091 0 2021 AARP Medicare Advantage Patriot (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2228 092 0 2021 AARP Medicare Advantage Choice Premier (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2228 093 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2228 094 0 2021 AARP Medicare Advantage Choice Plan 2 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H2228 095 0 2021 AARP Medicare Advantage Patriot (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2228 096 0 2021 AARP Medicare Advantage Walgreens Plan 2 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H2228 097 0 2021 AARP Medicare Advantage Walgreens Plan 3 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H2228 098 0 2021 AARP Medicare Advantage Patriot (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2228 805 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2228 807 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2228 808 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2228 812 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2228 813 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2228 814 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2228 815 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2228 816 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2228 820 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2228 821 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2228 822 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2228 823 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2228 824 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2228 825 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2228 826 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2228 828 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2228 830 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2228 831 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2228 832 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2228 833 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2228 834 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2228 835 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2228 836 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2228 837 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2228 838 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2230 002 0 2021 Medicare PPO Blue PlusRx (PPO) www.bluecrossma.com/medicare governmentprograms@bcbsma.com P. O. Box 55007 Boston MA 02205 8006782265 8006782265 711 711 8002004255 8002004255 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H2230 017 0 2021 Medicare PPO Blue SaverRx (PPO) www.bluecrossma.com/medicare governmentprograms@bcbsma.com P. O. Box 55007 Boston MA 02205 8006782265 8006782265 711 711 8002004255 8002004255 711 711 This plan does not charge an annual deductible for all drugs. The $405.00 annual deductible only applies to drugs on certain tiers.~ H2230 018 1 2021 Medicare PPO Blue ValueRx (PPO) www.bluecrossma.com/medicare governmentprograms@bcbsma.com P. O. Box 55007 Boston MA 02205 8006782265 8006782265 711 711 8002004255 8002004255 711 711 This plan does not charge an annual deductible for all drugs. The $320.00 annual deductible only applies to drugs on certain tiers.~ H2230 018 2 2021 Medicare PPO Blue ValueRx (PPO) www.bluecrossma.com/medicare governmentprograms@bcbsma.com P. O. Box 55007 Boston MA 02205 8006782265 8006782265 711 711 8002004255 8002004255 711 711 This plan does not charge an annual deductible for all drugs. The $320.00 annual deductible only applies to drugs on certain tiers.~ H2230 801 0 2021 Medicare PPO Blue (PPO) www.bluecrossma.com/medicare governmentprograms@bcbsma.com P. O. Box 55007 Boston MA 02205 8006782265 8006782265 711 711 8002004255 8002004255 711 711 H2230 809 0 2021 Medicare PPO Blue (PPO) www.bluecrossma.com/medicare governmentprograms@bcbsma.com P. O. Box 55007 Boston MA 02205 8006782265 8006782265 711 711 8002004255 8002004255 711 711 H2235 001 0 2021 BayCarePlus Complete (HMO) BayCarePlus.org PO Box 12487 St. Louis MO 63132 8669475820 8669475820 711 711 8665095396 8665095396 711 711 H2235 002 0 2021 BayCarePlus Rewards (HMO) BayCarePlus.org PO Box 12487 St. Louis MO 63132 8669475820 8669475820 711 711 8665095396 8665095396 711 711 H2235 003 0 2021 BayCarePlus Premier (HMO) BayCarePlus.org PO Box 12487 St. Louis MO 63132 8669475820 8669475820 711 711 8665095396 8665095396 711 711 H2235 004 0 2021 BayCarePlus Signature (HMO) BayCarePlus.org PO Box 12487 St. Louis MO 63132 8669475820 8669475820 711 711 8665095396 8665095396 711 711 H2235 801 0 2021 BayCarePlus EGWP MAPD calendar (HMO) BayCarePlus.org PO Box 12487 St. Louis MO 63132 8669475820 8669475820 711 711 8665095396 8665095396 711 711 H2235 802 0 2021 BayCarePlus EGWP MAPD non calendar (HMO) BayCarePlus.org PO Box 12487 St. Louis MO 63132 8669475820 8669475820 711 711 8665095396 8665095396 711 711 H2237 001 0 2021 iCare Medicare Plan (HMO D-SNP) www.icarehealthplan.org info@icarehealthplan.org 1555 N. RiverCenter Drive, Suite 206 Milwaukee WI 53212 8882419637 4142234847 8009473529 8009473529 8007774376 4142234847 8009473529 8009473529 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2237 007 0 2021 iCare Family Care Partnership (HMO D-SNP) www.icarehealthplan.org info@icarehealthplan.org 1555 N. RiverCenter Drive, Suite 206 Milwaukee WI 53212 8882419637 4142234847 8009473529 8009473529 8007774376 4142234847 8009473529 8009473529 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2241 007 1 2021 Connected Care (HMO) www.gsmhp.com P.O. Box 10729 Newport Beach CA 92658 8775414111 8775414111 711 711 8775414111 8775414111 711 711 Available to current members only.~ H2241 007 2 2021 Connected Care (HMO) www.gsmhp.com P.O. Box 10729 Newport Beach CA 92658 8775414111 8775414111 711 711 8775414111 8775414111 711 711 Available to current members only.~ H2241 012 0 2021 Connected Care (HMO) www.gsmhp.com P.O. Box 10729 Newport Beach CA 92658 8775414111 8775414111 711 711 8775414111 8775414111 711 711 Available to current members only.~ H2241 013 0 2021 Connected Care (HMO) www.gsmhp.com P.O. Box 10729 Newport Beach CA 92658 8775414111 8775414111 711 711 8775414111 8775414111 711 711 Available to current members only.~ H2241 014 0 2021 Golden State Senior Health Plan (HMO) www.gsmhp.com P.O. Box 10729 Newport Beach CA 92658 8775414111 8775414111 711 711 8775414111 8775414111 711 711 Available to current members only.~ H2241 015 0 2021 Connected Care (HMO) www.gsmhp.com P.O. Box 10729 Newport Beach CA 92658 8775414111 8775414111 711 711 8775414111 8775414111 711 711 Available to current members only.~ H2241 016 0 2021 Connected Care (HMO) www.gsmhp.com P.O. Box 10729 Newport Beach CA 92658 8775414111 8775414111 711 711 8775414111 8775414111 711 711 Available to current members only.~ H2241 017 0 2021 Connected Care (HMO) www.gsmhp.com P.O. Box 10729 Newport Beach CA 92658 8775414111 8775414111 711 711 8775414111 8775414111 711 711 Available to current members only.~ H2241 018 0 2021 Connected Care Select (HMO C-SNP) www.gsmhp.com P.O. Box 10729 Newport Beach CA 92658 8775414111 8775414111 711 711 8775414111 8775414111 711 711 Available to current members only.~ H2241 019 0 2021 Connected Care Select (HMO C-SNP) www.gsmhp.com P.O. Box 10729 Newport Beach CA 92658 8775414111 8775414111 711 711 8775414111 8775414111 711 711 Available to current members only.~ H2241 020 0 2021 Connected Care Select (HMO C-SNP) www.gsmhp.com P.O. Box 10729 Newport Beach CA 92658 8775414111 8775414111 711 711 8775414111 8775414111 711 711 Available to current members only.~ H2241 021 0 2021 Connected Care Select (HMO C-SNP) www.gsmhp.com P.O. Box 10729 Newport Beach CA 92658 8775414111 8775414111 711 711 8775414111 8775414111 711 711 Available to current members only.~ H2247 001 0 2021 UnitedHealthcare Dual Complete (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8443686885 8443686885 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2247 002 0 2021 UnitedHealthcare Dual Complete (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8443686885 8443686885 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2256 001 1 2021 Tufts Medicare Preferred HMO Prime Rx Plus (HMO) tuftsmedicarepreferred.org Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 H2256 001 2 2021 Tufts Medicare Preferred HMO Prime Rx Plus (HMO) tuftsmedicarepreferred.org Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 H2256 001 6 2021 Tufts Medicare Preferred HMO Prime Rx Plus (HMO) tuftsmedicarepreferred.org Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 H2256 015 1 2021 Tufts Medicare Preferred HMO Prime Rx (HMO) tuftsmedicarepreferred.org Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 H2256 015 2 2021 Tufts Medicare Preferred HMO Prime Rx (HMO) tuftsmedicarepreferred.org Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 H2256 015 6 2021 Tufts Medicare Preferred HMO Prime Rx (HMO) tuftsmedicarepreferred.org Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 H2256 016 1 2021 Tufts Medicare Preferred HMO Prime No Rx (HMO) tuftsmedicarepreferred.org Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 H2256 016 2 2021 Tufts Medicare Preferred HMO Prime No Rx (HMO) tuftsmedicarepreferred.org Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 H2256 018 1 2021 Tufts Medicare Preferred HMO Value Rx (HMO) tuftsmedicarepreferred.org Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H2256 018 7 2021 Tufts Medicare Preferred HMO Value Rx (HMO) tuftsmedicarepreferred.org Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H2256 018 8 2021 Tufts Medicare Preferred HMO Value Rx (HMO) tuftsmedicarepreferred.org Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H2256 019 1 2021 Tufts Medicare Preferred HMO Value No Rx (HMO) tuftsmedicarepreferred.org Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 H2256 019 7 2021 Tufts Medicare Preferred HMO Value No Rx (HMO) tuftsmedicarepreferred.org Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 H2256 026 1 2021 Tufts Medicare Preferred HMO Basic Rx (HMO) tuftsmedicarepreferred.org Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H2256 026 2 2021 Tufts Medicare Preferred HMO Basic Rx (HMO) tuftsmedicarepreferred.org Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H2256 026 3 2021 Tufts Medicare Preferred HMO Basic Rx (HMO) tuftsmedicarepreferred.org Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H2256 028 0 2021 Tufts Medicare Preferred HMO Saver Rx (HMO) tuftsmedicarepreferred.org Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H2256 029 0 2021 Tufts Health Plan Senior Care Options (HMO D-SNP) tuftsmedicarepreferred.org/sco Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8556705935 8556705935 711 711 8556705934 8556705934 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2256 033 0 2021 Tufts Medicare Preferred HMO Prime Rx (HMO) tuftsmedicarepreferred.org Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 H2256 034 0 2021 Tufts Medicare Preferred HMO Value Rx (HMO) tuftsmedicarepreferred.org Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H2256 036 0 2021 Tufts Medicare Preferred HMO Basic Rx (HMO) tuftsmedicarepreferred.org Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H2256 039 0 2021 Tufts Medicare Preferred HMO Prime No Rx (HMO) tuftsmedicarepreferred.org Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 H2256 040 0 2021 Tufts Medicare Preferred HMO Value No Rx (HMO) tuftsmedicarepreferred.org Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 H2256 041 0 2021 Tufts Medicare Preferred HMO Basic No Rx (HMO) tuftsmedicarepreferred.org Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 H2256 042 0 2021 Tufts Medicare Preferred HMO Basic No Rx (HMO) tuftsmedicarepreferred.org Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 H2256 801 0 2021 Tufts Medicare Preferred HMO Rx (HMO) tuftsmedicarepreferred.org/plans/employer-plans Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 H2256 802 0 2021 Tufts Medicare Preferred HMO (HMO) tuftsmedicarepreferred.org/plans/employer-plans Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 H2256 803 0 2021 Tufts Medicare Preferred HMO Rx (HMO) tuftsmedicarepreferred.org/plans/employer-plans Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 H2256 808 0 2021 Tufts Medicare Preferred HMO (HMO) tuftsmedicarepreferred.org/plans/employer-plans Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 H2261 005 0 2021 Medicare HMO Blue PlusRx (HMO) www.bluecrossma.com/medicare governmentprograms@bcbsma.com P. O. Box 55007 Boston MA 02205 8006782265 8006782265 711 711 8002004255 8002004255 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H2261 022 1 2021 Medicare HMO Blue ValueRx (HMO) www.bluecrossma.com/medicare governmentprograms@bcbsma.com P. O. Box 55007 Boston MA 02205 8006782265 8006782265 711 711 8002004255 8002004255 711 711 This plan does not charge an annual deductible for all drugs. The $320.00 annual deductible only applies to drugs on certain tiers.~ H2261 022 2 2021 Medicare HMO Blue ValueRx (HMO) www.bluecrossma.com/medicare governmentprograms@bcbsma.com P. O. Box 55007 Boston MA 02205 8006782265 8006782265 711 711 8002004255 8002004255 711 711 This plan does not charge an annual deductible for all drugs. The $320.00 annual deductible only applies to drugs on certain tiers.~ H2261 023 1 2021 Medicare HMO Blue FlexRx (HMO-POS) www.bluecrossma.com/medicare governmentprograms@bcbsma.com P. O. Box 55007 Boston MA 02205 8006782265 8006782265 711 711 8002004255 8002004255 711 711 This plan does not charge an annual deductible for all drugs. The $260.00 annual deductible only applies to drugs on certain tiers.~ H2261 023 2 2021 Medicare HMO Blue FlexRx (HMO-POS) www.bluecrossma.com/medicare governmentprograms@bcbsma.com P. O. Box 55007 Boston MA 02205 8006782265 8006782265 711 711 8002004255 8002004255 711 711 This plan does not charge an annual deductible for all drugs. The $260.00 annual deductible only applies to drugs on certain tiers.~ H2261 024 0 2021 Medicare HMO Blue SaverRx (HMO) www.bluecrossma.com/medicare governmentprograms@bcbsma.com P. O. Box 55007 Boston MA 02205 8006782265 8006782265 711 711 8002004255 8002004255 711 711 This plan does not charge an annual deductible for all drugs. The $320.00 annual deductible only applies to drugs on certain tiers.~ H2261 801 0 2021 Medicare HMO Blue (HMO) www.bluecrossma.com/medicare governmentprograms@bcbsma.com P. O. Box 55007 Boston MA 02205 8006782265 8006782265 711 711 8002004255 8002004255 711 711 H2261 809 0 2021 Medicare HMO Blue (HMO) www.bluecrossma.com/medicare governmentprograms@bcbsma.com P. O. Box 55007 Boston MA 02205 8006782265 8006782265 711 711 8002004255 8002004255 711 711 H2288 001 0 2021 Bright Advantage (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H2288 002 0 2021 Bright Advantage Plus (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H2288 003 0 2021 Bright Advantage Special Care (HMO D-SNP) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2288 005 0 2021 Bright Advantage Assist (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H2288 009 0 2021 Bright Advantage Senior Savings (HMO C-SNP) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H2288 010 0 2021 Bright Advantage Senior Savings Assist (HMO C-SNP) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H2292 001 0 2021 UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H2292 002 0 2021 UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H2292 003 0 2021 UnitedHealthcare Assisted Living Plan (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H2320 022 1 2021 PriorityMedicare Key (HMO-POS) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H2320 022 2 2021 PriorityMedicare Key (HMO-POS) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H2320 022 3 2021 PriorityMedicare Key (HMO-POS) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H2320 022 4 2021 PriorityMedicare Key (HMO-POS) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H2320 022 5 2021 PriorityMedicare Key (HMO-POS) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H2320 028 1 2021 PriorityMedicare (HMO-POS) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 H2320 028 2 2021 PriorityMedicare (HMO-POS) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 H2320 028 3 2021 PriorityMedicare (HMO-POS) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 H2320 028 4 2021 PriorityMedicare (HMO-POS) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 H2320 028 5 2021 PriorityMedicare (HMO-POS) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 H2320 029 1 2021 PriorityMedicare Value (HMO-POS) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 This plan does not charge an annual deductible for all drugs. The $75.00 annual deductible only applies to drugs on certain tiers.~ H2320 029 2 2021 PriorityMedicare Value (HMO-POS) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 This plan does not charge an annual deductible for all drugs. The $75.00 annual deductible only applies to drugs on certain tiers.~ H2320 029 3 2021 PriorityMedicare Value (HMO-POS) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 This plan does not charge an annual deductible for all drugs. The $75.00 annual deductible only applies to drugs on certain tiers.~ H2320 029 4 2021 PriorityMedicare Value (HMO-POS) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 This plan does not charge an annual deductible for all drugs. The $75.00 annual deductible only applies to drugs on certain tiers.~ H2320 029 5 2021 PriorityMedicare Value (HMO-POS) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 This plan does not charge an annual deductible for all drugs. The $75.00 annual deductible only applies to drugs on certain tiers.~ H2320 802 0 2021 PriorityMedicare EG Non-Calendar Year (HMO-POS) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8887729596 6164648850 711 711 8883896648 6164648820 711 711 H2320 803 0 2021 PriorityMedicare EG Calendar Year (HMO-POS) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8887729596 6164648850 711 711 8883896648 6164648820 711 711 H2320 804 0 2021 PriorityMedicare EG HMO w PD Non-Cal Year (HMO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8887729596 6164648850 711 711 8883896648 6164648820 711 711 H2320 805 0 2021 PriorityMedicare EG HMO w PD Cal Year (HMO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8887729596 6164648850 711 711 8883896648 6164648820 711 711 H2320 810 0 2021 PriorityMedicare EG HMO Cal Year (HMO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8887729596 6164648850 711 711 8883896648 6164648820 711 711 H2320 811 0 2021 PriorityMedicare EG HMO Non-Cal Year (HMO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8887729596 6164648850 711 711 8883896648 6164648820 711 711 H2320 812 0 2021 PriorityMedicare HMO-POS No RX EGWP Calendar (HMO-POS) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8887729596 6164648850 711 711 8883896648 6164648820 711 711 H2320 813 0 2021 PriorityMedicare HMO-POS No RX EGWP Non-Calendar (HMO-POS) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8887729596 6164648850 711 711 8883896648 6164648820 711 711 H2322 004 0 2021 HAP Senior Plus Option 4 (PPO) www.hap.org/medicare MEM_SVCS@hap.org 2850 West Grand Boulevard Detroit MI 48202 8339231630 8339231630 711 711 8886582536 3136647015 711 711 H2322 008 0 2021 HAP Senior Plus Option 3 (PPO) www.hap.org/medicare MEM_SVCS@hap.org 2850 West Grand Boulevard Detroit MI 48202 8339231630 8339231630 711 711 8886582536 3136647015 711 711 This plan's deductible only applies to out-of-network services.~ H2322 011 0 2021 HAP Senior Plus Option 1 (PPO) www.hap.org/medicare MEM_SVCS@hap.org 2850 West Grand Blvd. Detroit MI 48202 8339231630 8339231630 711 711 8886582536 3136647015 711 711 This plan's deductible only applies to out-of-network services.~ H2322 012 0 2021 HAP Senior Plus Option 2 (PPO) www.hap.org/medicare MEM_SVCS@hap.org 2850 West Grand Blvd. Detroit MI 48202 8339231630 8339231630 711 711 8886582536 3136647015 711 711 This plan's deductible only applies to out-of-network services.~ H2322 801 0 2021 HAP Senior Plus Group (PPO) www.hap.org/medicare MEM_SVCS@hap.org 2850 West Grand Boulevard Detroit MI 48202 8339231630 8339231630 711 711 8886582536 3136647015 711 711 H2322 803 0 2021 HAP Senior Plus Group (PPO) www.hap.org/medicare MEM_SVCS@hap.org 2850 West Grand Boulevard Detroit MI 48202 8339231630 8339231630 711 711 8886582536 3136647015 711 711 H2334 003 0 2021 Clear Spring Health Choice Plan (PPO) www.eonhealthplan.com P.O. BOX 278530 Miramar FL 33027 8773644566 8773644566 711 711 8773644566 8773644566 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H2334 005 0 2021 Clear Spring Health Gold Plus (PPO) www.eonhealthplan.com P.O. Box 278530 Miramar FL 33027 8773644566 8773644566 711 711 8773644566 8773644566 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H2354 015 0 2021 HAP Senior Plus (HMO) www.hap.org/medicare MEM_SVCS@hap.org 2850 West Grand Boulevard Detroit MI 48202 8339231630 8339231630 711 711 8008011770 3136647015 711 711 H2354 018 0 2021 HAP Senior Plus Henry Ford Tiered Access (HMO) www.hap.org/medicare MEM_SVCS@hap.org 2850 West Grand Boulevard Detroit MI 48202 8339231630 8339231630 711 711 8008011770 3136647015 711 711 H2354 019 0 2021 HAP Senior Plus Medical Only (HMO) www.hap.org/medicare MEM_SVCS@hap.org 2850 West Grand Boulevard Detroit MI 48202 8339231630 8339231630 711 711 8008011770 3136647015 711 711 H2354 021 0 2021 HAP Senior Plus Option 1 (HMO-POS) www.hap.org/medicare MEM_SVCS@hap.org 2850 West Grand Boulevard Detroit MI 48202 8339231630 8339231630 711 711 8008011770 3136647015 711 711 H2354 022 0 2021 HAP Senior Plus Option 2 (HMO-POS) www.hap.org/medicare MEM_SVCS@hap.org 2850 West Grand Boulevard Detroit MI 48202 8339231630 8339231630 711 711 8008011770 3136647015 711 711 H2354 024 0 2021 HAP Primary Choice (HMO) www.hap.org/medicare MEM_SVCS@hap.org 2850 West Grand Boulevard Detroit MI 48202 8339231630 8339231630 711 711 8667664714 3136640444 711 711 H2354 025 0 2021 HAP Empowered Duals (HMO D-SNP) www.hap.org/medicare MEM_SVCS@hap.org 2850 West Grand Boulevard Detroit MI 48202 8339231630 8339231630 711 711 8008484844 8102302046 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2354 026 0 2021 HAP Choice Medicare - West Michigan Option 1 (HMO) www.hap.org/medicare MEM_SVCS@hap.org 2850 West Grand Boulevard Detroit MI 48202 8339231630 8339231630 711 711 8008011770 3136647015 711 711 H2354 027 0 2021 HAP Choice Medicare - West Michigan Option 2 (HMO) www.hap.org/medicare MEM_SVCS@hap.org 2850 West Grand Boulevard Detroit MI 48202 8339231630 8339231630 711 711 8008011770 3136647015 711 711 H2354 801 0 2021 HAP Senior Plus Group (HMO) www.hap.org/medicare MEM_SVCS@hap.org 2850 West Grand Boulevard Detroit MI 48202 8339231630 8339231630 711 711 8008011770 3136647015 711 711 H2354 802 0 2021 HAP Senior Plus Group (HMO-POS) www.hap.org/medicare MEM_SVCS@hap.org 2850 West Grand Boulevard Detroit MI 48202 8339231630 8339231630 711 711 8008011770 3136647015 711 711 H2392 001 0 2021 Kansas Health Advantage (HMO I-SNP) KansasHealthAdvantage.com MemberServices@AmHealthPlans.com 201 Jordan Road, Suite 200 Franklin TN 37067 8003997524 8003997524 711 711 8003997524 8003997524 711 711 H2392 002 0 2021 Kansas Health Advantage Plus (HMO I-SNP) KansasHealthAdvantage.com MemberServices@AmHealthPlans.com 201 Jordan Road, Suite 200 Franklin TN 37067 8003997524 8003997524 711 711 8003997524 8003997524 711 711 H2400 001 0 2021 Signature Advantage Plan (HMO I-SNP) www.signatureadvantageplan.com Deb.Baverman@signatureadvantageplan.com 12201 Bluegrass Parkway Louisville KY 40299 8442148633 8442148633 711 711 8442148633 8442148633 711 711 H2400 002 0 2021 Signature Advantage Community (HMO I-SNP) www.signatureadvantageplan.com 12201 Bluegrass Parkway Louisville KY 40299 8442148633 8442148633 711 711 8442148633 8442148633 711 711 H2406 001 0 2021 UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H2406 008 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2406 009 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2406 010 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2406 011 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2406 012 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2406 013 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~ H2406 014 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~ H2406 015 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~ H2406 016 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2406 017 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2406 018 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2406 019 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2406 805 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2406 806 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2406 807 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2406 811 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2406 812 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2406 813 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2406 814 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2406 815 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2406 819 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2406 820 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2406 821 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2406 822 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2406 823 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2406 824 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2406 825 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2406 826 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2406 827 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2406 829 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2406 830 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2406 831 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2406 832 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2406 833 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2406 834 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2406 835 0 2021 UnitedHealthcare Group Medicare Advantage (PPO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2416 001 0 2021 PrimeWest Senior Health Complete (HMO D-SNP) www.primewest.org/pwshc matt.magnuson@primewest.org 3905 Dakota Street Alexandria MN 56308 8003662906 3203355243 711 711 8003662906 3203355243 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2417 001 0 2021 IMCare Classic (HMO D-SNP) www.imcare.org sarah.duell@co.itasca.mn.us 1219 SE 2nd Avenue Grand Rapids MN 55744 8008439536 2183276188 8006273529 8006273529 8008439536 2183276188 8006273529 8006273529 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2419 001 0 2021 SeniorCare Complete (HMO D-SNP) www.mnscha.org members@mnscha.org South Country Health Alliance, 2300 Park Drive, Suite 100 Owatonna MN 55060 8665677242 8665677242 711 711 8665677242 8665677242 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2422 002 0 2021 HealthPartners Minnesota Senior Health Options (HMO D-SNP) healthpartners.com/msho 8170 33rd Avenue South Bloomington MN 55425 8777138215 9528835050 711 711 8888204285 9529677029 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2425 001 0 2021 SecureBlue (HMO D-SNP) www.bluecrossmn.com/secureblue P.O. Box 64033 St Paul MN 55121 8664771584 8664771584 711 711 8887406013 6516626013 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2450 001 0 2021 Medica Prime Solution Basic w/Rx 2 (Cost) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8002348755 9529922300 711 711 H2450 002 0 2021 Medica Prime Solution Enhanced w/Rx 2 (Cost) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8002348755 9529922300 711 711 H2450 007 0 2021 Medica Prime Solution Thrift w/Rx (Cost) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8002348755 9529922300 711 711 H2450 016 0 2021 Medica Prime Solution Basic w/Rx (Cost) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8002348755 9529922300 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H2450 017 0 2021 Medica Prime Solution Enhanced w/Rx (Cost) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8002348755 9529922300 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H2450 022 0 2021 Medica Prime Solution Value w/Rx (Cost) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8002348755 9529922300 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H2450 030 0 2021 Medica Prime Solution Thrift (Cost) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8002348755 9529922300 711 711 H2450 031 0 2021 Medica Prime Solution Value (Cost) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8002348755 9529922300 711 711 H2450 032 0 2021 Medica Prime Solution Basic (Cost) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8002348755 9529922300 711 711 H2450 033 0 2021 Medica Prime Solution Enhanced (Cost) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8002348755 9529922300 711 711 H2450 034 0 2021 Medica Prime Solution Core (Cost) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8002348755 9529922300 711 711 H2450 035 0 2021 Medica Prime Solution Core w/Rx (Cost) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8002348755 9529922300 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H2450 036 0 2021 Medica Prime Solution Premier (Cost) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8002348755 9529922300 711 711 H2450 037 0 2021 Medica Prime Solution Premier w/Rx (Cost) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8002348755 9529922300 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H2450 038 0 2021 Medica Prime Solution Focus (Cost) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8002348755 9529922300 711 711 H2450 039 0 2021 Medica Prime Solution Focus w/Rx (Cost) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8002348755 9529922300 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H2450 040 0 2021 Medica Prime Solution Total (Cost) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8002348755 9529922300 711 711 H2450 041 0 2021 Medica Prime Solution Total w/Rx (Cost) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8002348755 9529922300 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H2450 042 0 2021 Medica Prime Solution Premier (Cost) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8002348755 9529922300 711 711 H2450 043 0 2021 Medica Prime Solution Premier (Cost) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8002348755 9529922300 711 711 H2450 044 0 2021 Medica Prime Solution Standard (Cost) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8002348755 9529922300 711 711 H2450 045 0 2021 Medica Prime Solution Core (Cost) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8002348755 9529922300 711 711 H2450 046 0 2021 Medica Prime Solution Core (Cost) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8002348755 9529922300 711 711 H2450 047 0 2021 Medica Prime Solution Core (Cost) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8002348755 9529922300 711 711 H2450 048 0 2021 Medica Prime Solution Premier (Cost) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8002348755 9529922300 711 711 H2450 049 0 2021 Medica Prime Solution Standard w/Rx (Cost) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8002348755 9529922300 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H2450 801 0 2021 Medica Group Prime Solution w/Rx (Cost) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8002348755 9529922300 711 711 H2456 002 0 2021 UCare's Minnesota Senior Health Options (HMO D-SNP) https://home.ucare.org PO Box 52 Minneapolis MN 55440 8776711065 6126766652 8006882534 6126766810 8662807202 6126766868 8006882534 6126766810 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2458 002 0 2021 Medica DUAL Solution (HMO D-SNP) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8002662157 9529922030 711 711 8883473630 9529922580 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2459 001 0 2021 UCare Value (HMO-POS) https://home.ucare.org PO Box 52 Minneapolis MN 55440 8776711058 6126766616 8006882534 6126766810 8775231515 6126763600 8006882534 6126766810 H2459 020 0 2021 UCare Prime (HMO-POS) https://home.ucare.org PO Box 52 Minneapolis MN 55440 8776711058 6126766616 8006882534 6126766810 8775231515 6126763600 8006882534 6126766810 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H2459 021 1 2021 UCare Classic (HMO-POS) https://home.ucare.org PO Box 52 Minneapolis MN 55440 8776711058 6126766616 8006882534 6126766810 8775231515 6126763600 8006882534 6126766810 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H2459 021 2 2021 UCare Classic (HMO-POS) https://home.ucare.org PO Box 52 Minneapolis MN 55440 8776711058 6126766616 8006882534 6126766810 8775231515 6126763600 8006882534 6126766810 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H2459 021 3 2021 UCare Classic (HMO-POS) https://home.ucare.org PO Box 52 Minneapolis MN 55440 8776711058 6126766616 8006882534 6126766810 8775231515 6126763600 8006882534 6126766810 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H2459 023 1 2021 UCare Essentials Rx (HMO-POS) https://home.ucare.org PO Box 52 Minneapolis MN 55440 8776711058 6126766616 8006882534 6126766810 8775231515 6126763600 8006882534 6126766810 This plan does not charge an annual deductible for all drugs. The $395.00 annual deductible only applies to drugs on certain tiers.~ H2459 023 2 2021 UCare Essentials Rx (HMO-POS) https://home.ucare.org PO Box 52 Minneapolis MN 55440 8776711058 6126766616 8006882534 6126766810 8775231515 6126763600 8006882534 6126766810 This plan does not charge an annual deductible for all drugs. The $395.00 annual deductible only applies to drugs on certain tiers.~ H2459 024 0 2021 UCare Standard (HMO-POS) https://home.ucare.org PO Box 52 Minneapolis MN 55440 8776711058 6126766616 8006882534 6126766810 8775231515 6126763600 8006882534 6126766810 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H2459 026 1 2021 UCare Complete (HMO-POS) https://home.ucare.org sales@ucare.org PO Box 52 Minneapolis MN 55440 8776711058 6126766616 8006882534 6126766810 8775231515 6126763600 8006882534 6126766810 This plan does not charge an annual deductible for all drugs. The $235.00 annual deductible only applies to drugs on certain tiers.~ H2459 026 3 2021 UCare Complete (HMO-POS) https://home.ucare.org sales@ucare.org PO Box 52 Minneapolis MN 55440 8776711058 6126766616 8006882534 6126766810 8775231515 6126763600 8006882534 6126766810 This plan does not charge an annual deductible for all drugs. The $235.00 annual deductible only applies to drugs on certain tiers.~ H2459 026 4 2021 UCare Complete (HMO-POS) https://home.ucare.org sales@ucare.org PO Box 52 Minneapolis MN 55440 8776711058 6126766616 8006882534 6126766810 8775231515 6126763600 8006882534 6126766810 This plan does not charge an annual deductible for all drugs. The $235.00 annual deductible only applies to drugs on certain tiers.~ H2459 028 0 2021 UCare Prime (HMO-POS) https://home.ucare.org PO Box 52 Minneapolis MN 55440 8776711058 6126766616 8006882534 6126766810 8775231515 6126763600 8006882534 6126766810 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H2459 029 0 2021 UCare Aware (HMO-POS) https://home.ucare.org PO Box 52 Minneapolis MN 55440 8776711058 6126766616 8006882534 6126766810 8775231515 6126763600 8006882534 6126766810 This plan does not charge an annual deductible for all drugs. The $395.00 annual deductible only applies to drugs on certain tiers.~ H2459 030 0 2021 UCare Value Plus (HMO-POS) https://home.ucare.org PO Box 52 Minneapolis MN 55440 8776711058 6126766616 8006882534 6126766810 8775231515 6126763600 8006882534 6126766810 H2459 031 0 2021 UCare Advocate Choice (HMO I-SNP) https://home.ucare.org PO BOX 52 Minneapolis MN 55440 8776711065 6126766652 8006882534 6126766810 8559314854 6126766772 8006882534 6126766810 This plan does not charge an annual deductible for all drugs. The $435.00 annual deductible only applies to drugs on certain tiers.~ H2459 032 0 2021 UCare Advocate Plus (HMO I-SNP) https://home.ucare.org PO BOX 52 Minneapolis MN 55440 8776711065 6126766652 8006882534 6126766810 8559314854 6126766772 8006882534 6126766810 This plan does not charge an annual deductible for all drugs. The $435.00 annual deductible only applies to drugs on certain tiers.~ H2459 801 0 2021 Group UCare (HMO-POS) https://home.ucare.org PO Box 52 Minneapolis MN 55440 8776711058 6126766616 8006882534 6126766810 8774474385 6126766840 8006882534 6126766810 H2461 005 0 2021 Platinum Blue Core Plan (Cost) www.bluecrossmnonline.com 3400 Yankee Drive Eagan MN 55121 8776622583 6516622583 711 711 8663408654 6516625654 711 711 H2461 006 0 2021 Platinum Blue Choice Plan (Cost) www.bluecrossmnonline.com 3400 Yankee Drive Eagan MN 55121 8776622583 6516622583 711 711 8663408654 6516625654 711 711 H2461 007 0 2021 Platinum Blue Complete Plan (Cost) www.bluecrossmnonline.com 3400 Yankee Drive Eagan MN 55121 8776622583 6516622583 711 711 8663408654 6516625654 711 711 H2461 008 0 2021 Platinum Blue Core Plan with Rx (Cost) www.bluecrossmnonline.com 3400 Yankee Drive Eagan MN 55121 8776622583 6516622583 711 711 8663408654 6516625654 711 711 H2461 009 0 2021 Platinum Blue Choice Plan with Rx (Cost) www.bluecrossmnonline.com 3400 Yankee Drive Eagan MN 55121 8776622583 6516622583 711 711 8663408654 6516625654 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H2461 010 0 2021 Platinum Blue Complete Plan with Rx (Cost) www.bluecrossmnonline.com 3400 Yankee Drive Eagan MN 55121 8776622583 6516622583 711 711 8663408654 6516625654 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H2462 004 0 2021 HealthPartners Freedom Basic (Cost) healthpartners.com/medicare 8170 33rd Avenue South Bloomington MN 55425 8002477015 9528835601 711 711 8002339645 9528837979 711 711 H2462 010 0 2021 HealthPartners Freedom Ultimate (Cost) healthpartners.com/medicare 8170 33rd Avenue South Bloomington MN 55425 8002477015 9528835601 711 711 8002339645 9528837979 711 711 H2462 016 0 2021 HealthPartners Freedom Balance (Cost) healthpartners.com/medicare 8170 33rd Avenue South Bloomington MN 55425 8002477015 9528835601 711 711 8002339645 9528837979 711 711 H2462 018 0 2021 HealthPartners Freedom Vital (Cost) healthpartners.com/medicare 8170 33rd Avenue South Bloomington MN 55425 8002477015 9528835601 711 711 8002339645 9528837979 711 711 H2462 022 0 2021 HealthPartners Sanford Basic (Cost) healthpartners.com/medicare 8170 33rd Avenue South Bloomington MN 55425 8002477015 8002477015 711 711 8002339645 8002339645 711 711 H2462 023 0 2021 HealthPartners Sanford Vital (Cost) healthpartners.com/medicare 8170 33rd Avenue South Bloomington MN 55425 8002477015 8002477015 711 711 8002339645 8002339645 711 711 H2462 024 0 2021 HealthPartners Sanford Active (Cost) healthpartners.com/medicare 8170 33rd Avenue South Bloomington MN 55425 8002477015 8002477015 711 711 8002339645 8002339645 711 711 H2462 025 0 2021 HealthPartners Sanford Ultimate (Cost) healthpartners.com/medicare 8170 33rd Avenue South Bloomington MN 55425 8002477015 8002477015 711 711 8002339645 8002339645 711 711 H2462 026 0 2021 HealthPartners Freedom Basic WI (Cost) healthpartners.com/medicare 8170 33rd Avenue South Bloomington MN 55425 8002477015 9528835601 711 711 8002339645 9528837979 711 711 H2462 027 0 2021 HealthPartners Freedom Vital WI (Cost) healthpartners.com/medicare 8170 33rd Avenue South Bloomington MN 55425 8002477015 9528835601 711 711 8002339645 9528837979 711 711 H2462 028 0 2021 HealthPartners Freedom Balance WI (Cost) healthpartners.com/medicare 8170 33rd Avenue South Bloomington MN 55425 8002477015 9528835601 711 711 8002339645 9528837979 711 711 H2462 801 0 2021 HealthPartners Retiree Group Calendar Year (Cost) healthpartners.com/medicare 8170 33rd Avenue South Bloomington MN 55425 8669937428 9528837428 711 711 8002339645 9528837979 711 711 H2462 802 0 2021 HealthPartners Retiree Group Non-Calendar Year (Cost) healthpartners.com/medicare 8170 33rd Avenue South Bloomington MN 55425 8669937428 9528837428 711 711 8002339645 9528837979 711 711 H2463 001 0 2021 Humana Gold Plus H2463-001 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H2486 003 0 2021 Humana Gold Plus H2486-003 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H2486 005 0 2021 Humana Community (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H2486 006 0 2021 Humana Gold Plus H2486-006 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H2486 007 0 2021 Humana Gold Plus H2486-007 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H2486 008 0 2021 Humana Gold Plus H2486-008 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~ H2486 801 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H2486 802 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H2486 805 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H2486 806 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H2491 004 0 2021 'Ohana Liberty (HMO D-SNP) www.ohanahealthplan.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8774577621 8774577621 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2491 006 0 2021 WellCare Access (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2491 007 0 2021 WellCare Value (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H2491 008 0 2021 WellCare Liberty (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2491 009 0 2021 'Ohana Value (HMO) www.ohanahealthplan.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8774577621 8774577621 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H2491 010 0 2021 WellCare Compass (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H2491 011 0 2021 WellCare Freedom (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2491 012 0 2021 WellCare Pinnacle (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2491 013 0 2021 'Ohana Plus (HMO) www.ohanahealthplan.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8774577621 8774577621 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H2491 014 0 2021 WellCare Baton Rouge Preferred (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H2491 015 0 2021 'Ohana Value (HMO) www.ohanahealthplan.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8774577621 8774577621 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H2491 016 0 2021 WellCare Endurance (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H2506 001 0 2021 Aetna Better Health Premier Plan (Medicare-Medicaid Plan) www.aetnabetterhealth.com/illinois 7400 W. Campus Rd., MC F494 New Albany OH 43054 8666002139 8666002139 711 711 8666002139 8666002139 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H2531 001 0 2021 UnitedHealthcare Connected for MyCareOhio (Medicare-Medicaid Plan) www.uhccommunityplan.com 9200 Worthington Road Westerville OH 43082 8775429236 8775429236 711 711 8775429236 8775429236 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H2533 001 0 2021 Molina Dual Options (Medicare-Medicaid Plan) www.molinahealthcare.com/duals 200 Oceangate, Suite 100 Long Beach CA 90802 8557014887 8557014887 711 711 8557355831 8557355831 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H2563 004 0 2021 Optima Community Complete (HMO D-SNP) www.optimahealth.com/medicare KRBROGAN@sentara.com 4417 Corporation Lane Virginia Beach VA 23462 8445634201 8445634201 8008281140 711 8009276048 8009276048 8008281140 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2563 005 1 2021 Optima Medicare Prime (HMO) www.optimahealth.com/medicare KRBROGAN@sentara.com 4417 Corporation Lane Virginia Beach VA 23462 8445634201 8445634201 8008281140 711 8009276048 8009276048 8008281140 711 This plan does not charge an annual deductible for all drugs. The $130.00 annual deductible only applies to drugs on certain tiers.~ H2563 005 2 2021 Optima Medicare Prime (HMO) www.optimahealth.com/medicare KRBROGAN@sentara.com 4417 Corporation Lane Virginia Beach VA 23462 8445634201 8445634201 8008281140 711 8009276048 8009276048 8008281140 711 This plan does not charge an annual deductible for all drugs. The $130.00 annual deductible only applies to drugs on certain tiers.~ H2563 008 0 2021 Optima Medicare Value (HMO) www.optimahealth.com/medicare KRBROGAN@sentara.com 4417 Corporation Lane Virginia Beach VA 23462 8445634201 8445634201 8008281140 711 8009276048 8009276048 8008281140 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2563 009 0 2021 Optima Medicare Value (HMO) www.optimahealth.com/medicare KRBROGAN@sentara.com 4417 Corporation Lane Virginia Beach VA 23462 8445634201 8445634201 8008281140 711 8009276048 8009276048 8008281140 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2563 012 0 2021 Optima Medicare Prime (HMO) www.optimahealth.com/medicare KRBROGAN@sentara.com 4417 Corporation Lane Virginia Beach VA 23462 8445634201 8445634201 8008281140 711 8009276048 8009276048 8008281140 711 This plan does not charge an annual deductible for all drugs. The $130.00 annual deductible only applies to drugs on certain tiers.~ H2563 013 0 2021 Optima Medicare Prime (HMO) www.optimahealth.com/medicare KRBROGAN@sentara.com 4417 Corporation Lane Virginia Beach VA 23462 8445634201 8445634201 8008281140 711 8009276048 8009276048 8008281140 711 This plan does not charge an annual deductible for all drugs. The $130.00 annual deductible only applies to drugs on certain tiers.~ H2563 014 0 2021 Optima Medicare Classic (HMO) www.optimahealth.com/medicare KRBROGAN@sentara.com 4417 Corporation Lane Virginia Beach VA 23462 8445634201 8445634201 8008281140 711 8009276048 8009276048 8008281140 711 H2563 015 0 2021 Optima Medicare Value (HMO) www.optimhealth.com/medicare KRBROGAN@sentara.com 4417 Corporation Lane Virginia Beach VA 23462 8445634201 8445634201 8008281140 711 8009276048 8009276048 8008281140 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2563 016 0 2021 Optima Medicare Value (HMO) www.optimahealth.com/medicare KRBROGAN@sentara.com 4417 Corporation Lane Virginia Beach VA 23462 8445634201 8445634201 8008281140 711 8009276048 8009276048 8008281140 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2563 017 1 2021 Optima Medicare Value (HMO) www.optimahealth.com/medicare KRBROGAN@sentara.com 4417 Corporation Lane Virginia Beach VA 23462 8445634201 8445634201 8008281140 711 8009276048 8009276048 8008281140 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2563 017 2 2021 Optima Medicare Value (HMO) www.optimahealth.com/medicare KRBROGAN@sentara.com 4417 Corporation Lane Virginia Beach VA 23462 8445634201 8445634201 8008281140 711 8009276048 8009276048 8008281140 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2563 801 0 2021 Optima Medicare - MAPD Calendar Year (HMO) www.optimahealth.com/medicare KRBROGAN@sentara.com 4417 Corporation Lane Virginia Beach VA 23462 8445634201 8445634201 8008281140 711 8009276048 8009276048 8008281140 711 H2563 802 0 2021 Optima Medicare - MAPD Non-Calendar Year (HMO) www.optimahealth.com/medicare KRBROGAN@sentara.com 4417 Corporation Lane Virginia Beach VA 23462 8445634201 8445634201 8008281140 711 8009276048 8009276048 8008281140 711 H2563 803 0 2021 Optima Medicare - MA Only Calendar Year (HMO) www.optimahealth.com/medicare KRBROGAN@sentara.com 4417 Corporation Lane Virginia Beach VA 23462 8445634201 8445634201 8008281140 711 8009276048 8009276048 8008281140 711 H2563 804 0 2021 Optima Medicare - MA Only Non-Calendar Year (HMO) www.optimahealth.com/medicare KRBROGAN@sentara.com 4417 Corporation Lane Virginia Beach VA 23462 8445634201 8445634201 8008281140 711 8009276048 8009276048 8008281140 711 H2577 001 1 2021 AARP Medicare Advantage Choice Plan 1 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H2577 001 2 2021 AARP Medicare Advantage Choice Plan 1 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H2577 002 0 2021 AARP Medicare Advantage Walgreens (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H2577 003 1 2021 AARP Medicare Advantage Choice Plan 2 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $435.00 annual deductible only applies to drugs on certain tiers.~ H2577 003 2 2021 AARP Medicare Advantage Choice Plan 2 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $435.00 annual deductible only applies to drugs on certain tiers.~ H2577 004 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H2577 005 0 2021 AARP Medicare Advantage Walgreens (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H2577 006 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H2577 007 0 2021 AARP Medicare Advantage Walgreens (PPO) www.AARPMedicarePlans.com memberservices@mypreferredcare.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2577 008 0 2021 AARP Medicare Advantage Walgreens (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2577 009 0 2021 AARP Medicare Advantage Walgreens (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H2577 011 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H2577 013 0 2021 AARP Medicare Advantage Walgreens (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H2577 014 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H2577 015 0 2021 AARP Medicare Advantage Patriot (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2577 016 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H2577 017 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H2577 018 0 2021 AARP Medicare Advantage Choice Plan 2 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H2577 019 0 2021 AARP Medicare Advantage Patriot (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2577 020 0 2021 UnitedHealthcare Medicare Advantage Choice (PPO) www.UHCCommunityPlan.com memberservices@mypreferredcare.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2577 021 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2582 002 0 2021 Rocky Mountain Health Plans DualCare Plus (HMO D-SNP) www.rmhpdualcare.org P.O. Box 10600 Grand Junction CO 81502 8888343721 8888343721 711 711 8003464643 8003464643 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2582 004 0 2021 Rocky Mountain Health Plans CareAdvantage Value (HMO) www.rmhpMedicare.org P.O. Box 10600 Grand Junction CO 81502 8005555757 8005555757 711 711 8003464643 8003464643 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H2582 005 0 2021 Rocky Mountain Health Plans CareAdvantage Enhanced (HMO) www.rmhpMedicare.org P.O. Box 10600 Grand Junction CO 81502 8005555757 8005555757 711 711 8003464643 8003464643 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2591 801 0 2021 Medicare Employer PPO (PPO) healthalliancemedicare.org mwmedicare@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8779338454 8779338454 711 711 8779178550 8779178550 711 711 H2591 802 0 2021 Health Alliance Medicare (PPO) healthalliancemedicare.org mwmedicare@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8779338454 8779338454 711 711 8779178550 8779178550 711 711 H2591 803 0 2021 Health Alliance Medicare (non calendar) (PPO) healthalliancemedicare.org mwmedicare@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8779338454 8779338454 711 711 8779178550 8779178550 711 711 H2593 001 0 2021 Amerivantage Classic (HMO) //shop.amerigroup.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930913 8555930913 711 711 8888162790 8888162790 711 711 H2593 003 0 2021 Amerivantage CareMore Care To You (HMO I-SNP) //shop.amerigroup.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930914 8555930914 711 711 8888162790 8888162790 711 711 H2593 005 0 2021 Amerivantage Lung Care (HMO C-SNP) //shop.amerigroup.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930915 8555930915 711 711 8888162790 8888162790 711 711 H2593 006 0 2021 Amerivantage Diabetes Care (HMO C-SNP) //shop.amerigroup.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930915 8555930915 711 711 8888162790 8888162790 711 711 H2593 013 0 2021 Amerivantage Heart Care (HMO C-SNP) //shop.amerigroup.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930915 8555930915 711 711 8888162790 8888162790 711 711 H2593 018 0 2021 Amerivantage Smart Value (HMO) //shop.amerigroup.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930913 8555930913 711 711 8888162790 8888162790 711 711 H2593 019 0 2021 Amerivantage CareMore Care To You (HMO I-SNP) //shop.amerigroup.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930914 8555930914 711 711 8888162790 8888162790 711 711 H2593 021 0 2021 Amerivantage Dual Coordination (HMO D-SNP) https://shop.amerigroup.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8555930916 8555930916 711 711 8774110929 8774110929 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2593 022 0 2021 Amerivantage Classic (HMO) https://shop.amerigroup.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8555930913 8555930913 711 711 8668054589 8668054589 711 711 H2593 023 0 2021 Amerivantage Classic (HMO) https://shop.amerigroup.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8555930913 8555930913 711 711 8668054589 8668054589 711 711 H2593 024 0 2021 Amerivantage Plus (HMO) https://shop.amerigroup.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8555930913 8555930913 711 711 8668054589 8668054589 711 711 H2593 025 0 2021 Amerivantage Balance (HMO) https://shop.amerigroup.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8555930913 8555930913 711 711 8668054589 8668054589 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H2593 026 0 2021 Amerivantage Select (HMO) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8555930913 8555930913 711 711 8668054589 8668054589 711 711 H2593 027 0 2021 Amerivantage Select (HMO) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8555930913 8555930913 711 711 8668054589 8668054589 711 711 H2593 028 1 2021 Amerivantage Classic (HMO) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8555930913 8555930913 711 711 8668054589 8668054589 711 711 H2593 028 2 2021 Amerivantage Classic (HMO) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8555930913 8555930913 711 711 8668054589 8668054589 711 711 H2593 028 3 2021 Amerivantage Classic (HMO) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8555930913 8555930913 711 711 8668054589 8668054589 711 711 H2593 028 4 2021 Amerivantage Classic (HMO) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8555930913 8555930913 711 711 8668054589 8668054589 711 711 H2593 028 5 2021 Amerivantage Classic (HMO) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8555930913 8555930913 711 711 8668054589 8668054589 711 711 H2593 028 6 2021 Amerivantage Classic (HMO) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8555930913 8555930913 711 711 8668054589 8668054589 711 711 H2593 029 0 2021 Amerivantage Select (HMO) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8555930913 8555930913 711 711 8668054589 8668054589 711 711 H2593 030 1 2021 Amerivantage Dual Coordination (HMO D-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8555930916 8555930916 711 711 8447655165 8447655165 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2593 030 2 2021 Amerivantage Dual Coordination (HMO D-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8555930916 8555930916 711 711 8447655165 8447655165 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2593 030 3 2021 Amerivantage Dual Coordination (HMO D-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8555930916 8555930916 711 711 8447655165 8447655165 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2593 030 4 2021 Amerivantage Dual Coordination (HMO D-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8555930916 8555930916 711 711 8447655165 8447655165 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2593 030 5 2021 Amerivantage Dual Coordination (HMO D-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8555930916 8555930916 711 711 8447655165 8447655165 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2593 030 6 2021 Amerivantage Dual Coordination (HMO D-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8555930916 8555930916 711 711 8447655165 8447655165 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2593 031 0 2021 Amerivantage ESRD Care (HMO-POS C-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8555930917 8555930917 711 711 8772695660 8772695660 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H2593 032 0 2021 Amerivantage Dual Secure (HMO D-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8555930916 8555930916 711 711 8447655165 8447655165 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2593 033 0 2021 Amerivantage Dual Secure (HMO D-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8555930916 8555930916 711 711 8444696822 8444696822 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2593 034 0 2021 Amerivantage Dual Secure (HMO D-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8555930916 8555930916 711 711 8444696822 8444696822 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2593 035 0 2021 Amerivantage Dual Secure (HMO D-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8555930916 8555930916 711 711 8444696822 8444696822 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2593 036 0 2021 Amerivantage Dual Secure (HMO D-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8555930916 8555930916 711 711 8444696822 8444696822 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2593 037 0 2021 Amerivantage Diabetes Care (HMO C-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8555930915 8555930915 711 711 8444696823 8444696823 711 711 H2593 038 0 2021 Amerivantage Heart Care (HMO C-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8555930915 8555930915 711 711 8444696823 8444696823 711 711 H2593 039 0 2021 Amerivantage Lung Care (HMO C-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8555930915 8555930915 711 711 8444696823 8444696823 711 711 H2593 040 0 2021 Amerivantage CareMore ESRD Care (HMO C-SNP) //shop.amerigroup.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8555930915 8555930915 711 711 8888162790 8888162790 711 711 H2593 041 0 2021 Amerivantage Diabetes Care (HMO C-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8555930915 8555930915 711 711 8444696823 8444696823 711 711 H2593 042 0 2021 Amerivantage Care To You (HMO I-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8555930914 8555930914 711 711 8442861378 8442861378 711 711 H2593 802 0 2021 Amerivantage EGWP MAPD (HMO) www.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8772116614 8772116614 711 711 8888162790 8888162790 711 711 H2610 005 0 2021 Essence Advantage (HMO) www.essencehealthcare.com customerservice@essencehealthcare.com PO Box 12487 St. Louis MO 63132 8665095399 3142093930 711 711 8665979560 3142092700 711 711 H2610 006 0 2021 Essence Advantage Plus (HMO) www.essencehealthcare.com customerservice@essencehealthcare.com PO Box 12487 St. Louis MO 63132 8665095399 3142093930 711 711 8665979560 3142092700 711 711 H2610 011 0 2021 Essence Advantage (HMO) www.essencehealthcare.com customerservice@essencehealthcare.com PO Box 12487 St. Louis MO 63132 8665095399 3142093930 711 711 8665979560 3142092700 711 711 H2610 015 0 2021 CoxHealth MedicarePlus (HMO) www.essencehealthcare.com customerservice@essencehealthcare.com PO Box 12487 St. Louis MO 63132 8665095399 3142093930 711 711 8665979560 3142092700 711 711 H2610 016 0 2021 Essence Advantage Select (HMO) www.essencehealthcare.com customerservice@essencehealthcare.com PO Box 12487 St. Louis MO 63132 8665095399 3142093930 711 711 8665979560 3142092700 711 711 H2610 803 0 2021 Essence Advantage EGWP MAPD calendar (HMO) www.essencehealthcare.com customerservice@essencehealthcare.com PO Box 12487 St. Louis MO 63132 8665095399 3142093930 711 711 8665979560 3142092700 711 711 H2610 804 0 2021 Essence Advantage EGWP MAPD non-calendar (HMO) www.essencehealthcare.com customerservice@essencehealthcare.com PO Box 12487 St. Louis MO 63132 8665095399 3142093930 711 711 8665979560 3142092700 711 711 H2624 001 0 2021 HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) www.healthteamadvantage.com conciergehta@healthteamadvantage.com 7800 McCloud Rd, Suite 100 Greensboro NC 27409 8779059216 8779059216 711 711 8333243242 8333243242 711 711 H2663 002 0 2021 Aetna Medicare Advantra 2 (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H2663 005 0 2021 Aetna Medicare Gold Advantage Prime (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H2663 006 0 2021 Aetna Medicare Advantra 1 (HMO-POS) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H2663 015 0 2021 Aetna Medicare Prime (HMO-POS) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H2663 017 0 2021 Aetna Medicare UnityPoint Health Prime (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H2663 021 0 2021 Aetna Medicare Premier (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H2663 022 0 2021 Aetna Medicare Eagle (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H2663 023 0 2021 Aetna Medicare Premier Plus (HMO-POS) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H2663 025 0 2021 Aetna Medicare Eagle (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H2663 026 0 2021 Aetna Medicare Premier (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H2663 028 0 2021 Aetna Medicare Premier (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H2663 029 0 2021 Aetna Medicare Premier (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H2663 032 0 2021 Aetna Medicare Gold Advantage Value Prime (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H2663 034 0 2021 Aetna Medicare Premier Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H2663 035 0 2021 Aetna Medicare Premier Preferred (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H2663 036 0 2021 Aetna Medicare Premier Preferred (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H2663 805 0 2021 Aetna Medicare Plan (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8552755888 8552755888 711 711 H2663 810 0 2021 Aetna Medicare Plan w/Rx (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Famington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8552755888 8552755888 711 711 H2678 001 0 2021 MoreCare For You (HMO) www.mymorecare.com P.O. Box 64540 Chicago IL 60664 8777702636 8777702636 711 711 8444808528 8444808528 711 711 H2678 002 0 2021 MoreCare + (HMO C-SNP) www.mymorecare.com P.O. Box 64540 Chicago IL 60664 8777702636 8777702636 711 711 8444808528 8444808528 711 711 H2678 003 0 2021 MoreCare Home (HMO I-SNP) www.mymorecare.com P.O. Box 64540 Chicago IL 60664 8777702636 8777702636 711 711 8444808528 8444808528 711 711 This plan does not charge an annual deductible for all drugs. The $365.00 annual deductible only applies to drugs on certain tiers.~ H2678 004 0 2021 MoreCare At Home (HMO I-SNP) www.mymorecare.com P.O. Box 64540 Chicago IL 60664 8777702636 8777702636 711 711 8444808528 8444808528 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H2697 001 0 2021 Devoted Health Core (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 H2697 002 0 2021 Devoted Health Prime (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2697 003 0 2021 Devoted Health Saver (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H2722 001 0 2021 Vantage TRADITIONAL PLUS (HMO-POS) www.VantageMedicare.com 130 DeSiard St, Suite 300 Monroe LA 71201 8667040109 3183610900 1 8665245144 3183612131 8667040109 3183610900 1 8665245144 3183612131 H2722 002 0 2021 Vantage BASIC (HMO-POS) www.VantageMedicare.com 130 DeSiard St, Suite 300 Monroe LA 71201 8667040109 3183610900 1 8665245144 3183612131 8667040109 3183610900 1 8665245144 3183612131 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H2722 003 0 2021 Vantage DUAL PLUS (HMO-POS D-SNP) www.VantageMedicare.com 130 DeSiard St, Suite 300 Monroe LA 71201 8667040109 3183610900 1 8665245144 3183612131 8667040109 3183610900 1 8665245144 3183612131 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2722 004 0 2021 Vantage STANDARD (HMO-POS) www.VantageMedicare.com 130 DeSiard St, Suite 300 Monroe LA 71201 8667040109 3183610900 1 8665245144 3183612131 8667040109 3183610900 1 8665245144 3183612131 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H2722 801 0 2021 Vantage - MAPD EGWP CY (HMO-POS) www.VantageMedicare.com 130 DeSiard St, Suite 300 Monroe LA 71201 8667040109 3183610900 1 8665245144 3183612131 8667040109 3183610900 1 8665245144 3183612131 H2765 001 0 2021 Summit Health Core (HMO-POS) yoursummithealth.com P.O. Box 820070 Portland OR 97282 8449311781 8449311781 711 711 8448272355 5416632721 711 711 H2765 002 0 2021 Summit Health Value + Rx (HMO) yoursummithealth.com P.O. Box 820070 Portland OR 97282 8449311781 8449311781 711 711 8448272355 5416632721 711 711 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~ H2765 003 0 2021 Summit Health Standard + Rx (HMO-POS) yoursummithealth.com P.O. Box 820070 Portland OR 97282 8449311781 8449311781 711 711 8448272355 5416632721 711 711 This plan does not charge an annual deductible for all drugs. The $230.00 annual deductible only applies to drugs on certain tiers.~ H2765 004 0 2021 Summit Health Premier + Rx (HMO-POS) yoursummithealth.com P.O. Box 820070 Portland OR 97282 8449311781 8449311781 711 711 8448272355 5416632721 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~ H2775 100 0 2021 WellCare Today's Options Advantage Plus 750B (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H2775 105 0 2021 WellCare Today's Options Advantage Plus 150A (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H2775 106 0 2021 WellCare Today's Options Advantage Plus 550B (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H2775 108 0 2021 WellCare Today's Options Advantage 300 (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H2775 109 0 2021 WellCare Today's Options Advantage Plus 550B (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H2775 111 0 2021 WellCare Absolute (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2775 112 0 2021 WellCare Imperial (PPO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2775 113 0 2021 WellCare Summit (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H2775 801 0 2021 Today's Options PPO - MA Group Plan (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H2775 802 0 2021 Today's Options PPO - MAPD Group Plan (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H2775 803 0 2021 Today's Options PPO - MAPD Group Plan - NCY (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H2782 002 0 2021 Western Health Advantage MyCare (HMO) medicare.westernhealth.com 2349 Gateway Oaks Drive, Suite 100 Sacramento CA 95833 8889927494 9162467494 8888775378 711 8885632250 9165632250 8888775378 711 H2782 003 0 2021 Western Health Advantage MyCare Plus (HMO) medicare.westernhealth.com 2349 Gateway Oaks Drive, Suite 100 Sacramento CA 95833 8889927494 9162467494 8888775378 711 8885632250 9165632250 8888775378 711 H2782 801 0 2021 Western Health Advantage MyCare EGWP (HMO) medicare.westernhealth.com 2349 Gateway Oaks Drive, Suite 100 Sacramento CA 95833 8889927494 9162467494 8888775378 711 8885632250 9165632250 8888775378 711 H2782 802 0 2021 Western Health Advantage MyCare EGWP MAPD (HMO) medicare.westernhealth.com 2349 Gateway Oaks Drive, Suite 100 Sacramento CA 95833 8889927494 9162467494 8888775378 711 8885632250 9165632250 8888775378 711 H2782 803 0 2021 Western Health Advantage MyCare EGWP MA Fiscal (HMO) medicare.westernhealth.com 2349 Gateway Oaks Drive, Suite 100 Sacramento CA 95833 8889927494 9162467494 8888775378 711 8885632250 9165632250 8888775378 711 H2782 804 0 2021 Western Health Advantage MyCare EGWP MAPD Fiscal (HMO) medicare.westernhealth.com 2349 Gateway Oaks Drive, Suite 100 Sacramento CA 95833 8889927494 9162467494 8888775378 711 8885632250 9165632250 8888775378 711 H2793 003 0 2021 Imperial Insurance Company Traditional (HMO) www.imperialhealthplan.com Members@imperialhealthplan.com 1100 East Green Street Pasadena CA 91106 8008385914 6267080333 711 711 8008388271 6267080333 711 711 H2793 004 0 2021 Imperial Insurance Company Dual (HMO D-SNP) www.imperialhealthplan.com Members@imperialhealthplan.com 1100 East Green Street Pasadena CA 91106 8008385914 6267080333 711 711 8008388271 6267080333 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2793 005 0 2021 Imperial Insurance Value (HMO C-SNP) www.imperialhealthplan.com Members@imperialhealthplan.com 1100 East Green Street Pasadena CA 91106 8008385914 6267080333 711 711 8008388271 6267080333 711 711 H2793 007 0 2021 Imperial Insurance Traditional Plus (HMO) www.imperialhealthplan.com Members@imperialhealthplan.com 1100 East Green Street Pasadena CA 91106 8008385914 6267080333 711 711 8008388271 6267080333 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H2802 001 0 2021 AARP Medicare Advantage (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H2802 007 0 2021 AARP Medicare Advantage Profile (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $210.00 annual deductible only applies to drugs on certain tiers.~ H2802 008 0 2021 AARP Medicare Advantage Plan 1 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $190.00 annual deductible only applies to drugs on certain tiers.~ H2802 010 0 2021 AARP Medicare Advantage Plan 1 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2802 012 0 2021 AARP Medicare Advantage Plan 1 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $125.00 annual deductible only applies to drugs on certain tiers.~ H2802 015 0 2021 AARP Medicare Advantage Plan 2 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2802 016 0 2021 AARP Medicare Advantage Plan 1 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2802 018 0 2021 AARP Medicare Advantage Plan 1 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2802 020 0 2021 AARP Medicare Advantage Plan 1 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $240.00 annual deductible only applies to drugs on certain tiers.~ H2802 024 0 2021 AARP Medicare Advantage Access (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H2802 025 0 2021 AARP Medicare Advantage Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H2802 026 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $60.00 annual deductible only applies to drugs on certain tiers.~ H2802 027 0 2021 UnitedHealthcare Nursing Home Plan 1 (HMO-POS I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H2802 028 0 2021 AARP Medicare Advantage (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2802 029 0 2021 AARP Medicare Advantage Plan 1 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H2802 030 0 2021 AARP Medicare Advantage Plan 2 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H2802 031 0 2021 AARP Medicare Advantage Plan 1 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2802 032 0 2021 AARP Medicare Advantage Plan 2 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2802 033 0 2021 AARP Medicare Advantage Plan 1 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2802 034 0 2021 AARP Medicare Advantage Plan 1 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2802 035 0 2021 AARP Medicare Advantage Plan 2 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2802 041 0 2021 AARP Medicare Advantage Plan 3 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $55.00 annual deductible only applies to drugs on certain tiers.~ H2802 044 0 2021 UnitedHealthcare Dual Complete Plan 2 (HMO D-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8664801086 8664801086 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2802 048 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H2802 049 0 2021 AARP Medicare Advantage (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2802 050 0 2021 AARP Medicare Advantage Patriot (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H2802 801 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2802 802 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2802 803 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2802 804 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2802 805 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2802 806 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2802 807 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2802 808 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2802 809 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H2816 013 0 2021 WellCare Today's Options Premier Plus 250A (PFFS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H2816 019 0 2021 WellCare Today's Options Premier Plus 650B (PFFS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H2816 037 0 2021 WellCare Today's Options Premier 200 (PFFS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H2816 038 0 2021 WellCare Today's Options Premier 300 (PFFS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H2816 039 0 2021 WellCare Today's Options Premier 200 (PFFS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H2816 040 0 2021 WellCare Today's Options Premier 300 (PFFS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H2816 801 0 2021 Today's Options PFFS - MA Group Plan (PFFS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H2816 802 0 2021 Today's Options PFFS - MAPD Group Plan (PFFS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H2816 803 0 2021 Today's Options PFFS - MAPD Group Plan - NCY (PFFS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H2825 001 0 2021 Mary Washington Medicare Advantage Complete (HMO) www.mwmaplan.com PO Box 12487 St. Louis MO 63132 8445293827 8445293827 711 711 8445293760 8445293760 711 711 H2825 002 0 2021 Mary Washington Medicare Advantage Rewards (HMO) www.mwmaplan.com PO Box 12487 St. Louis MO 63132 8445293827 8445293827 711 711 8445293760 8445293760 711 711 H2825 801 0 2021 EGWP MAPD Calendar year (HMO) www.mwmaplan.com PO Box 12487 St. Louis MO 63132 8445293827 8445293827 711 711 8445293760 8445293760 711 711 H2825 802 0 2021 EGWP MAPD Non-Calendar year (HMO) www.mwmaplan.com PO Box 12487 St. Louis MO 63132 8445293827 8445293827 711 711 8445293760 8445293760 711 711 H2829 001 0 2021 Innovation Health-Aetna Medicare Connect (HMO) www.innovationhealthmedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8556055295 8556055295 711 711 8552491282 8552491282 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H2829 002 0 2021 Innovation Health-Aetna Medicare Eagle (HMO) www.innovationhealthmedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8556055295 8556055295 711 711 8552491282 8552491282 711 711 H2836 005 0 2021 Anthem MediBlue Access Select (PPO) www.anthem.com/shop P.O. Box 659403 San Antonio TX 78265 8555930918 8555930918 711 711 8337131076 8337131076 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H2836 801 0 2021 Anthem MediBlue Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H2853 001 0 2021 Ascension Complete Saint Thomas Reward (HMO) www.ascensioncomplete.com PO Box 10420 Van Nuys CA 91410 8449420038 8449420038 711 711 8339062876 8339062876 711 711 This plan does not charge an annual deductible for all drugs. The $390.00 annual deductible only applies to drugs on certain tiers.~ H2853 002 0 2021 Ascension Complete Saint Thomas Secure (HMO) ascensioncomplete.com PO Box 10420 Van Nuys CA 91410 8449420038 8449420038 711 711 8339062876 8339062876 711 711 H2879 001 0 2021 Molina Medicare Complete Care (HMO D-SNP) www.molinahealthcare.com/medicare 200 Oceangate, Suite 100 Long Beach CA 90802 8664038293 8664038293 711 711 8553155663 8553155663 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2915 001 0 2021 Allwell Dual Medicare (HMO D-SNP) allwell.pahealthwellness.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8663309368 8663309368 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2915 002 0 2021 Allwell Dual Medicare (HMO D-SNP) allwell.pahealthwellness.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8663309368 8663309368 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2915 003 0 2021 Allwell Medicare (HMO) allwell.pahealthwellness.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661456 8557661456 711 711 H2915 007 0 2021 Allwell Dual Medicare (HMO D-SNP) allwell.pahealthwellness.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8663309368 8663309368 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2915 010 0 2021 Allwell Medicare Simple (HMO) allwell.pahealthwellness.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661456 8557661456 711 711 H2915 011 0 2021 Allwell Medicare Complement (HMO) allwell.pahealthwellness.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661456 8557661456 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H2915 012 0 2021 Allwell Medicare Boost (HMO) allwell.pahealthwellness.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661456 8557661456 711 711 H2915 013 0 2021 Allwell Medicare Simple (HMO) allwell.pahealthwellness.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661456 8557661456 711 711 H2915 014 0 2021 Allwell Medicare Boost (HMO) allwell.pahealthwellness.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661456 8557661456 711 711 H2915 015 2 2021 Allwell Medicare (HMO) allwell.pahealthwellness.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661456 8557661456 711 711 H2915 015 3 2021 Allwell Medicare (HMO) allwell.pahealthwellness.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661456 8557661456 711 711 H2915 801 0 2021 Allwell Group (HMO) allwell.pahealthwellness.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661456 8557661456 711 711 H2915 802 0 2021 Allwell Group (HMO) allwell.pahealthwellness.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661456 8557661456 711 711 H2915 803 0 2021 Allwell Group (HMO) allwell.pahealthwellness.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661456 8557661456 711 711 H2926 001 0 2021 Prime Health Complete (HMO D-SNP) www.primewest.org/phc matt.magnuson@primewest.org 3905 Dakota Street Alexandria MN 56308 8776004913 3203355243 711 711 8776004913 3203355243 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H2944 013 0 2021 Humana Gold Choice H2944-013 (PFFS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H2944 114 0 2021 Humana Gold Choice H2944-114 (PFFS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $340.00 annual deductible only applies to drugs on certain tiers.~ H2944 197 0 2021 Humana Gold Choice H2944-197 (PFFS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H2960 009 0 2021 Senior Care Plus Patriot Plan (HMO) www.SeniorCarePlus.com Customer_Service@hometownhealth.com 10315 Professional Circle Reno NV 89521 8887757003 7759823112 711 711 8887757003 7759823112 711 711 H2960 012 0 2021 Senior Care Plus Essential plan (HMO) www.SeniorCarePlus.com Customer_Service@hometownhealth.com 10315 Professional Circle Reno NV 89521 8887757003 7759823112 711 711 8887757003 7759823112 711 711 H2960 018 0 2021 Senior Care Plus Select Plan (HMO) www.SeniorCarePlus.com Customer_Service@hometownhealth.com 10315 Professional Circle Reno NV 89521 8887757003 7759823112 711 711 8887757003 7759823112 711 711 H2960 019 0 2021 Senior Care Plus Complete Plan (HMO) www.SeniorCarePlus.com Customer_Service@hometownhealth.com 10315 Professional Circle Reno NV 89521 8887757003 7029140863 711 711 8887757003 7029140863 711 711 H2960 021 0 2021 Senior Care Plus Comprehensive plan (HMO) www.SeniorCarePlus.com customer_service@hometownhealth.com 10315 Professional Circle Reno NV 89521 8887757003 7759823112 711 711 8887757003 7759823112 711 711 H2960 022 0 2021 Senior Care Plus Encompass Plan (HMO C-SNP) www.SeniorCarePlus.com Customer_Service@hometownhealth.com 10315 Professional Circle reno NV 89521 8887757003 7759823112 711 711 8887757003 7759823112 711 711 H2960 023 0 2021 Renown Preferred Plan by Senior Care Plus (HMO) www.SeniorCarePlus.com Customer_Service@hometownhealth.com 10315 Professional Cir Reno NV 89521 8887757003 7759823112 711 711 8887757003 7759823112 711 711 H2960 803 0 2021 Senior Care Plus: Value Group Plan (HMO) www.SeniorCarePlus.com Customer_Service@hometownhealth.com 10315 Professional Circle Reno NV 89521 8887757003 7759823112 711 711 8887757003 7759823112 711 711 H2962 001 0 2021 Premier by Ultimate (HMO) www.chooseultimate.com memberadvocate@ulthp.com 2713 Forest Road Spring Hill FL 34606 8558587526 3522775427 711 711 8886574170 2243994282 711 711 H2962 011 0 2021 Premier by Ultimate (HMO) www.chooseultimate.com memberadvocate@ulthp.com 2713 Forest Road Spring Hill FL 34606 8558587526 3522775427 711 711 8886574170 2243994282 711 711 H2962 012 0 2021 Premier Plus by Ultimate (HMO) www.chooseultimate.com memberadvocate@ulthp.com 2713 Forest Road Spring Hill FL 34606 8558587526 3522775427 711 711 8886574170 2243994282 711 711 H2962 013 3 2021 Premier by Ultimate (HMO) www.chooseultimate.com memberadvocate@ulthp.com 2713 Forest Road Spring Hill FL 34606 8558587526 3522775427 711 711 8886574170 2243994282 711 711 H2962 013 4 2021 Premier by Ultimate (HMO) www.chooseultimate.com memberadvocate@ulthp.com 2713 Forest Road Spring Hill FL 34606 8558587526 3522775427 711 711 8886574170 2243994282 711 711 H2962 014 1 2021 Premier Plus by Ultimate (HMO) www.chooseultimate.com memberadvocate@ulthp.com 2713 Forest Road Spring Hill FL 34606 8558587526 3522775427 711 711 8886574170 2243994282 711 711 H2962 014 2 2021 Premier Plus by Ultimate (HMO) www.chooseultimate.com memberadvocate@ulthp.com 2713 Forest Road Spring Hill FL 34606 8558587526 3522775427 711 711 8886574170 2243994282 711 711 H2962 016 0 2021 Premier Plus by Ultimate (HMO) www.chooseultimate.com memberadvocate@ulthp.com 2713 Forest Road Spring Hill FL 34606 8558587526 3522775427 711 711 8886574170 2243994282 711 711 H2962 019 1 2021 Advantage Care by Ultimate (HMO C-SNP) www.chooseultimate.com memberadvocate@ulthp.com 2713 Forest Road Spring Hill FL 34606 8558587526 3522775427 711 711 8886574170 2243994282 711 711 H2962 019 2 2021 Advantage Care by Ultimate (HMO C-SNP) www.chooseultimate.com memberadvocate@ulthp.com 2713 Forest Road Spring Hill FL 34606 8558587526 3522775427 711 711 8886574170 2243994282 711 711 H2962 021 0 2021 Advantage Care by Ultimate (HMO C-SNP) www.chooseultimate.com memberadvocate@ulthp.com 2713 Forest Road Spring Hill FL 34606 8558587526 3522775427 711 711 8886574170 2243994282 711 711 H2962 022 0 2021 Advantage Care CHF by Ultimate (HMO C-SNP) www.chooseultimate.com memberadvocate@ulthp.com 2713 Forest Road Spring Hill FL 34606 8558587526 3522775427 711 711 8886574170 2243994282 711 711 H2962 023 0 2021 Advantage Care COPD by Ultimate (HMO C-SNP) www.chooseultimate.com memberadvocate@ulthp.com 2713 Forest Road Spring Hill FL 34606 8558587526 3522775427 711 711 8886574170 2243994282 711 711 H2962 024 0 2021 Advantage Care CHF by Ultimate (HMO C-SNP) www.chooseultimate.com memberadvocate@ulthp.com 2713 Forest Road Spring Hill FL 34606 8558587526 3522775427 711 711 8886574170 2243994282 711 711 H2962 025 0 2021 Advantage Care COPD by Ultimate (HMO C-SNP) www.chooseultimate.com memberadvocate@ulthp.com 2713 Forest Road Spring Hill FL 34606 8558587526 3522775427 711 711 8886574170 2243994282 711 711 H2962 026 0 2021 Advantage Care by Ultimate (HMO C-SNP) www.chooseultimate.com memberadvocate@ulthp.com 2713 Forest Road Spring Hill FL 34606 8558587526 3522775427 711 711 8886574170 2243994282 711 711 H2962 027 0 2021 Advantage Care COPD by Ultimate (HMO C-SNP) www.chooseultimate.com memberadvocate@ulthp.com 2713 Forest Road Spring Hill FL 34606 8558587526 3522775427 711 711 8886574170 2243994282 711 711 H2962 028 0 2021 Premier by Ultimate (HMO) www.chooseultimate.com memberadvocate@ulthp.com 2713 Forest Road Spring Hill FL 34606 8558587526 3522775427 711 711 8886574170 2243994282 711 711 H2962 029 0 2021 Advantage Care by Ultimate (HMO C-SNP) www.chooseultimate.com memberadvocate@ulthp.com 2713 Forest Road Spring Hill FL 34606 8558587526 3522775427 711 711 8886574170 2243994282 711 711 H2962 030 0 2021 Advantage Care COPD by Ultimate (HMO C-SNP) www.chooseultimate.com memberadvocate@ulthp.com 2713 Forest Road Spring Hill FL 34606 8558587526 3522775427 711 711 8886574170 2243994282 711 711 H2962 031 0 2021 Premier by Ultimate (HMO) www.chooseultimate.com memberadvocate@ulthp.com 2713 Forest Road Spring Hill FL 34606 8558587526 3522775427 711 711 8886574170 2243994282 711 711 H2962 032 0 2021 Premier Plus by Ultimate (HMO) www.chooseultimate.com memberadvocate@ulthp.com 2713 Forest Road Spring Hill FL 34606 8558587526 3522775427 711 711 8886574170 2243994282 711 711 H2962 033 0 2021 Advantage Care by Ultimate (HMO C-SNP) www.chooseultimate.com memberadvocate@ulthp.com 2713 Forest Road Spring Hill FL 34606 8558587526 3522775427 711 711 8886574170 2243994282 711 711 H2962 034 0 2021 Advantage Care COPD by Ultimate (HMO C-SNP) www.chooseultimate.com memberadvocate@ulthp.com 2713 Forest Road Spring Hill FL 34606 8558587526 3522775427 711 711 8886574170 2243994282 711 711 H2986 001 0 2021 Stanford Health Care Advantage - Platinum (HMO) www.StanfordHealthCareAdvantage.org PO Box 5904 Troy MI 48007 8552000109 8552000109 711 711 8559968422 8559968422 711 711 H2986 002 0 2021 Stanford Health Care Advantage - Gold (HMO) www.StanfordHealthCareAdvantage.org PO Box 5904 Troy MI 48007 8552000109 8552000109 711 711 8559968422 8559968422 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H2986 004 0 2021 Stanford Health Care Advantage - Platinum (HMO) www.StanfordHealthCareAdvantage.org PO Box 5904 Troy MI 48007 8552000109 8552000109 711 711 8559968422 8559968422 711 711 H2986 006 0 2021 Stanford Health Care Advantage - Platinum (HMO) www.StanfordHealthCareAdvantage.org PO Box 5904 Troy MI 48007 8552000109 8552000109 711 711 8559968422 8559968422 711 711 H2986 007 0 2021 Stanford Health Care Advantage - Gold (HMO) www.StanfordHealthCareAdvantage.org PO Box 5904 Troy MI 48007 8552000109 8552000109 711 711 8559968422 8559968422 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H2986 801 0 2021 Stanford Health Care Advantage EGWP MAPD calendar (HMO) www.StanfordHealthCareAdvantage.org PO Box 5904 Troy MI 48007 8552000109 8552000109 711 711 8559968422 8559968422 711 711 H2986 802 0 2021 Stanford Health Care Advantage EGWP MAPD non-CY (HMO) www.StanfordHealthCareAdvantage.org PO Box 5904 Troy MI 48007 8552000109 8552000109 711 711 8559968422 8559968422 711 711 H2986 803 0 2021 Stanford Health Care Advantage EGWP MA only CY (HMO) www.StanfordHealthCareAdvantage.org PO Box 5904 Troy MI 48007 8552000109 8552000109 711 711 8559968422 8559968422 711 711 H3015 001 0 2021 Shared Health Dual Plus (HMO D-SNP) www.sharedhealthms.com 1 Cameron Hill Circle Chattanooga TN 37402 8558901234 7695723900 711 711 8444746477 7695723875 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3047 001 0 2021 WellCare Premier (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $75.00 annual deductible only applies to drugs on certain tiers.~ H3047 002 0 2021 Wellcare Absolute (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3071 002 0 2021 Clear Spring Health Community Advantage Plan (HMO) www.ccaillinois.com/medicare P.O. BOX 278530 miramar FL 33027 8773644566 8773644566 711 711 8773644566 8773644566 711 711 H3071 003 0 2021 Clear Spring Health Community Flex Plan (HMO-POS) www.ccaillinois.com/medicare P.O. BOX 278530 Miramar FL 33027 8773644566 8773644566 711 711 8773644566 8773644566 711 711 H3113 001 0 2021 UnitedHealthcare Nursing Home Plan (HMO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H3113 005 0 2021 UnitedHealthcare Dual Complete ONE (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30769 Salt Lake City UT 84130 8888343721 8888343721 711 711 8005144911 8005144911 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3113 008 0 2021 UnitedHealthcare Assisted Living Plan (HMO-POS I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3113 009 0 2021 UnitedHealthcare Dual Complete (HMO D-SNP) www.UHC.com/PADual P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8002904009 8002904009 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3113 010 0 2021 UnitedHealthcare Dual Complete (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8664801086 8664801086 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3113 011 0 2021 UnitedHealthcare Dual Complete (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8662629919 8662629919 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3132 001 0 2021 PHP (HMO C-SNP) www.php-fl.org php@positivehealthcare.org P.O. Box 46160 Los Angeles CA 90046 8884564715 8884564715 711 711 8884564715 8884564715 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H3146 001 0 2021 Aetna Medicare Value Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3146 002 0 2021 Aetna Medicare Assure Plan (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3146 003 0 2021 Aetna Medicare Assure Plan (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3146 004 0 2021 Aetna Medicare Value Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3146 005 0 2021 Aetna Medicare Value Plus Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3146 006 0 2021 Aetna Medicare Value Plus Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3146 007 0 2021 Aetna Medicare Prime (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3146 008 0 2021 Aetna Medicare Assure Plan (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3146 009 0 2021 Aetna Medicare Assure Plan (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3146 010 0 2021 Aetna Medicare Value Plus Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3146 011 0 2021 Aetna Medicare Value Plus Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3146 012 0 2021 Aetna Medicare Value Plus Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3146 013 0 2021 Aetna Medicare Value Plus Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3146 801 0 2021 Aetna Medicare Plan (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H3146 802 0 2021 Aetna Medicare Plan w/Rx (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H3152 022 0 2021 Aetna Medicare Explorer Premier (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H3152 045 0 2021 Aetna Medicare Eagle (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H3152 048 0 2021 Aetna Medicare Explorer Premier Plus (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H3152 080 0 2021 Aetna Medicare Prime Value (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3152 082 0 2021 Aetna Medicare Explorer Value (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3152 084 0 2021 Aetna Medicare Explorer Elite (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H3152 088 0 2021 Aetna Medicare Value 2 (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3152 092 0 2021 Aetna Medicare Explorer Elite 2 (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3152 801 0 2021 Aetna Medicare Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H3152 804 0 2021 Aetna Medicare Plan w/Rx (HMO) www.aetnamedicare.com HicksJS@aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H3154 004 0 2021 Horizon Medicare Blue Value w/Rx (HMO) www.HorizonBlue.com/Medicare 3 Penn Plaza East, PP-12F Newark NJ 07105 8887657134 8887657134 711 711 8003652223 8003652223 711 711 H3154 013 0 2021 Horizon Medicare Blue Value (HMO) www.HorizonBlue.com/Medicare 3 Penn Plaza East, PP-12F Newark NJ 07105 8887657134 8887657134 711 711 8003652223 8003652223 711 711 H3154 022 0 2021 Horizon Medicare Blue Choice w/Rx (HMO) www.HorizonBlue.com/Medicare 3 Penn Plaza East, PP-12F Newark NJ 07105 8887657134 8887657134 711 711 8003652223 8003652223 711 711 H3154 029 0 2021 Horizon Medicare Blue Advantage (HMO) www.HorizonBlue.com/Medicare 3 Penn Plaza East, PP-12F Newark NJ 07105 8887657134 8887657134 711 711 8003652223 8003652223 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3154 030 0 2021 Horizon Medicare Blue Advantage (HMO) www.HorizonBlue.com/Medicare 3 Penn Plaza East, PP-12F Newark NJ 07105 8887657134 8887657134 711 711 8003652223 8003652223 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3154 031 0 2021 Horizon Medicare Blue Advantage (HMO) www.HorizonBlue.com/Medicare 3 Penn Plaza East, PP-12F Newark NJ 07105 8887657134 8887657134 711 711 8003652223 8003652223 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3154 032 0 2021 Horizon Medicare Blue Advantage (HMO) www.HorizonBlue.com/Medicare 3 Penn Plaza East, PP-12F Newark NJ 07105 8887657134 8887657134 711 711 8003652223 8003652223 711 711 H3154 033 0 2021 Horizon Medicare Blue Select (HMO-POS) www.HorizonBlue.com/Medicare 3 Penn Plaza East, PP-12F Newark NJ 07105 8887657134 8887657134 711 711 8003652223 8003652223 711 711 H3154 801 0 2021 Horizon Medicare Blue Access Group (HMO-POS) www.HorizonBlue.com 3 Penn Plaza East, PP- 12F Newark NJ 07105 8887657134 8887657134 711 711 8003652223 8003652223 711 711 H3154 802 0 2021 Horizon Medicare Blue Access Group w/Rx (HMO-POS) www.HorizonBlue.com 3 Penn Plaza East, PP- 12F Newark NJ 07105 8887657134 8887657134 711 711 8003652223 8003652223 711 711 H3154 811 0 2021 Horizon Medicare Advantage HMO10 (HMO-POS) www.HorizonBlue.com 3 Penn Plaza East, PP- 12F Newark NJ 07105 8887657134 8887657134 711 711 8003652223 8003652223 711 711 H3154 812 0 2021 Horizon Medicare Blue Access Group w/Rx Value (HMO-POS) www.HorizonBlue.com 3 Penn Plaza East, PP- 12F Newark NJ 07105 8887657134 8887657134 711 711 8003652223 8003652223 711 711 H3170 002 0 2021 Blue Cross Blue Shield Nebraska MA Choice (HMO-POS) https://Medicare.NebraskaBlue.com PO Box 261276 Plano TX 75026 8448996060 8448996060 711 711 8884889850 8884889850 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3170 003 1 2021 Blue Cross Blue Shield Nebraska MA Core (HMO) https://Medicare.NebraskaBlue.com PO Box 261276 Plano TX 75026 8448996060 8448996060 711 711 8884889850 8884889850 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3170 003 2 2021 Blue Cross Blue Shield Nebraska MA Core (HMO) https://Medicare.NebraskaBlue.com PO Box 261276 Plano TX 75026 8448996060 8448996060 711 711 8884889850 8884889850 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3192 001 0 2021 Aetna Medicare Prime (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H3192 002 0 2021 Aetna Medicare Premier (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H3192 003 0 2021 Aetna Medicare Premier (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H3192 004 0 2021 Aetna Medicare Prime (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H3192 005 0 2021 Aetna Medicare Prime (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H3192 006 0 2021 Aetna Medicare Prime (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H3192 007 0 2021 Aetna Medicare Assure Premier (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3192 801 0 2021 Aetna Medicare Plan (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H3192 802 0 2021 Aetna Medicare Plan w/Rx (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H3204 001 0 2021 Presbyterian Senior Care Plan 2 with Rx (HMO) www.phs.org/Medicare kgarcia3@phs.org P.O. Box 27489 Albuquerque NM 87125 8003474766 5059238458 8006598331 711 8007975343 5059236060 8006598331 711 H3204 007 0 2021 Presbyterian Senior Care Plan 3 with Rx (HMO) www.phs.org/Medicare kgarcia3@phs.org P.O. Box 27489 Albuquerque NM 87125 8003474766 5059238458 8006598331 711 8007975343 5059236060 8006598331 711 H3204 008 0 2021 Presbyterian Senior Care Plan 1 (HMO) www.phs.org/Medicare kgarcia3@phs.org P.O. Box 27489 Albuquerque NM 87125 8003474766 5059238458 8006598331 711 8007975343 5059236060 8006598331 711 H3204 013 4 2021 Presbyterian Dual Plus (HMO D-SNP) www.phs.org/Medicare kgarcia3@phs.org P.O. Box 27489 Albuquerque NM 87125 8667575264 5059235264 8006598331 711 8554657737 5059237675 8006598331 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3204 013 5 2021 Presbyterian Dual Plus (HMO D-SNP) www.phs.org/Medicare kgarcia3@phs.org P.O. Box 27489 Albuquerque NM 87125 8667575264 5059235264 8006598331 711 8554657737 5059237675 8006598331 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3204 801 0 2021 Pres Senior Care Emp Group Plan 2 with Rx (HMO-POS) www.phs.org/Medicare kgarcia3@phs.org P.O. Box 27489 Albuquerque NM 87125 8003474766 5059238458 8006598331 711 8007975343 5059236060 8006598331 711 H3204 802 0 2021 Pres Senior Care Emp Group Plan 1 (HMO-POS) www.phs.org/Medicare kgarcia3@phs.org P.O. Box 27489 Albuquerque NM 87125 8003474766 5059238458 8006598331 711 8007975343 5059236060 8006598331 711 H3204 803 0 2021 Pres Senior Care Emp Group Plan 2 w/ Rx NC (HMO-POS) www.phs.org/Medicare kgarcia3@phs.org P.O. Box 27489 Albuquerque NM 87125 8003474766 5059238458 8006598331 711 8007975343 5059236060 8006598331 711 H3204 808 0 2021 Presbyterian Senior Care Emp Group Plan 5 (HMO-POS) www.phs.org/Medicare kgarcia3@phs.org P.O. Box 27489 Albuquerque NM 87125 8003474766 5059238458 8006598331 711 8007975343 5059236060 8006598331 711 H3204 809 0 2021 Presbyterian Senior Care Emp Group Plan 6 (HMO-POS) www.phs.org/Medicare kgarcia3@phs.org P.O. Box 27489 Albuquerque NM 87125 8003474766 5059238458 8006598331 711 8007975343 5059236060 8006598331 711 H3204 810 0 2021 Presbyterian Senior Care Emp Group Plan 5 NC (HMO-POS) www.phs.org/Medicare kgarcia3@phs.org P.O. Box 27489 Albuquerque NM 87125 8003474766 5059238458 8006598331 711 8007975343 5059236060 8006598331 711 H3206 001 0 2021 Presbyterian MediCare PPO Plan 2 with Rx (PPO) www.phs.org/Medicare kgarcia3@phs.org P.O. Box 27489 Albuquerque NM 87125 8003474766 5059238458 8006598331 711 8007975343 5059236060 8006598331 711 H3206 003 0 2021 Presbyterian MediCare PPO Plan 1 (PPO) www.phs.org/Medicare kgarcia3@phs.org P.O. Box 27489 Albuquerque NM 87125 8003474766 5059238458 8006598331 711 8007975343 5059236060 8006598331 711 H3206 801 0 2021 Pres MediCare PPO Emp Group Plan 2 with Rx (PPO) www.phs.org/Medicare kgarcia3@phs.org P.O. Box 27489 Albuquerque NM 87125 8003474766 5059238458 8006598331 711 8007975343 5059236060 8006598331 711 H3206 802 0 2021 Pres Medicare PPO Employer Group Plan 1 (PPO) www.phs.org/Medicare kgarcia3@phs.org P.O. Box 27489 Albuquerque NM 87125 8003474766 5059238458 8006598331 711 8007975343 5059236060 8006598331 711 H3206 803 0 2021 Pres MediCare PPO Empl Group Plan 2 +Rx NC (PPO) www.phs.org/Medicare kgarcia3@phs.org P.O. Box 27489 Albuquerque NM 87125 8003474766 5059238458 8006598331 711 8007975343 5059236060 8006598331 711 H3213 011 0 2021 CareSource Advantage (HMO) www.caresource.com/ky/plans/medicare/ P.O. Box 8738 Dayton OH 45401 8446072830 8446072830 711 711 8446072827 8446072827 711 711 This plan does not charge an annual deductible for all drugs. The $30.00 annual deductible only applies to drugs on certain tiers.~ H3213 012 0 2021 CareSource Advantage (HMO) www.caresource.com/ky/plans/medicare/ P.O. Box 8738 Dayton OH 45401 8446072830 8446072830 711 711 8446072827 8446072827 711 711 This plan does not charge an annual deductible for all drugs. The $75.00 annual deductible only applies to drugs on certain tiers.~ H3213 013 0 2021 CareSource Advantage Zero Premium (HMO) www.caresource.com/ky/plans/medicare/ P.O. Box 8738 Dayton OH 45401 8446072830 8446072830 711 711 8446072827 8446072827 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H3213 014 0 2021 CareSource Advantage Zero Premium (HMO) www.caresource.com/ky/plans/medicare/ P.O. Box 8738 Dayton OH 45401 8446072830 8446072830 711 711 8446072827 8446072827 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3213 015 0 2021 CareSource Dual Advantage (HMO D-SNP) http://www.caresource.com/ky/plans/dsnp/ P.O. Box 8738 Dayton OH 45401 8446072830 8446072830 711 711 8332302020 8332302020 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3213 016 0 2021 CareSource Dual Advantage (HMO D-SNP) http://www.caresource.com/ky/plans/dsnp/ P.O. Box 8738 Dayton OH 45401 8446072830 8446072830 711 711 8332302020 8332302020 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3219 001 0 2021 Allina Health Aetna Medicare Discover Plus (PPO) www.AllinaHealthAetnaMedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8332068764 8332068764 711 711 8335706671 8335706671 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3219 002 0 2021 Allina Health Aetna Medicare Discover Premier (PPO) www.AllinaHealthAetnaMedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8332068764 8332068764 711 711 8335706671 8335706671 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3219 003 0 2021 Allina Health Aetna Medicare Discover Grand (PPO) www.AllinaHealthAetnaMedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8332068764 8332068764 711 711 8335706671 8335706671 711 711 H3219 004 0 2021 Allina Health Aetna Medicare Discover Elite (PPO) www.AllinaHealthAetnaMedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8332068764 8332068764 711 711 8335706671 8335706671 711 711 H3219 005 0 2021 Allina Health Aetna Medicare Discover Value (PPO) www.AllinaHealthAetnaMedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8332068764 8332068764 711 711 8335706671 8335706671 711 711 H3219 801 0 2021 Allina Health Aetna Medicare Plan (PPO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H3219 802 0 2021 Allina Health Aetna Medicare w/Rx Plan (PPO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H3237 001 0 2021 Health Net Cal MediConnect Plan (Medicare-Medicaid Plan) www.healthnet.com/calmediconnect Internet_response_team@healthnet.com 4349 Easton Way, Suite 300 Columbus OH 43219 8887885395 8887885395 711 711 8554643571 8554643571 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H3237 002 0 2021 Health Net Cal MediConnect Plan (Medicare-Medicaid Plan) www.healthnet.com/calmediconnect Internet_response_team@healthnet.com 4349 Easton Way, Suite 300 Columbus OH 43219 8887885805 8887885805 711 711 8554643572 8554643572 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H3239 001 0 2021 Aetna Medicare Dual Preferred Plan (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3239 002 0 2021 Aetna Medicare Dual Preferred Plan (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $220.00 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3239 003 0 2021 Aetna Medicare Dual Preferred Plan (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $220.00 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3239 005 0 2021 Aetna Medicare Dual Preferred Plan (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3239 006 0 2021 Aetna Medicare Dual Preferred Plan (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3239 007 0 2021 Aetna Medicare Dual Preferred Plan (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3240 013 0 2021 Amerivantage Dual Coordination (HMO D-SNP) https://shop.amerigroup.com/medicare/ Amerigroup New Jersey, 101 Wood Ave South Suite 800 Iselin NJ 08830 8555930919 8555930919 711 711 8447655160 8447655160 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3240 017 0 2021 Amerivantage ESRD Care (HMO-POS C-SNP) https://shop.amerigroup.com/medicare/ Amerigroup New Jersey, 101 Wood Ave South Suite 800 Iselin NJ 08830 8555930920 8555930920 711 711 8448876350 8448876350 711 711 This plan does not charge an annual deductible for all drugs. The $160.00 annual deductible only applies to drugs on certain tiers.~ H3240 021 0 2021 Amerivantage Balance (HMO) https://shop.amerigroup.com/medicare/ Amerigroup New Jersey, 101 Wood Ave South Suite 800 Iselin NJ 08830 8555930921 8555930921 711 711 8668054589 8668054589 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H3240 022 0 2021 Amerivantage Classic (HMO) https://shop.amerigroup.com/medicare/ mediblue@empireblue.com Amerigroup New Jersey, 101 Wood Ave South Suite 800 Iselin NJ 08830 8555930921 8555930921 711 711 8668054589 8668054589 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3240 024 0 2021 Amerivantage Dual Secure (HMO-POS D-SNP) https://shop.amerigroup.com/medicare/ Amerigroup New Jersey, 101 Wood Ave South Suite 800 Iselin NJ 08830 8555930922 8555930922 711 711 8447655160 8447655160 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3251 002 0 2021 Blue Cross Medicare Advantage Select (HMO) www.getbluenm.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3251 029 0 2021 Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) www.getbluenm.com/dsnp PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8776881813 8776881813 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3251 804 0 2021 Blue Cross Group Medicare Advantage Plan (HMO) getbluenm.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H3256 001 0 2021 UnitedHealthcare Dual Complete Choice LP (PPO D-SNP) www.UHCCommunityPlan.com memberservices@mypreferredcare.com P.O. Box 30769 Salt Lake City UT 84130 8888343721 8888343721 711 711 8664801086 8664801086 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3259 001 0 2021 BlueCare Plus (HMO D-SNP) bluecareplus.bcbst.com 1 Cameron Hill Circle Chattanooga TN 37402 8884139637 8884139637 711 711 8003325762 8003325762 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3259 002 0 2021 BlueCare Plus Choice (HMO D-SNP) bluecareplus.bcbst.com 1 Cameron Hill Circle Chattanooga TN 37402 8884139637 8884139637 711 711 8003325762 8003325762 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3276 001 0 2021 ConnectiCare Choice Dual (HMO D-SNP) www.connecticare.com/medicare PO Box 4001 Farmington CT 06034 8772248220 8772248220 711 711 8002242273 8002242273 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3276 002 0 2021 ConnectiCare Choice Dual Basic (HMO D-SNP) www.connecticare.com/medicare PO Box 4001 Farmington CT 06034 8772248220 8772248220 711 711 8002242273 8002242273 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3281 001 0 2021 Bright Advantage Health Dollars (PPO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H3281 003 0 2021 Bright Advantage Choice (PPO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H3281 005 0 2021 Bright Advantage Part B Savings (PPO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H3281 007 0 2021 Bright Advantage Part B Savings (PPO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~ H3281 009 0 2021 Bright Advantage Part B Savings (PPO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3281 010 0 2021 Bright Advantage Part B Savings (PPO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~ H3281 011 0 2021 Bright Advantage Part B Savings (PPO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~ H3288 001 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3288 002 0 2021 Aetna Medicare Choice II Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3288 003 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3288 004 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3288 005 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3288 006 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3288 007 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3288 008 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3288 009 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3288 010 0 2021 Aetna Medicare Plus Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3288 011 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3288 012 0 2021 Aetna Medicare Plus Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3288 013 0 2021 Aetna Medicare Plus Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3288 015 0 2021 Aetna Medicare Plus Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3288 016 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3288 017 0 2021 Aetna Medicare Freedom Preferred Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3288 018 0 2021 Aetna Medicare Choice II Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3288 019 0 2021 Aetna Medicare Freedom Preferred Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3288 020 0 2021 Aetna Medicare Freedom Core Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3288 021 0 2021 Aetna Medicare Freedom Core Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3288 022 0 2021 Aetna Medicare Plus Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3288 023 0 2021 Aetna Medicare Freedom Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3288 024 0 2021 Aetna Medicare Freedom Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3288 025 0 2021 Aetna Medicare Freedom Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3288 026 0 2021 Aetna Medicare Freedom Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3288 027 0 2021 Aetna Medicare Freedom Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3288 028 0 2021 Aetna Medicare Freedom Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3288 029 0 2021 Aetna Medicare Freedom Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3288 030 0 2021 Aetna Medicare Freedom Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3288 031 0 2021 Aetna Medicare Freedom Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3288 032 0 2021 Aetna Medicare Freedom Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3288 033 0 2021 Aetna Medicare Freedom Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3288 034 0 2021 Aetna Medicare Eagle Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3288 035 0 2021 Aetna Medicare Freedom Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3288 036 0 2021 Aetna Medicare Preferred Premium Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3288 037 0 2021 Aetna Medicare Preferred Premium Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3288 038 0 2021 Aetna Medicare Preferred Premium Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3288 039 0 2021 Aetna Medicare Preferred Premium Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3288 040 0 2021 Aetna Medicare Preferred Premium Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3288 041 0 2021 Aetna Medicare Preferred Premium Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3288 042 0 2021 Aetna Medicare Preferred Premium Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3288 043 0 2021 Aetna Medicare Preferred Premium Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3288 044 0 2021 Aetna Medicare Preferred Premium Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3288 045 0 2021 Aetna Medicare Plus Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~ H3288 046 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3288 047 0 2021 Aetna Medicare Value Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3288 048 0 2021 Aetna Medicare Choice II Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3288 049 0 2021 Aetna Medicare Eagle Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3288 050 0 2021 Aetna Medicare Eagle Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3288 051 0 2021 Aetna Medicare Eagle Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3288 801 0 2021 Aetna Medicare Plan (PPO) https://www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H3288 802 0 2021 Aetna Medicare Plan w/Rx (PPO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H3291 001 0 2021 PruittHealth Premier (HMO I-SNP) www.pruitthealthpremier.com PO Box 2190 Glen Allen VA 23058 8442243659 8442243659 711 711 8442243659 8442243659 711 711 H3291 002 0 2021 PruittHealth Premier D-SNP (HMO D-SNP) www.pruitthealthpremier.com PO Box 2190 Glen Allen VA 23058 8442243659 8442243659 711 711 8442243659 8442243659 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3293 003 0 2021 MMM EXTRA (HMO) www.mmm-fl.com myra.plumey@mmm-fl.com PO Box 260430 Miami FL 33126 8442129858 7865844608 711 711 8442129858 7865844608 711 711 H3293 004 0 2021 MMM PLATINUM (HMO D-SNP) www.mmm-fl.com myra.plumey@mmm-fl.com PO Box 260430 Miami FL 33126 8442129858 7865844608 711 711 8442129858 7865844608 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3293 005 0 2021 MMM ELITE (HMO) www.mmm-fl.com myra.plumey@mmm-fl.com PO Box 260430 Miami FL 33126 8442129858 7865844608 711 711 8442129858 7865844608 711 711 H3305 007 0 2021 MVP Medicare Preferred Gold without Part D (HMO-POS) www.joinMVPmedicare.com memberservices@mvphealthcare.com 220 Alexander St., Medicare Sales Rochester NY 14607 8003243899 8003243899 8006621220 8006621220 8006657924 8006657924 8006621220 8006621220 H3305 015 0 2021 MVP Medicare Preferred Gold with Part D (HMO-POS) www.joinMVPmedicare.com memberservices@mvphealthcare.com 220 Alexander St., Medicare Sales Rochester NY 14607 8003243899 8003243899 8006621220 8006621220 8006657924 8006657924 8006621220 8006621220 H3305 020 0 2021 MVP Medicare Preferred Gold without Part D (HMO-POS) www.joinmvpmedicare.com memberservices@mvphealthcare.com 220 Alexander St., Medicare Sales Rochester NY 14607 8003243899 8003243899 8006621220 8006621220 8006657924 8006657924 8006621220 8006621220 H3305 021 0 2021 MVP Medicare Preferred Gold with Part D (HMO-POS) www.joinmvpmedicare.com memberservices@mvphealthcare.com 220 Alexander St., Medicare Sales Rochester NY 14607 8003243899 8003243899 8006621220 8006621220 8006657924 8006657924 8006621220 8006621220 H3305 022 0 2021 MVP Medicare Secure Plus with Part D (HMO-POS) www.joinmvpmedicare.com memberservices@mvphealthcare.com 220 Alexander St., Medicare Sales Rochester NY 14607 8003243899 8003243899 8006621220 8006621220 8006657924 8006657924 8006621220 8006621220 H3305 030 0 2021 MVP Medicare Secure with Part D (HMO-POS) www.joinmvpmedicare.com memberservices@mvphealthcare.com 220 Alexander St., Medicare Sales Rochester NY 14607 8003243899 8003243899 8006621220 8006621220 8006657924 8006657924 8006621220 8006621220 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H3305 032 0 2021 MVP Medicare Secure with Part D (HMO-POS) www.joinMVPmedicare.com memberservices@mvphealthcare.com 220 Alexander St., Medicare Sales Rochester NY 14607 8003243899 8003243899 8006621220 8006621220 8006657924 8006657924 8006621220 8006621220 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3305 801 0 2021 MVP Preferred Gold - Employer Group (HMO-POS) www.mvphealthcare.com memberservices@mvphealthcare.com 220 Alexander St., Medicare Sales Rochester NY 14607 8003243899 8003243899 8006621220 8006621220 8006657924 8006657924 8006621220 8006621220 H3305 803 0 2021 MVP Preferred Gold Rx - Employer Group (HMO-POS) www.mvphealthcare.com memberservices@mvphealthcare.com 220 Alexander St., Medicare Sales Rochester NY 14607 8003243899 8003243899 8006621220 8006621220 8006657924 8006657924 8006621220 8006621220 H3305 804 0 2021 MVP Preferred Gold Rx - Employer Group (HMO-POS) www.mvphealthcare.com memberservices@mvphealthcare.com 220 Alexander St., Medicare Sales Rochester NY 14607 8003243899 8003243899 8006621220 8006621220 8006657924 8006657924 8006621220 8006621220 H3307 002 0 2021 AARP Medicare Advantage Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $395.00 annual deductible only applies to drugs on certain tiers.~ H3307 012 0 2021 AARP Medicare Advantage Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $395.00 annual deductible only applies to drugs on certain tiers.~ H3307 015 0 2021 AARP Medicare Advantage Prime (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8668709604 8668709604 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H3307 018 0 2021 AARP Medicare Advantage Patriot (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H3307 023 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H3307 025 0 2021 AARP Medicare Advantage (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $395.00 annual deductible only applies to drugs on certain tiers.~ H3307 802 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H3307 804 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H3307 805 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H3312 002 0 2021 Aetna Medicare Value Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3312 018 0 2021 Aetna Medicare Value Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3312 048 0 2021 Aetna Medicare Value Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H3312 062 0 2021 Aetna Medicare Value Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3312 064 0 2021 Aetna Medicare Value Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3312 065 0 2021 Aetna Medicare Value Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3312 068 0 2021 Aetna Medicare Elite Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3312 069 0 2021 Aetna Medicare Assure Plan (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3312 070 0 2021 Aetna Medicare Assure Plan (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3312 801 0 2021 Aetna Medicare Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H3312 804 0 2021 Aetna Medicare Plan w/Rx (HMO) www.aetnamedicare.com HicksJS@aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H3330 021 1 2021 EmblemHealth VIP Gold (HMO) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3330 021 2 2021 EmblemHealth VIP Gold (HMO) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3330 021 3 2021 EmblemHealth VIP Gold (HMO) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3330 021 4 2021 EmblemHealth VIP Gold (HMO) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3330 032 1 2021 EmblemHealth VIP Essential (HMO) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H3330 032 2 2021 EmblemHealth VIP Essential (HMO) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H3330 032 3 2021 EmblemHealth VIP Essential (HMO) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H3330 032 4 2021 EmblemHealth VIP Essential (HMO) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H3330 036 0 2021 EmblemHealth VIP Value (HMO) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H3330 038 0 2021 EmblemHealth VIP Gold Plus (HMO) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3330 039 1 2021 EmblemHealth VIP Rx Saver (HMO) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 This plan does not charge an annual deductible for all drugs. The $395.00 annual deductible only applies to drugs on certain tiers.~ H3330 039 2 2021 EmblemHealth VIP Rx Saver (HMO) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 This plan does not charge an annual deductible for all drugs. The $395.00 annual deductible only applies to drugs on certain tiers.~ H3330 040 0 2021 EmblemHealth VIP Part B Saver (HMO) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H3330 041 1 2021 EmblemHealth VIP Go (HMO-POS) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3330 041 2 2021 EmblemHealth VIP Go (HMO-POS) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3330 042 1 2021 EmblemHealth VIP Dual (HMO D-SNP) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3330 042 2 2021 EmblemHealth VIP Dual (HMO D-SNP) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3330 042 3 2021 EmblemHealth VIP Dual (HMO D-SNP) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3330 814 0 2021 EmblemHealth VIP Premier (HMO) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 H3330 815 0 2021 EmblemHealth VIP Rx Carveout (HMO) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 H3330 820 0 2021 EmblemHealth VIP Choice (HMO-POS) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 H3330 821 0 2021 EmblemHealth VIP Choice Rx Carveout (HMO-POS) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 H3335 014 0 2021 Medicare BlueSecure (PPO) www.ExcellusMedicare.com P.O. Box 211316 Eagan MN 55121 8006591986 8006591986 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 H3335 015 0 2021 Medicare BlueEnhanced (PPO) www.ExcellusMedicare.com P.O. Box 211316 Eagan MN 55121 8006591986 8006591986 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 H3335 018 0 2021 Medicare BluePlus (PPO) www.ExcellusMedicare.com P.O. Box 211316 Eagan MN 55121 8006591986 8006591986 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 H3335 038 0 2021 Medicare BlueClassic (PPO) www.ExcellusMedicare.com P.O. Box 211316 Eagan MN 55121 8006591986 8006591986 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 H3335 043 0 2021 Medicare BlueBasic (PPO) www.ExcellusMedicare.com P.O. Box 211316 Eagan MN 55121 8006591986 8006591986 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 H3335 044 0 2021 Medicare BlueBasic (PPO) www.ExcellusMedicare.com P.O. Box 211316 Eagan MN 55121 8006591986 8006591986 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 H3335 053 0 2021 Medicare BlueEssential (PPO) www.ExcellusMedicare.com P.O. Box 211316 Eagan MN 55121 8006591986 8006591986 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3335 801 0 2021 Univera Medicare PPO Group (PPO) www.UniveraMedicare.com P.O. Box 211316 Eagan MN 55121 8778839577 8778839577 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 H3335 811 0 2021 Medicare Blue PPO Group (PPO) www.ExcellusMedicare.com P.O. Box 211316 Eagan MN 55121 8778839577 8778839577 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 H3335 813 0 2021 Univera Medicare PPO Group (PPO) www.UniveraMedicare.com P.O. Box 211316 Eagan MN 55121 8778839577 8778839577 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 H3335 819 0 2021 Medicare Blue PPO Group (PPO) www.ExcellusMedicare.com P.O. Box 211316 Eagan MN 55121 8778839577 8778839577 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 H3335 820 0 2021 Medicare Blue PPO Group Non-Calendar (PPO) www.ExcellusMedicare.com P.O. Box 211316 Eagan MN 55121 8778839577 8778839577 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 H3335 822 0 2021 Univera Medicare PPO Group Non-Calendar (PPO) www.UniveraMedicare.com P.O. Box 211316 Eagan MN 55121 8778839577 8778839577 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 H3342 023 1 2021 Empire MediBlue Access (PPO) https://shop.empireblue.com/medicare mediblue@empireblue.com 3 Huntington Quadrangle Melville NY 11747 8555930923 8555930923 711 711 8663955175 8663955175 711 711 This plan does not charge an annual deductible for all drugs. The $310.00 annual deductible only applies to drugs on certain tiers.~ H3342 023 2 2021 Empire MediBlue Access (PPO) https://shop.empireblue.com/medicare mediblue@empireblue.com 3 Huntington Quadrangle Melville NY 11747 8555930923 8555930923 711 711 8663955175 8663955175 711 711 This plan does not charge an annual deductible for all drugs. The $310.00 annual deductible only applies to drugs on certain tiers.~ H3342 808 0 2021 Empire MediBlue Freedom (PPO) www.empireblue.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H3342 809 0 2021 Empire MediBlue Freedom (PPO) www.empireblue.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H3342 810 0 2021 Empire MediBlue Freedom (PPO) www.empireblue.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H3342 812 0 2021 Empire MediBlue Freedom (PPO) www.empireblue.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H3342 817 0 2021 Empire MediBlue Freedom (PPO) www.empireblue.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H3342 818 0 2021 Empire MediBlue Freedom (PPO) www.empireblue.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H3342 819 0 2021 Empire MediBlue Freedom (PPO) www.empireblue.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H3342 820 0 2021 Empire MediBlue Freedom (PPO) www.empireblue.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H3344 005 0 2021 Independent Health's Medicare Passport Advantage (PPO) independenthealth.com/medicare medicareservice@servicing.independenthealth.com 511 Farber Lakes Drive Buffalo NY 14221 8009584405 7166354900 711 711 8006651502 7162504401 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H3344 010 0 2021 Independent Health's Medicare Passport Prime (PPO) independenthealth.com/medicare medicareservice@servicing.independenthealth.com 511 Farber Lakes Drive Buffalo NY 14221 8009584405 7166354900 711 711 8006651502 7162504401 711 711 H3344 801 0 2021 Independent Health's Medicare PPO Base (PPO) independenthealth.com/medicare medicareservice@servicing.independenthealth.com 511 Farber Lakes Drive Buffalo NY 14221 8009584405 7166354900 711 711 8006651502 7162504401 711 711 H3344 804 0 2021 Independent Health's Medicare PPO Base (PPO) independenthealth.com/medicare medicareservice@servicing.independenthealth.com 511 Farber Lakes Drive Buffalo NY 14221 8009584405 7166354900 711 711 8006651502 7162504401 711 711 H3344 805 0 2021 Independent Health's Medicare PPO Base (PPO) www.independentheaalth.com/medicare medicareservice@servicing.independenthealth.com 511 Farber Lakes Drive Buffalo NY 14221 8009584405 7166354900 711 711 8006651502 7162504401 711 711 H3347 002 0 2021 Elderplan For Medicaid Beneficiaries (HMO D-SNP) www.elderplan.org MemberServices@mjhs.org Elderplan, Inc., 6323 7th Avenue Brooklyn NY 11220 8666958101 8666958101 711 711 8003533765 7189217979 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3347 003 0 2021 Elderplan Advantage For Nursing Home Residents (HMO I-SNP) www.elderplan.org MemberServices@mjhs.org Elderplan, Inc., 6323 7th Avenue Brooklyn NY 11220 8666958101 8666958101 711 711 8003533765 7189217979 711 711 H3347 007 0 2021 Elderplan Plus Long Term Care (HMO D-SNP) www.elderplan.org MemberServices@mjhs.org Elderplan, Inc., 6323 7th Avenue Brooklyn NY 11220 8666958101 8666958101 711 711 8778916447 7189217979 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3347 009 0 2021 Elderplan Extra Help (HMO) www.elderplan.org MemberServices@mjhs.org Elderplan, Inc., 6323 7th Avenue Brooklyn NY 11220 8666958101 8666958101 711 711 8003533765 7189217979 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H3347 015 0 2021 Elderplan Assist (HMO I-SNP) www.elderplan.org MemberServices@mjhs.org Elderplan, Inc., 6323 7th Avenue Brooklyn NY 11220 8666958101 8666958101 711 711 8003533765 7189217979 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H3351 001 0 2021 Univera SeniorChoice Select (HMO-POS) www.UniveraMedicare.com P.O. Box 211316 Eagan MN 55121 8006591986 8006591986 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 H3351 002 0 2021 Univera SeniorChoice Secure (HMO-POS) www.UniveraMedicare.com P.O. Box 211316 Eagan MN 55121 8006591986 8006591986 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 H3351 006 0 2021 Medicare Blue Choice Optimum (HMO-POS) www.ExcellusMedicare.com P.O. Box 211316 Eagan MN 55121 8006591986 8006591986 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 H3351 007 0 2021 Medicare Blue Choice Platinum (HMO-POS) www.ExcellusMedicare.com P.O. Box 211316 Eagan MN 55121 8006591986 8006591986 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 H3351 010 0 2021 Univera SeniorChoice Value (HMO) www.UniveraMedicare.com P.O. Box 211316 Eagan MN 55121 8006591986 8006591986 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 H3351 011 0 2021 Medicare Blue Choice Value (HMO) www.ExcellusMedicare.com P.O. Box 211316 Eagan MN 55121 8006591986 8006591986 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H3351 012 0 2021 Univera SeniorChoice Value Plus (HMO-POS) www.UniveraMedicare.com P.O. Box 211316 Eagan MN 55121 8006591986 8006591986 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 H3351 013 0 2021 Medicare Blue Choice Value Plus (HMO-POS) www.ExcellusMedicare.com P.O. Box 211316 Eagan MN 55121 8006591986 8006591986 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 H3351 015 0 2021 Medicare Bassett (HMO-POS) www.ExcellusMedicare.com P.O. Box 211316 Eagan MN 55121 8006591986 8006591986 8006621220 8006621220 8448544063 8448544063 8006621220 8006621220 H3351 016 0 2021 Medicare Blue Choice Select (HMO) www.ExcellusMedicare.com P.O. Box 211316 Eagan MN 55121 8006591986 8006591986 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 This plan does not charge an annual deductible for all drugs. The $380.00 annual deductible only applies to drugs on certain tiers.~ H3351 017 0 2021 Univera SeniorChoice Basic (HMO) www.UniveraMedicare.com P.O. Box 211316 Eagan MN 55121 8006591986 8006591986 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 This plan does not charge an annual deductible for all drugs. The $360.00 annual deductible only applies to drugs on certain tiers.~ H3351 018 0 2021 Medicare Blue Choice Advanced (HMO-POS) www.ExcellusMedicare.com P.O. Box 211316 Eagan MN 55121 8006591986 8006591986 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3351 019 0 2021 Univera SeniorChoice Advanced (HMO-POS) www.UniveraMedicare.com P.O. Box 211316 Eagan MN 55121 8006591986 8006591986 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3351 801 0 2021 Univera SeniorChoice - Group (HMO-POS) www.UniveraMedicare.com P.O. Box 211316 Eagan MN 55121 8778839577 8778839577 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 H3351 802 0 2021 Medicare Blue Choice - Group (HMO-POS) www.ExcellusMedicare.com P.O. Box 211316 Eagan MN 55121 8778839577 8778839577 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 H3351 803 0 2021 Univera SeniorChoice - Group (HMO-POS) www.UniveraMedicare.com P.O. Box 211316 Eagan MN 55121 8778839577 8778839577 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 H3351 804 0 2021 Medicare Blue Choice - Group (HMO-POS) www.ExcellusMedicare.com P.O. Box 211316 Eagan MN 55121 8778839577 8778839577 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 H3351 805 0 2021 Univera SeniorChoice Group Non-Calendar (HMO-POS) www.UniveraMedicare.com P.O. Box 211316 Eagan MN 55121 8778839577 8778839577 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 H3351 806 0 2021 Medicare Blue Choice Group Non-Calendar (HMO-POS) www.ExcellusMedicare.com P.O. Box 211316 Eagan MN 55121 8778839577 8778839577 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 H3359 001 0 2021 Healthfirst 65 Plus Plan (HMO) www.healthfirst.org/medicare Healthfirst Medicare Plan, PO Box 5165 New York NY 10274 8772371303 8772371303 8885423821 8885423821 8882601010 8882601010 8885423821 8885423821 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H3359 019 0 2021 Healthfirst Increased Benefits Plan (HMO) www.healthfirst.org/medicare Healthfirst Medicare Plan, PO Box 5165 New York NY 10274 8772371303 8772371303 8885423821 8885423821 8882601010 8882601010 8885423821 8885423821 H3359 021 0 2021 Healthfirst Life Improvement Plan (HMO D-SNP) www.healthfirst.org/medicare Healthfirst Medicare Plan, PO Box 5165 New York NY 10274 8772371303 8772371303 8885423821 8885423821 8882601010 8882601010 8885423821 8885423821 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3359 027 0 2021 Healthfirst Coordinated Benefits Plan (HMO) www.healthfirst.org/medicare Healthfirst Medicare Plan, PO Box 5165 New York NY 10274 8772371303 8772371303 8885423821 8885423821 8882601010 8882601010 8885423821 8885423821 H3359 034 0 2021 Healthfirst CompleteCare (HMO D-SNP) www.healthfirst.org/medicare Healthfirst Medicare Plan, PO Box 5165 New York NY 10274 8772371303 8772371303 8885423821 8885423821 8882601010 8882601010 8885423821 8885423821 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3359 808 0 2021 Healthfirst Employer Group 1 (HMO) www.healthfirst.org/medicare Healthfirst Medicare Plan, PO Box 5165 New York NY 10274 8772371303 8885423821 8885423821 8882601010 8885423821 8885423821 H3359 809 0 2021 Healthfirst Employer Group 2 (HMO) www.healthfirst.org/medicare Healthfirst Medicare Plan, PO Box 5165 New York NY 10274 8772371303 8885423821 8885423821 8882601010 8885423821 8885423821 H3362 016 0 2021 Independent Health's Encompass 65 (HMO) independenthealth.com/medicare medicareservice@servicing.independenthealth.com 511 Farber Lakes Drive Buffalo NY 14221 8009584405 7166354900 711 711 8006651502 7162504401 711 711 H3362 017 0 2021 Independent Health's Encompass 65 Basic (HMO) independenthealth.com/medicare medicareservice@servicing.independenthealth.com 511 Farber Lakes Drive Buffalo NY 14221 8009584405 7166354900 711 711 8006651502 7162504401 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3362 020 0 2021 Independent Health's Medicare Family Choice (HMO I-SNP) independenthealth.com/medicare medicareservice@servicing.independenthealth.com 511 Farber Lakes Drive Buffalo NY 14221 8009584405 7166354900 711 711 8006651502 7162504401 711 711 H3362 033 0 2021 Independent Health's Encompass 65 Core (HMO) independenthealth.com/medicare medicareservice@servicing.independenthealth.com 511 Farber Lakes Dr. Buffalo NY 14221 8009584405 7166354900 711 711 8006651502 7162504401 711 711 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H3362 035 0 2021 Independent Health's Assure Advantage (HMO C-SNP) www.independenthealth.com medicareservice@servicing.independenthealth.com 511 Farber Lakes Drive Buffalo NY 14221 8009584405 7166354900 711 711 8006651502 7162504401 711 711 H3362 038 0 2021 Independent Health's Encompass 65 Element (HMO) www.independenthealth.com/medicare medicareservice@servicing.independenthealth.com 511 Farber Lakes Drive Buffalo NY 14221 8009584405 7166354900 711 711 8006651502 7162504401 711 711 This plan does not charge an annual deductible for all drugs. The $375.00 annual deductible only applies to drugs on certain tiers.~ H3362 801 0 2021 Independent Health's Medicare Encompass (HMO) independenthealth.com/medicare medicareservice@servicing.independenthealth.com 511 Farber Lakes Drive Buffalo NY 14221 8009584405 7166354900 711 711 8006651502 7162504401 711 711 H3362 807 0 2021 Independent Health's Medicare Encompass (HMO-POS) independenthealth.com/medicare medicareservice@servicing.independenthealth.com 511 Farber Lakes Drive Buffalo NY 14221 8009584405 7166354900 711 711 8006651502 7162504401 711 711 H3362 819 0 2021 Independent Health's Medicare Encompass (HMO-POS) independenthealth.com/medicare medicareservice@servicing.independenthealth.com 511 Farber Lakes Drive Buffalo NY 14221 8009584405 7166354900 711 711 8006651502 7162504401 711 711 H3362 820 0 2021 Independent Health's Medicare Encompass (HMO) independenthealth.com/medicare medicareservice@servicing.independenthealth.com 511 Farber Lakes Drive Buffalo NY 14221 8009584405 7166354900 711 711 8006651502 7162504401 711 711 H3379 001 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $395.00 annual deductible only applies to drugs on certain tiers.~ H3379 002 0 2021 UnitedHealthcare Nursing Home Plan 2 (HMO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H3379 022 0 2021 UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H3379 039 0 2021 AARP Medicare Advantage (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3379 040 0 2021 AARP Medicare Advantage (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3379 041 0 2021 AARP Medicare Advantage (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $395.00 annual deductible only applies to drugs on certain tiers.~ H3379 042 0 2021 UnitedHealthcare Nursing Home Plan 2 (HMO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H3384 013 0 2021 BlueShield Senior Blue 652 (HMO) www.bsneny.com/medicare customerservice@bsneny.com PO Box 80 Buffalo NY 14202 8772587453 8772587453 711 711 8003292792 8003292792 711 711 H3384 019 0 2021 BlueCross BlueShield Senior Blue 651 (HMO) www.bcbswny.com/medicare customerservice@bcbswny.com PO Box 80 Buffalo NY 14202 8002489296 8002489296 711 711 8003292792 8003292792 711 711 H3384 022 0 2021 BlueCross BlueShield Senior Blue 601 (HMO) www.bcbswny.com/medicare customerservice@bcbswny.com PO Box 80 Buffalo NY 14202 8002489296 8002489296 711 711 8003292792 8003292792 711 711 H3384 058 0 2021 BlueCross BlueShield Senior Blue Select (HMO) www.bcbswny.com/medicare customerservice@bcbswny.com PO Box 80 Buffalo NY 14202 8002489296 8002489296 711 711 8003292792 8003292792 711 711 This plan does not charge an annual deductible for all drugs. The $190.00 annual deductible only applies to drugs on certain tiers.~ H3384 059 0 2021 BlueShield Freedom Plus (HMO) www.bsneny.com/medicare customerservice@bsneny.com PO Box 80 Buffalo NY 14202 8772587453 8772587453 711 711 8003292792 8003292792 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H3384 062 0 2021 BlueCross BlueShield BlueSaver (HMO) www.bcbswny.com/medicare customerservice@bcbswny.com PO Box 80 Buffalo NY 14202 8002489296 8002489296 711 711 8003292792 8003292792 711 711 This plan does not charge an annual deductible for all drugs. The $290.00 annual deductible only applies to drugs on certain tiers.~ H3384 063 0 2021 BlueShield Freedom Value (HMO) www.bsneny.com/medicare customerservice@bsneny.com PO Box 80 Buffalo NY 14202 8772587453 8772587453 711 711 8003292792 8003292792 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H3384 064 0 2021 BlueShield Freedom Premier (HMO) www.bsneny.com/medicare customerservice@bsneny.com PO Box 80 Buffalo NY 14202 8772587453 8772587453 711 711 8003292792 8003292792 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H3384 066 0 2021 BlueShield Freedom No Rx (HMO) www.bsneny.com/medicare customerservice@bsneny.com PO Box 80 Buffalo NY 14202 8772587453 8772587453 711 711 8003292792 8003292792 711 711 H3384 805 0 2021 HMO Group MA Only Plan (HMO) www.nymedicare.com PO Box 80 Buffalo NY 14202 8552159237 8552159237 711 711 8003292792 8003292792 711 711 H3384 806 0 2021 HMO Group (MA-PD) Calendar Year (HMO) www.nymedicare.com PO Box 80 Buffalo NY 14202 8552159237 8552159237 711 711 8003292792 8003292792 711 711 H3384 811 0 2021 HMOPOS Group (MA-PD) Calendar Year (HMO-POS) www.nymedicare.com PO Box 80 Buffalo NY 14202 8552159237 8552159237 711 711 8003292792 8003292792 711 711 H3384 812 0 2021 HMOPOS Group MA Only Calendar Year (HMO-POS) www.nymedicare.com PO Box 80 Buffalo NY 14202 8552159237 8552159237 711 711 8003292792 8003292792 711 711 H3387 010 0 2021 UnitedHealthcare Dual Complete (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8005144912 8005144912 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3387 013 0 2021 UnitedHealthcare Dual Complete One (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8665470772 8665470772 711 711 Available to current members only.~This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3388 001 0 2021 CDPHP Choice (HMO) http://www.CDPHP.com/medicare info@cdphp.com 500 Patroon Creek Blvd. Albany NY 12206 8885194455 5186413400 711 711 8882486522 5186413950 711 711 H3388 002 0 2021 CDPHP Choice Rx (HMO) http://www.CDPHP.com/medicare info@cdphp.com 500 Patroon Creek Blvd. Albany NY 12206 8885194455 5186413400 711 711 8882486522 5186413950 711 711 H3388 004 0 2021 CDPHP Value Rx (HMO) http://www.CDPHP.com/medicare info@cdphp.com 500 Patroon Creek Blvd. Albany NY 12206 8885194455 5186413400 711 711 8882486522 5186413950 711 711 H3388 013 0 2021 CDPHP Basic RX (HMO) http://www.CDPHP.com/medicare info@cdphp.com 500 Patroon Creek Blvd. Albany NY 12206 8885194455 5186413400 711 711 8882486522 5186413950 711 711 H3388 014 0 2021 CDPHP $0 Medicare Rx (HMO) http://www.CDPHP.com/medicare info@cdphp.com 500 Patroon Creek Blvd Albany NY 12206 8885194455 5186413400 711 711 8882486522 5186413950 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3388 801 0 2021 CDPHP Group Medicare Rx (HMO) http://www.CDPHP.com/medicare info@cdphp.com 500 Patroon Creek Blvd. Albany NY 12206 8885194455 5186413400 711 711 8882486522 5186413950 711 711 H3388 803 0 2021 CDPHP Group Medicare Rx (HMO) http://www.CDPHP.com/medicare info@cdphp.com 500 Patroon Creek Blvd. Albany NY 12206 8885194455 5186413400 711 711 8882486522 5186413950 711 711 H3388 804 0 2021 CDPHP Group Medicare (HMO) http://www.CDPHP.com/medicare info@cdphp.com 500 Patroon Creek Blvd. Albany NY 12206 8885194455 5186413400 711 711 8882486522 5186413950 711 711 H3404 003 1 2021 Blue Medicare PPO Enhanced (PPO) https://www.bluecrossnc.com/medicare PO Box 17509 Winston Salem NC 27116 8006658037 8006658037 711 711 8774947647 8774947647 711 711 H3404 003 2 2021 Blue Medicare PPO Enhanced (PPO) https://www.bluecrossnc.com/medicare PO Box 17509 Winston Salem NC 27116 8006658037 8006658037 711 711 8774947647 8774947647 711 711 H3404 801 0 2021 Blue Medicare PPO EGWP Medical Only (PPO) https://www.bluecrossnc.com/medicare PO Box 17509 Winston Salem NC 27116 8006658037 8006658037 711 711 8774947647 8774947647 711 711 H3404 803 0 2021 Blue Medicare PPO EGWP (PPO) https://www.bluecrossnc.com/medicare PO Box 17509 Winston Salem NC 27116 8006658037 8006658037 711 711 8774947647 8774947647 711 711 H3404 809 0 2021 Blue Medicare PPO EGWP Value (PPO) https://www.bluecrossnc.com/medicare PO Box 17509 Winston Salem NC 27116 8006658037 8006658037 711 711 8774947647 8774947647 711 711 H3404 810 0 2021 Blue Medicare PPO EGWP Complete (PPO) https://www.bluecrossnc.com/medicare P.O. Box 17509 Winston Salem NC 27116 8006658037 8006658037 711 711 8774947647 8774947647 711 711 H3407 001 0 2021 El Paso Health Advantage Dual SNP (HMO D-SNP) www.ephmedicare.com medicare@elpasohealth.com P. O. Box 971100 El Paso TX 79997 8337423125 8337423125 711 711 8337423125 8337423125 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3416 001 6 2021 HealthPartners UnityPoint Health Align (PPO) Oneplanforme.com/medicareplan 8170 33rd Avenue South Bloomington MN 55425 8883600796 8883600796 711 711 8883600544 8883600544 711 711 H3416 001 7 2021 HealthPartners UnityPoint Health Align (PPO) Oneplanforme.com/medicareplan 8170 33rd Avenue South Bloomington MN 55425 8883600796 8883600796 711 711 8883600544 8883600544 711 711 H3416 002 4 2021 HealthPartners UnityPoint Health Symmetry (PPO) Oneplanforme.com/medicareplan 8170 33rd Avenue South Bloomington MN 55425 8883600796 8883600796 711 711 8883600544 8883600544 711 711 H3416 002 5 2021 HealthPartners UnityPoint Health Symmetry (PPO) Oneplanforme.com/medicareplan 8170 33rd Avenue South Bloomington MN 55425 8883600796 8883600796 711 711 8883600544 8883600544 711 711 H3416 801 0 2021 HealthPartners UnityPoint Health Group MAPD CY (PPO) Oneplanforme.com/medicareplan 8170 33rd Avenue South Bloomington MN 55425 8883600796 8883600796 711 711 8883600544 8883600544 711 711 H3416 803 0 2021 HealthPartners UnityPoint Health Group MA Only (PPO) Oneplanforme.com/medicareplan 8170 33rd Avenue South Bloomington MN 55425 8883600796 8883600796 711 711 8883600544 8883600544 711 711 H3418 001 0 2021 AARP Medicare Advantage Mosaic Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H3419 001 0 2021 Perennial Advantage Strive (HMO I-SNP) www.perennialadvantage.com 9570 S. Kingston Ct., Suite 300 Englewood CO 80112 8447886959 8447886959 711 711 8447886959 8447886959 711 711 H3419 002 0 2021 Perennial Advantage Concierge (HMO C-SNP) www.perennialadvantage.com 9570 S. Kingston Ct., Suite 300 Englewood CO 80112 8447886959 8447886959 711 711 8447886959 8447886959 711 711 H3442 001 0 2021 AARP Medicare Advantage Walgreens (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H3442 003 0 2021 AARP Medicare Advantage Walgreens (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3442 004 0 2021 AARP Medicare Advantage Walgreens (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3442 005 0 2021 AARP Medicare Advantage Patriot (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H3442 006 0 2021 AARP Medicare Advantage Choice Plan 1 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H3442 007 0 2021 AARP Medicare Advantage Walgreens (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3442 008 0 2021 AARP Medicare Advantage Patriot (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H3447 001 0 2021 Anthem MediBlue Local (HMO) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8556790538 8556790538 711 711 8883263584 8883263584 711 711 H3447 003 0 2021 Anthem MediBlue COPD (HMO C-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8556790539 8556790539 711 711 8883263584 8883263584 711 711 H3447 004 0 2021 Anthem MediBlue Diabetes (HMO C-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8556790539 8556790539 711 711 8883263584 8883263584 711 711 H3447 005 0 2021 Anthem MediBlue Smart Fit (HMO) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8556790538 8556790538 711 711 8883263584 8883263584 711 711 H3447 010 0 2021 Anthem MediBlue Care On Site (HMO I-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8556790540 8556790540 711 711 8883263584 8883263584 711 711 H3447 011 0 2021 Anthem MediBlue Full Dual Advantage (HMO D-SNP) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8556790541 8556790541 711 711 8553630724 8553630724 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3447 012 0 2021 Anthem MediBlue Full Dual Advantage (HMO D-SNP) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8556790541 8556790541 711 711 8553630724 8553630724 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3447 013 0 2021 Anthem MediBlue Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8556790538 8556790538 711 711 8443951019 8443951019 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3447 014 0 2021 Anthem MediBlue Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8556790538 8556790538 711 711 8443951019 8443951019 711 711 This plan does not charge an annual deductible for all drugs. The $325.00 annual deductible only applies to drugs on certain tiers.~ H3447 018 0 2021 Anthem MediBlue Dual Advantage (HMO D-SNP) https://shop.anthem.com/medicare 1351 William Howard Taft, CN14B-818 Cincinnati OH 45206 8556790541 8556790541 711 711 8448793611 8448793611 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3447 019 0 2021 Anthem MediBlue Plus (HMO) https://shop.anthem.com/medicare 1351 William Howard Taft, CN14B-818 Cincinnati OH 45206 8556790538 8556790538 711 711 8552518826 8552518826 711 711 H3447 020 0 2021 Anthem MediBlue Dual Advantage (HMO D-SNP) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790541 8556790541 711 711 8445332021 8445332021 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3447 021 0 2021 Anthem MediBlue Plus (HMO) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790538 8556790538 711 711 8552518827 8552518827 711 711 H3447 022 0 2021 Anthem MediBlue Plus (HMO) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790538 8556790538 711 711 8552518827 8552518827 711 711 This plan does not charge an annual deductible for all drugs. The $120.00 annual deductible only applies to drugs on certain tiers.~ H3447 023 0 2021 Anthem MediBlue Plus (HMO) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790538 8556790538 711 711 8552518827 8552518827 711 711 This plan does not charge an annual deductible for all drugs. The $75.00 annual deductible only applies to drugs on certain tiers.~ H3447 024 0 2021 Anthem MediBlue Extra (HMO) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790538 8556790538 711 711 8552518827 8552518827 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H3447 025 0 2021 Anthem MediBlue Essential (HMO) www.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8556790538 8556790538 711 711 8443951019 8443951019 711 711 This plan does not charge an annual deductible for all drugs. The $325.00 annual deductible only applies to drugs on certain tiers.~ H3447 026 0 2021 Anthem MediBlue Care To You (HMO I-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8556790540 8556790540 711 711 8442096375 8442096375 711 711 H3447 027 0 2021 Anthem MediBlue Extra (HMO) www.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8556790538 8556790538 711 711 8443951019 8443951019 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H3447 028 0 2021 Anthem MediBlue Extra (HMO) www.anthem.com/medicare P.O. Box 659404 San Antonio GA 78265 8556790538 8556790538 711 711 8443951019 8443951019 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H3447 030 0 2021 Anthem MediBlue Dual Advantage (HMO D-SNP) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8556790541 8556790541 711 711 8553630724 8553630724 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3447 031 0 2021 Anthem MediBlue Dual Advantage (HMO D-SNP) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8556790541 8556790541 711 711 8553630724 8553630724 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3447 802 0 2021 Anthem MediBlue EGWP MAPD (HMO) www.anthem.com/va/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8886495968 8886495968 711 711 8552957811 8552957811 711 711 H3447 804 0 2021 Anthem MediBlue (HMO) www.anthem.com/va/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H3447 805 0 2021 Anthem MediBlue (HMO) www.anthem.com/va/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H3447 808 0 2021 Anthem MediBlue (HMO) www.anthem.com/va/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H3447 809 0 2021 Anthem MediBlue (HMO) www.anthem.com/va/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H3447 811 0 2021 Anthem MediBlue (HMO) www.anthem.com/IN/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8552751405 8552751405 711 711 H3447 812 0 2021 Anthem MediBlue (HMO) www.anthem.com/IN/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8552751405 8552751405 711 711 H3447 815 0 2021 Anthem MediBlue (HMO) www.anthem.com/IN/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H3447 816 0 2021 Anthem MediBlue (HMO) www.anthem.com/IN/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H3447 818 0 2021 Anthem MediBlue (HMO) www.anthem.com/MO/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8552751404 8552751404 711 711 H3447 819 0 2021 Anthem MediBlue (HMO) www.anthem.com/MO/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8552751404 8552751404 711 711 H3447 822 0 2021 Anthem MediBlue (HMO) www.anthem.com/MO/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H3447 823 0 2021 Anthem MediBlue (HMO) www.anthem.com/MO/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H3449 012 0 2021 Blue Medicare Medical Only (HMO) https://www.bluecrossnc.com/medicare P.O. Box 17509 Winston Salem NC 27116 8006658037 8006658037 711 711 8883104110 8883104110 711 711 H3449 023 1 2021 Blue Medicare Essential Plus (HMO) https://www.bluecrossnc.com/medicare P.O. Box 17509 Winston Salem NC 27116 8006658037 8006658037 711 711 8883104110 8883104110 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3449 023 2 2021 Blue Medicare Essential Plus (HMO) https://www.bluecrossnc.com/medicare P.O. Box 17509 Winston Salem NC 27116 8006658037 8006658037 711 711 8883104110 8883104110 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3449 023 4 2021 Blue Medicare Essential Plus (HMO) https://www.bluecrossnc.com/medicare P.O. Box 17509 Winston Salem NC 27116 8006658037 8006658037 711 711 8883104110 8883104110 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3449 023 5 2021 Blue Medicare Essential Plus (HMO) https://www.bluecrossnc.com/medicare P.O. Box 17509 Winston Salem NC 27116 8006658037 8006658037 711 711 8883104110 8883104110 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3449 024 1 2021 Blue Medicare Enhanced (HMO) https://www.bluecrossnc.com/medicare PO Box 17509 Winston Salem NC 27116 8006658037 8006658037 711 711 8883104110 8883104110 711 711 H3449 024 2 2021 Blue Medicare Enhanced (HMO) https://www.bluecrossnc.com/medicare PO Box 17509 Winston Salem NC 27116 8006658037 8006658037 711 711 8883104110 8883104110 711 711 H3449 024 3 2021 Blue Medicare Enhanced (HMO) https://www.bluecrossnc.com/medicare PO Box 17509 Winston Salem NC 27116 8006658037 8006658037 711 711 8883104110 8883104110 711 711 H3449 025 0 2021 Blue Medicare Essential (HMO) https://www.bluecrossnc.com/medicare P.O. Box 17509 Winston Salem NC 27116 8006658037 8006658037 711 711 8883104110 8883104110 711 711 This plan does not charge an annual deductible for all drugs. The $375.00 annual deductible only applies to drugs on certain tiers.~ H3449 026 0 2021 Blue Medicare Choice (HMO) https://www.bluecrossnc.com/medicare P.O. Box 17509 Winston Salem NC 27116 8006658037 8006658037 711 711 8883104110 8883104110 711 711 H3449 801 0 2021 Blue Medicare HMO EGWP (HMO) https://www.bluecrossnc.com/medicare PO Box 17509 Winston Salem NC 27116 8006658037 8006658037 711 711 8883104110 8883104110 711 711 H3449 805 0 2021 Blue Medicare HMO EGWP Medical Only (HMO) https://www.bluecrossnc.com/medicare PO Box 17509 Winston Salem NC 27116 8006658037 8006658037 711 711 8883104110 8883104110 711 711 H3449 813 0 2021 Blue Medicare HMO EGWP Value (HMO) https://www.bluecrossnc.com/medicare PO Box 17509 Winston Salem NC 27116 8006658037 8006658037 711 711 8883104110 8883104110 711 711 H3449 814 0 2021 Blue Medicare HMO EGWP Complete (HMO) https://www.bluecrossnc.com/medicare P.O. Box 17509 Winston Salem NC 27116 8006658037 8006658037 711 711 8883104110 8883104110 711 711 H3464 001 0 2021 AARP Medicare Advantage Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3464 002 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H3464 003 0 2021 AARP Medicare Advantage Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3464 004 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H3464 007 0 2021 AARP Medicare Advantage Patriot (HMO) www.AARPMedicarePlans.com memberservices@mypreferredcare.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H3467 001 0 2021 ProCare Advantage (HMO I-SNP) www.procareadvantageplan.com 2537 Golden Bear Drive Carrollton TX 21122 8442063719 8442063719 711 711 8442063719 8442063719 711 711 H3471 001 0 2021 Health Alliance NW Companion Rx (HMO) www.healthalliancemedicare.org healthalliancemedicare@healthalliance.org 411 N. Chelan Ave. Suite A Wenatchee WA 98801 8775611463 8775611463 711 711 8777503350 5096620736 711 711 H3471 002 0 2021 Health Alliance NW Companion Rx Plus (HMO) www.healthalliancemedicare.org healthalliancemedicare@healthalliance.org 411 N. Chelan Ave. Suite A Wenatchee WA 98801 8775611463 8775611463 711 711 8777503350 5096620736 711 711 H3471 003 0 2021 Health Alliance NW Companion HMO (HMO) www.healthalliancemedicare.org healthalliancemedicare@healthalliance.org 411 N. Chelan Ave. Suite A Wenatchee WA 98801 8775611463 8775611463 711 711 8777503350 5096620736 711 711 H3471 004 0 2021 Health Alliance NW SignalAdvantage HMO Rx (HMO) www.healthalliancemedicare.org WAMedicare@healthalliance.org 1701 Creekside Loop #100 Yakima WA 98902 8776423331 5094531318 711 711 8777956117 5094531210 711 711 H3471 005 0 2021 Health Alliance NW SignalAdvantage HMO Rx Plus (HMO) www.healthalliancemedicare.org WAMedicare@healthalliance.org 1701 Creekside Loop #100 Yakima WA 98902 8776423331 5094531318 711 711 8777956117 5094531210 711 711 H3471 006 0 2021 Health Alliance NW SignalAdvantage HMO (HMO) www.healthalliancemedicare.org WAMedicare@healthalliance.org 1701 Creekside Loop #100 Yakima WA 98902 8776423331 5094531318 711 711 8777956117 5094531210 711 711 H3471 010 0 2021 Health Alliance NW Companion Basic Rx (HMO) www.healthalliancemedicare.org healthalliancemedicare@healthalliance.org 411 N. Chelan Ave. Suite A Wenatchee WA 98801 8775611463 8775611463 711 711 8777503350 5096620736 711 711 H3471 013 0 2021 Health Alliance NW SignalAdvantage POS Rx (HMO-POS) www.healthalliancemedicare.org WAMedicare@healthalliance.org 1701 Creekside Loop #100 Yakima WA 98902 8776423331 5094531318 711 711 8777956117 5094531210 711 711 H3471 014 0 2021 Health Alliance NW SignalAdvantage POS Rx Plus (HMO-POS) www.healthalliancemedicare.org WAMedicare@healthalliance.org 1701 Creekside Loop #100 Yakima WA 98902 8776423331 5094531318 711 711 8777956117 5094531210 711 711 H3471 015 0 2021 Health Alliance NW SignalAdvantage POS (HMO-POS) www.healthalliancemedicare.org WAMedicare@healthalliance.org 1701 Creekside Loop #100 Yakima WA 98902 8776423331 8776423331 711 711 8777956117 5094531210 711 711 H3471 017 0 2021 Health Alliance NW Companion Basic Rx 2 (HMO) healthalliancemedicare.org Memberservices@healthalliance.org 411 N. Chelan Ave. Suite A Wenatchee WA 98801 8775611463 8775611463 711 711 8777503350 5096620736 711 711 H3471 018 0 2021 Health Alliance NW Companion POS Rx (HMO-POS) healthalliancemedicare.org healthalliancemedicare@healthalliance.org 411 N. Chelan Ave. Suite A Wenatchee WA 98801 8775611463 8775611463 711 711 8777503350 8777503350 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~ H3471 801 0 2021 Medicare Employer HMO (HMO) www.healthalliancemedicare.org healthalliancemedicare@healthalliance.org 411 N Chelan Ave. Suite A Wenatchee WA 98801 8776423331 8775611463 711 711 8777956117 8777956117 711 711 H3471 802 0 2021 Medicare Employer HMO Rx (HMO) www.healthalliancemedicare.org healthalliancemedicare@healthalliance.org 411 N Chelan Ave. Suite A Wenatchee WA 98801 8776423331 8775611463 711 711 8777956117 8777956117 711 711 H3471 803 0 2021 Medicare Employer HMO Rx - non calendar year (HMO) www.healthalliancemedicare.org healthalliancemedicare@healthalliance.org 411 N Chelan Ave. Suite A Wenatchee WA 98801 8776423331 8775611463 711 711 8777956117 8777956117 711 711 H3471 804 0 2021 Medicare Employer HMO-POS (HMO-POS) www.healthalliancemedicare.org healthalliancemedicare@healthalliance.org 411 N Chelan Ave. Suite A Wenatchee WA 98801 8776423331 8775611463 711 711 8777956117 8777956117 711 711 H3471 805 0 2021 Medicare Employer HMO-POS with Rx (HMO-POS) www.healthalliancemedicare.org healthalliancemedicare@healthalliance.org 411 N Chelan Ave. Suite A Wenatchee WA 98801 8776423331 8775611463 711 711 8777956117 8777956117 711 711 H3471 806 0 2021 Medicare Employer HMO-POS with Rx (HMO-POS) www.healthalliancemedicare.org healthalliancemedicare@healthalliance.org 411 N Chelan Ave. Suite A Wenatchee WA 98801 8776423331 8775311463 711 711 8777956117 8777956117 711 711 H3499 002 0 2021 Allwell Medicare (HMO) allwell.mhsindiana.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661541 8557661541 711 711 H3499 005 0 2021 Allwell Dual Medicare (HMO D-SNP) allwell.mhsindiana.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8332024704 8332024704 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3499 007 0 2021 Allwell Medicare Boost (HMO) allwell.mhsindiana.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661541 8557661541 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3499 008 0 2021 Allwell Medicare Complement (HMO) allwell.mhsindiana.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661541 8557661541 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H3499 801 0 2021 Allwell Group (HMO) allwell.mhsindiana.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661541 8557661541 711 711 H3499 802 0 2021 Allwell Group (HMO) allwell.mhsindiana.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661541 8557661541 711 711 H3499 803 0 2021 Allwell Group (HMO) allwell.mhsindiana.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661541 8557661541 711 711 H3528 003 0 2021 ConnectiCare Choice Plan 2 (HMO) www.connecticare.com/medicare PO Box 4001 Farmington CT 06034 8772248220 8772248220 711 711 8002242273 8002242273 711 711 H3528 006 0 2021 ConnectiCare Flex Plan 1 (HMO-POS) www.connecticare.com/medicare PO Box 4001 Farmington CT 06034 8772248220 8772248220 711 711 8002242273 8002242273 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3528 010 0 2021 ConnectiCare Passage Plan 1 (HMO) www.connecticare.com/medicare PO Box 4001 Farmington CT 06034 8772248220 8772248220 711 711 8002242273 8002242273 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H3528 011 1 2021 ConnectiCare Flex Plan 3 (HMO-POS) www.connecticare.com/medicare PO Box 4001 Farmington CT 06034 8772248220 8772248220 711 711 8002242273 8002242273 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3528 011 2 2021 ConnectiCare Flex Plan 3 (HMO-POS) www.connecticare.com/medicare PO Box 4001 Farmington CT 06034 8772248220 8772248220 711 711 8002242273 8002242273 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3528 014 0 2021 ConnectiCare Choice Plan 3 (HMO) www.connecticare.com/medicare PO Box 4001 Farmington CT 06034 8772248220 8772248220 711 711 8002242273 8002242273 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H3528 015 0 2021 ConnectiCare Flex Plan 2 (HMO-POS) www.connecticare.com/medicare PO Box 4001 Farmington CT 06034 8772248220 8772248220 711 711 8002242273 8002242273 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3528 016 0 2021 ConnectiCare Choice Plan 1 (HMO) www.connecticare.com/medicare PO Box 4001 Farmington CT 06034 8772248220 8772248220 711 711 8002242273 8002242273 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3528 017 0 2021 ConnectiCare Choice Part B Saver (HMO) www.connecticare.com/medicare PO Box 4001 Farmington CT 06034 8772248220 8772248220 711 711 8002242273 8002242273 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H3528 801 0 2021 ConnectiCare Employer Group Plan (HMO) www.connecticare.com/medicare PO Box 4001 Farmington CT 06034 8772248220 8772248220 711 711 8002242273 8002242273 711 711 H3528 805 0 2021 ConnectiCare Employer Group Plan (HMO) www.connecticare.com/medicare PO Box 4001 Farmington CT 06034 8772248220 8772248220 711 711 8002242273 8002242273 711 711 H3528 806 0 2021 ConnectiCare Employer Group Plan (HMO-POS) www.connecticare.com/medicare PO Box 4001 Farmington CT 06034 8772248220 8772248220 711 711 8002242273 8002242273 711 711 H3528 807 0 2021 ConnectiCare Employer Group Plan (HMO-POS) www.connecticare.com/medicare PO Box 4001 Farmington CT 06034 8772248220 8772248220 711 711 8002242273 8002242273 711 711 H3533 001 0 2021 Humana Gold Plus H3533-001 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H3533 002 0 2021 Humana Gold Plus SNP-DE H3533-002 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3533 006 0 2021 Humana Gold Plus H3533-006 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3533 010 0 2021 Humana Gold Plus H3533-010 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3533 013 0 2021 Humana Gold Plus H3533-013 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H3533 027 0 2021 Humana Gold Plus H3533-027 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~ H3533 031 0 2021 Humana Gold Plus SNP-DE H3533-031 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3533 032 1 2021 Humana Gold Plus H3533-032 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3533 032 2 2021 Humana Gold Plus H3533-032 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3533 033 0 2021 Humana Gold Plus H3533-033 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H3533 802 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H3533 803 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H3533 805 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H3533 806 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H3536 002 0 2021 Anthem MediBlue Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8556790542 8556790542 711 711 8553102473 8553102473 711 711 This plan does not charge an annual deductible for all drugs. The $190.00 annual deductible only applies to drugs on certain tiers.~ H3536 004 0 2021 Anthem MediBlue Coordination Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8556790542 8556790542 711 711 8553102473 8553102473 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H3536 005 0 2021 Anthem MediBlue Select (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8556790542 8556790542 711 711 8553102473 8553102473 711 711 This plan does not charge an annual deductible for all drugs. The $190.00 annual deductible only applies to drugs on certain tiers.~ H3536 801 0 2021 Anthem MediBlue (HMO) www.anthem.com/nh/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H3536 802 0 2021 Anthem MediBlue (HMO) www.anthem.com/nh/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H3536 805 0 2021 Anthem MediBlue (HMO) www.anthem.com/nh/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H3536 806 0 2021 Anthem MediBlue (HMO) www.anthem.com/nh/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H3554 001 0 2021 BlueMedicare Saver Choice (PPO) www.arkansasbluecross.com/medicare P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8442014934 8442014934 711 711 This plan does not charge an annual deductible for all drugs. The $385.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H3554 002 0 2021 BlueMedicare Saver Choice (PPO) www.arkansasbluecross.com/medicare P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8442014934 8442014934 711 711 This plan does not charge an annual deductible for all drugs. The $385.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H3554 003 0 2021 BlueMedicare Value Choice (PPO) www.arkansasbluecross.com/medicare P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8442014934 8442014934 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3554 004 0 2021 BlueMedicare Value Choice (PPO) www.arkansasbluecross.com/medicare P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8442014934 8442014934 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3554 005 0 2021 BlueMedicare Value Choice (PPO) www.arkansasbluecross.com/medicare P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8442014934 8442014934 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H3554 006 0 2021 BlueMedicare Value Choice (PPO) www.arkansasbluecross.com/medicare P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8442014934 8442014934 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H3554 007 0 2021 BlueMedicare Premier Choice (PPO) www.arkansasbluecross.com/medicare P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8442014934 8442014934 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3554 008 0 2021 BlueMedicare Premier Choice (PPO) www.arkansasbluecross.com/medicare P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8442014934 8442014934 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3554 009 0 2021 BlueMedicare Premier Choice (PPO) www.arkansasbluecross.com/medicare P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8442014934 8442014934 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3554 010 0 2021 BlueMedicare Premier Choice (PPO) www.arkansasbluecross.com/medicare P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8442014934 8442014934 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H3557 001 0 2021 HealthMate for Medicare (PPO) www.BCBSRI.com/Medicare 500 Exchange Street Providence RI 02903 8005052583 4013512583 711 711 8002670439 4012772958 711 711 H3557 801 0 2021 HealthMate Coast-to-Coast for Medicare Group (PPO) www.BCBSRI.com/Medicare 500 Exchange Street Providence RI 02903 8005052583 4013512583 711 711 8002670439 4012772958 711 711 H3561 001 0 2021 Health Net Amber II Premier (HMO D-SNP) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8004319007 8004319007 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3561 002 0 2021 Health Net Sapphire Premier (HMO) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8004319007 8004319007 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H3561 004 0 2021 Health Net Sapphire Premier (HMO) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8004319007 8004319007 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H3561 005 0 2021 Health Net Sapphire Premier II (HMO) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8004319007 8004319007 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H3561 006 0 2021 Health Net Sapphire Premier II (HMO) ca.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8004319007 8004319007 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H3561 801 0 2021 Health Net Seniority Plus Employer (HMO) healthnet.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8002754737 8002754737 711 711 H3561 802 0 2021 Health Net Seniority Plus Employer (HMO) healthnet.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8002754737 8002754737 711 711 H3561 803 0 2021 Health Net Seniority Plus Employer (HMO) healthnet.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8002754737 8002754737 711 711 H3572 001 0 2021 PHP (HMO C-SNP) www.php-ga.org php@positivehealthcare.org P.O. Box 46160 Los Angeles CA 90046 8332676768 8332676768 711 711 8332676768 8332676768 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H3597 001 0 2021 Aetna Medicare Value Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H3597 007 0 2021 Aetna Medicare Value Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H3597 009 0 2021 Aetna Medicare Value Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3597 011 0 2021 Aetna Medicare Assure Plan (HMO-POS D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3597 801 0 2021 Aetna Medicare Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H3597 802 0 2021 Aetna Medicare Plan w/Rx (HMO) www.aetnamedicare.com HicksJS@aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H3632 001 0 2021 Medica Advantage Solution H3632-001 (PPO) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8663987374 9529922134 711 711 H3653 004 0 2021 Paramount Elite - Enhanced Medical & Drug (HMO) www.paramounthealthcare.com/medicareplans brianna.eighmey@promedica.org P.O. Box 928 Toledo OH 43697 8004623589 4198872525 8887405670 8887405670 8004623589 4198872525 8887405670 8887405670 H3653 015 0 2021 Paramount Elite - Standard Medical & Drug (HMO) www.paramounthealthcare.com/medicareplans brianna.eighmey@promedica.org P.O. Box 928 Toledo OH 43697 8004623589 4198872525 8887405670 8887405670 8004623589 4198872525 8887405670 8887405670 This plan does not charge an annual deductible for all drugs. The $50.00 annual deductible only applies to drugs on certain tiers.~ H3653 018 0 2021 Paramount Elite - Enhanced Medical Only (HMO) www.paramounthealthcare.com/medicareplans brianna.eighmey@promedica.org P.O. Box 928 Toledo OH 43697 8004623589 4198872525 8887405670 8887405670 8004623589 4198872525 8887405670 8887405670 H3653 022 0 2021 Paramount Elite - Prime Medical & Drug (HMO) www.paramounthealthcare.com/medicareplans brianna.eighmey@promedica.org P.O. Box 928 Toledo OH 43697 8004623589 4198872525 8887405670 8887405670 8004623589 4198872525 8887405670 8887405670 H3653 023 0 2021 Paramount Elite Choice Medical & Drug (HMO) www.paramounthealthcare.com/medicareplans brianna.eighmey@promedica.org P.O. Box 928 Toledo OH 43697 8004623589 4198872525 8887405670 8887405670 8004623589 4198872525 8887405670 8887405670 H3653 024 0 2021 Paramount Elite Essential Medical & Drug (HMO) www.paramounthealthcare.com/medicareplans brianna.eighmey@promedica.org P.O. Box 928 Toledo OH 43697 8004623589 4198872525 8887405670 8887405670 8004623589 4198872525 8887405670 8887405670 H3653 803 0 2021 Paramount Elite - Emp Group A/B No Rx (HMO) paramounthealthcare.com/medicareplans brianna.eighmey@promedica.org P.O. Box 928 Toledo OH 43697 8004623589 4198872525 8887405670 8887405670 8004623589 4198872525 8887405670 8887405670 H3653 809 0 2021 Paramount Elite-Emp Group A/B Rx (HMO) paramounthealthcare.com/medicareplans brianna.eighmey@promedica.org P.O. Box 928 Toledo OH 43697 8004623589 4198872525 8887405670 8887405670 8004623589 4198872525 8887405670 8887405670 H3655 032 0 2021 Anthem MediBlue Essential (HMO) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790543 8556790543 711 711 8556907796 8556907796 711 711 This plan does not charge an annual deductible for all drugs. The $60.00 annual deductible only applies to drugs on certain tiers.~ H3655 033 0 2021 Anthem MediBlue Dual Advantage (HMO D-SNP) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790544 8556790544 711 711 8448793610 8448793610 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3655 034 0 2021 Anthem MediBlue Plus (HMO) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790543 8556790543 711 711 8556907796 8556907796 711 711 H3655 038 0 2021 Anthem MediBlue Prime Select (HMO) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790543 8556790543 711 711 8556907796 8556907796 711 711 H3655 040 0 2021 Anthem MediBlue Preferred (HMO) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790543 8556790543 711 711 8556907796 8556907796 711 711 H3655 041 0 2021 Anthem MediBlue Extra (HMO) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790543 8556790543 711 711 8556907796 8556907796 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H3655 042 0 2021 Anthem MediBlue Preferred Plus (HMO) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790543 8556790543 711 711 8556907796 8556907796 711 711 H3655 801 0 2021 Anthem Senior Advantage (HMO) www.anthem.com/oh/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H3655 803 0 2021 Anthem Senior Advantage (HMO) www.anthem.com/oh/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H3655 807 0 2021 Anthem Senior Advantage (HMO) www.anthem.com/oh/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H3655 808 0 2021 Anthem Senior Advantage (HMO) www.anthem.com/oh/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H3660 028 0 2021 SummaCare Medicare Emerald (HMO-POS) www.summacare.com/medicare medicarecustomerservice@summacare.com P.O. Box 3620 Akron OH 44309 8884648440 3309968440 8007500750 8007500750 8009966250 3309968885 8007500750 8007500750 H3660 029 0 2021 SummaCare Medicare Sapphire (HMO-POS) www.summacare.com/medicare medicarecustomerservice@summacare.com P.O. Box 3620 Akron OH 44309 8884648440 3309968440 8007500750 8007500750 8009966250 3309968885 8007500750 8007500750 H3660 044 0 2021 SummaCare Medicare Ruby (HMO) www.summacare.com/medicare medicarecustomerservice@summacare.com P.O. Box 3620 Akron OH 44309 8884648440 3309968440 8007500750 8007500750 8009966250 3309968885 8007500750 8007500750 H3660 047 0 2021 SummaCare Medicare Ruby (HMO) www.summacare.com/medicare medicarecustomerservice@summacare.com P.O. Box 3620 Akron OH 44309 8884648440 3309968440 8007500750 8007500750 8009966250 3309968885 8007500750 8007500750 H3660 048 0 2021 SummaCare Medicare Sapphire (HMO-POS) www.summacare.com/medicare medicarecustomerservice@summacare.com P.O. Box 3620 Akron OH 44309 8884648440 3309968440 8007500750 8007500750 8009966250 3309968885 8007500750 8007500750 H3660 050 0 2021 SummaCare Medicare Topaz (HMO) www.summacare.com/medicare medicarecustomerservice@summacare.com P.O. Box 3620 Akron OH 44309 8884648440 3309968440 8007500750 8007500750 8009966250 3309968885 8007500750 8007500750 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3660 052 1 2021 SummaCare Medicare Amber (HMO) www.summacare.com/medicare medicarecustomerservice@summacare.com P.O. Box 3620 Akron OH 44309 8884648440 3309968440 8007500750 8007500750 8009966250 3309968885 8007500750 8007500750 H3660 052 2 2021 SummaCare Medicare Amber (HMO) www.summacare.com/medicare medicarecustomerservice@summacare.com P.O. Box 3620 Akron OH 44309 8884648440 3309968440 8007500750 8007500750 8009966250 3309968885 8007500750 8007500750 H3660 053 1 2021 SummaCare Medicare Garnet (HMO) www.summacare.com/medicare medicarecustomerservice@summacare.com P.O. Box 3620 Akron OH 44309 8884648440 3309968440 8007500750 8007500750 8009966250 3309968885 8007500750 8007500750 H3660 053 2 2021 SummaCare Medicare Garnet (HMO) www.summacare.com/medicare medicarecustomerservice@summacare.com P.O. Box 3620 Akron OH 44309 8884648440 3309968440 8007500750 8007500750 8009966250 3309968885 8007500750 8007500750 H3660 801 0 2021 SummaCare Medicare Employer Plan with Part D (HMO) www.summacare.com/medicare medicarecustomerservice@summacare.com P.O. Box 3620 Akron OH 44309 8884648440 3309968440 8007500750 8007500750 8009966250 3309968885 8007500750 8007500750 H3660 802 0 2021 SummaCare Medicare Employer Plan without Part D (HMO) www.summacare.com/medicare medicarecustomerservice@summacare.com P.O. Box 3620 Akron OH 44309 8884648440 3309968440 8007500750 8007500750 8009966250 3309968885 8007500750 8007500750 H3660 805 0 2021 SummaCare Medicare Employer Plan with Part D (HMO-POS) www.summacare.com/medicare medicarecustomerservice@summacare.com P.O. Box 3620 Akron OH 44309 8884648440 3309968440 8007500750 8007500750 8009966250 3309968885 8007500750 8007500750 H3660 806 0 2021 SummaCare Medicare Employer Plan without Part D (HMO-POS) www.summacare.com/medicare medicarecustomerservice@summacare.com P.O. Box 3620 Akron OH 44309 8884648440 3309968440 8007500750 8007500750 8009966250 3309968885 8007500750 8007500750 H3664 014 0 2021 PrimeTime Health Plan Basic - MA Only (HMO-POS) www.primetimehealthplan.com Morrow House, 2600 Sixth Street SW Canton OH 44710 8558771049 3303637424 711 711 8005775084 3303637407 711 711 H3664 017 0 2021 PrimeTime Health Plan Plus (HMO-POS) www.primetimehealthplan.com Morrow House, 2600 Sixth Street SW Canton OH 44710 8558771049 3303637424 711 711 8005775084 3303637407 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H3664 020 0 2021 PrimeTime Health Plan Classic (HMO-POS) www.primetimehealthplan.com Morrow House, 2600 Sixth Street SW Canton OH 44710 8558771049 3303637424 711 711 8005775084 3303637407 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3664 021 0 2021 PrimeTime Health Plan Aultimate (HMO-POS) www.primetimehealthplan.com Morrow House, 2600 Sixth Street SW Canton OH 44710 8558771049 3303637424 711 711 8005775084 3303637407 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3664 801 0 2021 PrimeTime Health Plan Employer Group HMO - CY (HMO-POS) www.primetimehealthplan.com Morrow House, 2600 Sixth Street SW Canton OH 44710 8558771049 3303637424 711 711 8005775084 3303637407 711 711 H3664 802 0 2021 PrimeTime Health Plan Employer Group HMO MA-Only (HMO-POS) www.primetimehealthplan.com Morrow House, 2600 Sixth Street SW Canton OH 44710 8558771049 3303637424 711 711 8005775084 3303637407 711 711 H3664 803 0 2021 PrimeTime Health Plan Employer Group - Non CY (HMO-POS) www.primetimehealthplan.com Morrow House, 2600 Sixth Street SW Canton OH 44710 8558771049 3303637424 711 711 8005775084 3303637407 711 711 H3664 807 0 2021 PrimeTime Health Plan Employer Group HMO - CY (HMO-POS) www.primetimehealthplan.com Morrow House, 2600 Sixth Street SW Canton OH 44710 8558771049 3303637424 711 711 8005775084 3303637407 711 711 H3668 013 0 2021 MediGold Medical Only (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 014 0 2021 MediGold Southeast OH Classic Preferred (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 015 0 2021 MediGold Southeast OH Essential Care (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3668 016 0 2021 MediGold Southwest OH Classic Preferred (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 017 0 2021 MediGold Southwest OH Essential Care (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 018 1 2021 MediGold Classic Preferred (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 018 2 2021 MediGold Classic Preferred (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 018 3 2021 MediGold Classic Preferred (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 019 1 2021 MediGold Essential Care (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 019 2 2021 MediGold Essential Care (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 019 3 2021 MediGold Essential Care (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 020 0 2021 MediGold Essential Care (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 021 0 2021 MediGold True Advantage (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 022 0 2021 MediGold True Advantage (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 023 0 2021 MediGold True Advantage (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 024 0 2021 MediGold True Advantage (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 025 0 2021 MediGold Essential Care (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 026 0 2021 MediGold True Advantage (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 027 0 2021 MediGold Essential Care (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 028 0 2021 MediGold True Advantage (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 029 0 2021 MediGold Medical Only (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 801 0 2021 EGWP MediGold Medical Only (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 802 0 2021 EGWP MediGold Classic (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 803 0 2021 EGWP MediGold Custom (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 804 0 2021 EGWP MediGold Classic (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 805 0 2021 EGWP MediGold Southeast OH Medical Only (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 806 0 2021 EGWP MediGold Southeast OH Classic (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 807 0 2021 EGWP MediGold Southeast OH Custom (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 808 0 2021 EGWP MediGold Southwest OH Medical Only (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 809 0 2021 EGWP MediGold Southwest OH Classic (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3668 810 0 2021 EGWP MediGold Southwest OH Custom (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H3672 013 0 2021 The Health Plan SecureCare - Option II (HMO) www.healthplan.org/medicare information@healthplan.org The Health Plan, 1110 Main Street Wheeling WV 26003 8778477915 8778477915 711 711 8778477907 8778477907 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H3672 014 0 2021 The Health Plan SecureCare - Option I, MA Only (HMO) www.healthplan.org/medicare information@healthplan.org The Health Plan, 1110 Main Street Wheeling WV 26003 8778477915 8778477915 711 711 8778477907 8778477907 711 711 H3672 019 0 2021 The Health Plan SecureCare SNP (HMO D-SNP) www.healthplan.org/medicare information@healthplan.org The Health Plan, 1110 Main Street Wheeling WV 26003 8778477915 8778477915 711 711 8778477907 8778477907 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3672 020 0 2021 The Health Plan SecureCare - Option II (HMO) www.healthplan.org/medicare information@healthplan.org The Health Plan, 1110 Main Street Wheeling WV 26003 8778477915 8778477915 711 711 8778477907 8778477907 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H3672 021 0 2021 The Health Plan SecureCare - Option I, MA Only (HMO) www.healthplan.org/medicare information@healthplan.org The Health Plan, 1110 Main Street Wheeling WV 26003 8778477915 8778477915 711 711 8778477907 8778477907 711 711 H3672 023 0 2021 The Health Plan SecureCare Capitol Plan (HMO) www.healthplan.org/medicare information@healthplan.org The Health Plan, 1110 Main Street Wheeling WV 26003 8778477915 8778477915 711 711 8778477907 8778477907 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H3672 024 0 2021 The Health Plan SecureCare Capitol Plan, MA Only (HMO) www.healthplan.org/medicare information@healthplan.org The Health Plan, 1110 Main Street Wheeling WV 26003 8778477915 8778477915 711 711 8778477907 8778477907 711 711 H3672 025 0 2021 WVU Medicine - The Health Plan SecureCare (HMO) www.healthplan.org/medicare information@healthplan.org The Health Plan, 1110 Main Street Wheeling WV 26003 8778477915 8778477915 711 711 8778477907 8778477907 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H3672 805 0 2021 The Health Plan SecureCare - Employer (HMO) www.healthplan.org/medicare information@healthplan.org The Health Plan, 1110 Main Street Wheeling WV 26003 8778477915 8778477915 711 711 8778477907 8778477907 711 711 H3706 001 0 2021 Generations Classic (HMO) www.GlobalHealth.com/medicare MedicareAnswers@globalhealth.com 210 Park Ave, Ste 2800 Oklahoma City OK 73102 8442805555 4052805555 711 711 8442805555 4052805555 711 711 H3706 009 0 2021 Generations Value (HMO) www.GlobalHealth.com/medicare MedicareAnswers@globalhealth.com 210 Park Ave, Ste 2800 Oklahoma City OK 73102 8442805555 4052805555 711 711 8442805555 4052805555 711 711 H3706 018 0 2021 Generations Select (HMO) www.GlobalHealth.com/medicare MedicareAnswers@globalhealth.com 210 Park Ave, Ste 2800 Oklahoma City OK 73102 8442805555 4052805555 711 711 8442805555 4052805555 711 711 H3706 021 0 2021 Generations Classic Choice (HMO-POS) www.GlobalHealth.com/medicare MedicareAnswers@globalhealth.com 210 Park Ave, Ste 2800 Oklahoma City OK 73102 8442805555 4052805555 711 711 8442805555 4052805555 711 711 H3706 803 0 2021 Generations EGHP CY (HMO) www.GlobalHealth.com/medicare MedicareAnswers@globalhealth.com 210 Park Ave, Ste 2800 Oklahoma City OK 73102 8442805555 4052805555 711 711 8442805555 4052805555 711 711 H3706 804 0 2021 Generations EGHP Non CY (HMO) www.GlobalHealth.com/medicare MedicareAnswers@globalhealth.com 210 Park Ave, Ste 2800 Oklahoma City OK 73102 8442805555 4052805555 711 711 8442805555 4052805555 711 711 H3706 807 0 2021 Generations EGHP MA only (HMO) www.GlobalHealth.com/medicare MedicareAnswers@globalhealth.com 210 Park Ave, Ste 2800 Oklahoma City OK 73102 8442805555 4052805555 711 711 8442805555 4052805555 711 711 H3708 001 0 2021 American Health Advantage of Oklahoma (HMO I-SNP) ok.AmHealthPlans.com MemberServices@AmHealthPlans.com 201 Jordan Road, Suite 200 Franklin TN 37067 8665834649 8665834649 711 711 8665834649 8665834649 711 711 H3725 001 0 2021 Bright Advantage Choice Plus (PPO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H3725 004 0 2021 Bright Advantage Choice (PPO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~ H3727 001 1 2021 CommuniCare Advantage CSNP (HMO C-SNP) www.communicare-advantage.com CommuniCare Advantage, 4700 Ashwood Drive Suite 200 Cincinnati OH 45241 8559695869 8559695869 711 711 8559695869 8559695869 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H3727 001 2 2021 CommuniCare Advantage CSNP (HMO C-SNP) www.communicare-advantage.com CommuniCare Advantage, 4700 Ashwood Drive Suite 200 Cincinnati OH 45241 8559695869 8559695869 711 711 8559695869 8559695869 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H3727 001 3 2021 CommuniCare Advantage CSNP (HMO C-SNP) www.communicare-advantage.com CommuniCare Advantage, 4700 Ashwood Drive Suite 200 Cincinnati OH 45241 8559695869 8559695869 711 711 8559695869 8559695869 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H3727 002 1 2021 CommuniCare Advantage ISNP (HMO I-SNP) www.communicare-advantage.com CommuniCare Advantage, 4700 Ashwood Drive, Suite 200 Cincinnati OH 45241 8559695861 8559695861 711 711 8559695861 8559695861 711 711 H3727 002 2 2021 CommuniCare Advantage ISNP (HMO I-SNP) www.communicare-advantage.com CommuniCare Advantage, 4700 Ashwood Drive, Suite 200 Cincinnati OH 45241 8559695861 8559695861 711 711 8559695861 8559695861 711 711 H3727 002 3 2021 CommuniCare Advantage ISNP (HMO I-SNP) www.communicare-advantage.com CommuniCare Advantage, 4700 Ashwood Drive, Suite 200 Cincinnati OH 45241 8559695861 8559695861 711 711 8559695861 8559695861 711 711 H3748 001 0 2021 Aetna Medicare Value Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3748 003 0 2021 Aetna Medicare Value Plus Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3748 004 0 2021 Aetna Medicare Platinum Plus Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3748 005 0 2021 Aetna Medicare Value Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3748 006 0 2021 Aetna Medicare Elite Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3748 007 0 2021 Aetna Medicare Elite Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3748 008 0 2021 Aetna Medicare Prime Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3748 009 0 2021 Aetna Medicare Elite Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3748 801 0 2021 Aetna Medicare Plan (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H3748 802 0 2021 Aetna Medicare Plan w/Rx (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H3749 001 0 2021 AARP Medicare Advantage Plan 1 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H3749 017 0 2021 AARP Medicare Advantage Plan 1 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 H3749 018 0 2021 AARP Medicare Advantage Plan 2 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3749 020 0 2021 AARP Medicare Advantage Plan 2 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H3749 801 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H3749 803 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H3749 804 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H3755 001 0 2021 Senior Health Plan Platinum (HMO) www.ccokadvantage.com/2021/SHP ccare@ccok.com Two W 2nd Street, Suite 100 Tulsa OK 74103 8006428065 9185945323 8007220353 8007220353 8006428065 9185945323 8007220353 8007220353 H3755 002 0 2021 Senior Health Plan Silver (HMO) www.ccokadvantage.com/2021/SHP ccare@ccok.com Two W 2nd Street, Suite 100 Tulsa OK 74103 8006428065 9185945323 8007220353 8007220353 8006428065 9185945323 8007220353 8007220353 H3755 004 0 2021 Senior Health Plan Platinum Plus (HMO) www.ccokadvantage.com/2021/SHP ccare@ccok.com Two W 2nd Street, Suite 100 Tulsa OK 74103 8006428065 9185945323 8007220353 8007220353 8006428065 9185945323 8007220353 8007220353 H3755 005 0 2021 Senior Health Plan Silver Plus (HMO) www.ccokadvantage.com/2021/SHP ccare@ccok.com Two W 2nd Street, Suite 100 Tulsa OK 74103 8006428065 9185945323 8007220353 8007220353 8006428065 9185945323 8007220353 8007220353 H3755 801 0 2021 Senior Health EGHP+D (HMO) www.ccokadvantage.com/2021/SHP ccare@ccok.com Two W 2nd Street, Suite 100 Tulsa OK 74103 8006428065 9185945323 8007220353 8007220353 8006428065 9185945323 8007220353 8007220353 H3777 001 2 2021 Experience Health Medicare Advantage (HMO) www.experiencehealthnc.com PO Box 52382 Durham NC 27717 8339051299 9196469835 711 711 8337777394 9843643974 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H3777 001 3 2021 Experience Health Medicare Advantage (HMO) www.experiencehealthnc.com PO Box 52382 Durham NC 27717 8339051299 9196469835 711 711 8337777394 9843643974 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H3777 001 4 2021 Experience Health Medicare Advantage (HMO) www.experiencehealthnc.com PO Box 52382 Durham NC 27717 8339051299 9196469835 711 711 8337777394 9843643974 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H3794 002 0 2021 UnitedHealthcare Dual Complete LP1 (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003961942 8003961942 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3800 001 0 2021 Provider Partners Illinois Advantage Plan (HMO I-SNP) www.pphealthplan.com info@pphealthplan.com 785 Elkridge Landing Rd, Suite 300 Linthicum Heights MD 21090 8004059681 8004059681 711 711 8004059681 8004059681 711 711 H3805 001 0 2021 AARP Medicare Advantage Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3805 007 0 2021 AARP Medicare Advantage Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3805 015 0 2021 AARP Medicare Advantage Plan 3 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H3805 016 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H3805 017 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H3805 019 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3805 020 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H3805 021 0 2021 AARP Medicare Advantage (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H3805 023 1 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3805 023 2 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3805 025 1 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3805 025 2 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3805 029 0 2021 AARP Medicare Advantage (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3805 030 0 2021 AARP Medicare Advantage Walgreens (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 This plan does not charge an annual deductible for all drugs. The $125.00 annual deductible only applies to drugs on certain tiers.~ H3805 032 0 2021 AARP Medicare Advantage Walgreens (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 H3805 033 0 2021 AARP Medicare Advantage Plan 1 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3805 034 0 2021 AARP Medicare Advantage Plan 2 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $180.00 annual deductible only applies to drugs on certain tiers.~ H3805 035 0 2021 AARP Medicare Advantage Patriot (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H3805 036 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3805 037 0 2021 AARP Medicare Advantage Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 This plan does not charge an annual deductible for all drugs. The $185.00 annual deductible only applies to drugs on certain tiers.~ H3805 801 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H3805 803 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H3805 804 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H3805 805 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H3805 806 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H3805 807 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H3810 001 0 2021 AllCare Advantage Gold (HMO) www.AllCareHealth.com/Advantage sheila.anders@allcarehealth.com 1701 NE 7th Street Grants Pass OR 97526 8884600185 5414714106 711 711 8884600185 5414714106 711 711 H3810 003 0 2021 AllCare Advantage Gold Plus Rx (HMO) www.AllCareHealth.com/Advantage sheila.anders@allcarehealth.com 1701 NE 7th Street Grants Pass OR 97526 8884600185 5414714106 711 711 8884600185 5414714106 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~ H3810 020 0 2021 AllCare Advantage Preferred Rx (HMO) www.AllCareHealth.com/Advantage sheila.anders@allcarehealth.com 1701 NE 7th Street Grants Pass OR 97526 8884600185 5414714106 711 711 8884600185 5414714106 711 711 H3810 021 0 2021 AllCare Advantage Focus (HMO) www.AllCareHealth.com/Advantage sheila.anders@allcarehealth.com 1701 NE 7th Street Grants Pass OR 97526 8884600185 5414714106 711 711 8884600185 5414714106 711 711 H3810 022 0 2021 AllCare Advantage Focus Rx (HMO) www.AllCareHealth.com/Advantage sheila.anders@allcarehealth.com 1701 NE 7th Street Grants Pass OR 97526 8884600185 5414714106 711 711 8884600185 5414714106 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H3811 001 0 2021 Samaritan Advantage Conventional Plan (HMO) https://medicare.samhealthplans.org 2300 NW Walnut Boulevard Corvallis OR 97330 8008324580 5417684550 8007352900 8007352900 8008324580 5417684550 8007352900 8007352900 H3811 002 0 2021 Samaritan Advantage Premier Plan (HMO) https://medicare.samhealthplans.org 2300 NW Walnut Boulevard Corvallis OR 97330 8008324580 5417684550 8007352900 8007352900 8008324580 5417684550 8007352900 8007352900 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3811 003 0 2021 Samaritan Advantage Special Needs Plan (HMO D-SNP) https://medicare.samhealthplans.org 2300 NW Walnut Boulevard Corvallis OR 97330 8008324580 5417684550 8007352900 8007352900 8008324580 5417684550 8007352900 8007352900 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3811 009 0 2021 Samaritan Advantage Premier Plan Plus (HMO) https://medicare.samhealthplans.org 2300 NW Walnut Boulevard Corvallis OR 97330 8008324580 5417684550 8007352900 8007352900 8008324580 5417684550 8007352900 8007352900 H3813 001 0 2021 Moda Health PPO (PPO) www.modahealth.com/medicare MedicalMedicare@modahealth.com PO Box 40384, Attn: Moda Health PPO Portland OR 97240 8882172375 5032652975 711 711 8772999062 5032654762 711 711 H3813 009 0 2021 Moda Health PPORX Enhanced (PPO) www.modahealth.com/medicare MedicalMedicare@modahealth.com PO Box 40384, Attn: Moda Health PPORX Portland OR 97240 8882172375 5032652975 711 711 8772999062 5032654762 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~ H3813 010 0 2021 Moda Health Central PPORX (PPO) www.modahealth.com/medicare MedicalMedicare@modahealth.com PO Box 40384, Attn: Moda Health PPORX Portland OR 97240 8882172375 5032652975 711 711 8772999062 5032654762 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3813 011 0 2021 Moda Health NW PPORX (PPO) www.modahealth.com/medicare MedicalMedicare@modahealth.com PO Box 40384, Attn: Moda Health PPORX Portland OR 97240 8882172375 5032652975 711 711 8772999062 5032654762 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H3813 012 0 2021 Moda Health Southern PPORX (PPO) www.modahealth.com/medicare MedicalMedicare@modahealth.com PO Box 40384, Attn: Moda Health PPORX Portland OR 97240 8882172375 5032652975 711 711 8772999062 5032654762 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3813 013 0 2021 Moda Health Metro PPORX (PPO) www.modahealth.com/medicare MedicalMedicare@modahealth.com PO Box 40384, Attn: Moda Health PPORX Portland OR 97240 8882172375 5032652975 711 711 8772999062 5032654762 711 711 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~ H3813 014 0 2021 Moda Health Mid-valley PPORX (PPO) www.modahealth.com/medicare MedicalMedicare@modahealth.com P.O. Box 40384, ATTN: MODA HEALTH PPORX Portland OR 97240 8882172375 5032652975 711 711 8772999062 5032654762 711 711 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~ H3813 804 0 2021 Moda Health Group Plan + Rx (PPO) www.modahealth.com/medicare MedicalMedicare@modahealth.com PO Box 40384, Attn: Moda Health PPORX Portland OR 97240 8882172375 5032652975 711 711 8772999062 5032654762 711 711 H3814 007 0 2021 ATRIO Special Needs Plan (HMO D-SNP) atriohp.com customerservice@atriohp.com 2965 Ryan Dr SE Salem OR 97301 8776728620 5416728620 711 711 8776728620 5416728620 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3815 001 0 2021 My Choice (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H3815 006 0 2021 My Choice (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H3815 007 0 2021 My Choice (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H3815 008 0 2021 Platinum (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H3815 009 0 2021 CalPlus (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H3815 010 0 2021 Heart & Diabetes (HMO C-SNP) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H3815 011 0 2021 AllCare Preferred Plan (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H3815 013 0 2021 smartHMO (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd., Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H3815 015 0 2021 Platinum (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd., Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H3815 016 0 2021 Platinum (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd., Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H3815 018 0 2021 Platinum (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H3815 019 0 2021 Sutter Advantage (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H3815 020 0 2021 Sutter Advantage (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H3815 021 0 2021 Sutter Advantage (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H3815 022 0 2021 Sutter Advantage (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H3815 023 0 2021 Sutter Advantage (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H3815 024 0 2021 Sutter Advantage (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H3815 025 0 2021 Platinum (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H3815 026 0 2021 AVA (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H3815 027 0 2021 AVA (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H3815 028 0 2021 My Choice (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H3815 029 0 2021 My Choice (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H3815 030 0 2021 CalPlusDuals (HMO D-SNP) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3815 031 0 2021 Harmony (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H3815 032 0 2021 Select (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H3815 801 0 2021 Retiree Options (HMO) www.alignmenthealthplan.com lwent@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H3815 802 0 2021 Retiree Option (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H3817 008 1 2021 Regence MedAdvantage + Rx Classic (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8005418981 8005418981 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3817 008 2 2021 Regence MedAdvantage + Rx Classic (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8005418981 8005418981 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3817 009 1 2021 Regence MedAdvantage + Rx Enhanced (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8005418981 8005418981 711 711 H3817 009 2 2021 Regence MedAdvantage + Rx Enhanced (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8005418981 8005418981 711 711 H3817 010 0 2021 Regence Valiance (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8005418981 8005418981 711 711 H3817 011 1 2021 Regence MedAdvantage + Rx Primary (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8005418981 8005418981 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3817 011 2 2021 Regence MedAdvantage + Rx Primary (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8005418981 8005418981 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3817 801 0 2021 Regence MedAdvantage (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883198904 8883198904 711 711 8883198904 8883198904 711 711 H3817 802 0 2021 Regence MedAdvantage + Rx (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883198904 8883198904 711 711 8883198904 8883198904 711 711 H3817 803 0 2021 Regence MedAdvantage + Rx 02 (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883198904 8883198904 711 711 8883198904 8883198904 711 711 H3817 804 0 2021 Regence MedAdvantage + Rx 03 (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883198904 8883198904 711 711 8883198904 8883198904 711 711 H3822 001 0 2021 Blue Cross Medicare Advantage Basic (HMO) www.getblueil.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 H3822 002 0 2021 Blue Cross Medicare Advantage Basic (HMO) www.getbluenm.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3822 007 0 2021 Blue Cross Medicare Advantage Basic Plus (HMO-POS) www.getblueil.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 H3822 008 0 2021 Blue Cross Medicare Advantage Premier Plus (HMO-POS) www.getblueil.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 H3822 012 0 2021 Blue Cross Medicare Advantage Basic (HMO) www.getblueil.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 H3822 801 0 2021 Blue Cross Group Medicare Advantage Plan (HMO) www.hcsc.com PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H3822 802 0 2021 Blue Cross Group Medicare Advantage Plan (HMO) www.hcsc.com PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H3822 805 0 2021 Blue Cross Group Medicare Advantage Plan (HMO) www.hcsc.com PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H3822 806 0 2021 Blue Cross Group Medicare Advantage Plan (HMO) www.hcsc.com PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H3822 809 0 2021 Blue Cross Group Medicare Advantage Plan (HMO) www.hcsc.com PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H3822 810 0 2021 Blue Cross Group Medicare Advantage Plan (HMO) www.hcsc.com PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H3822 813 0 2021 Blue Cross Group Medicare Advantage Plan (HMO) www.hcsc.com PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H3822 814 0 2021 Blue Cross Group Medicare Advantage Plan (HMO) www.hcsc.com PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H3822 815 0 2021 Blue Cross Group Medicare Advantage Plan (HMO) www.hcsc.com PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H3832 007 0 2021 HMSA Akamai Advantage Standard (PPO) www.hmsa.com/advantage AMS, P.O. Box 860 Honolulu HI 96808 8006934672 8089486235 711 711 8006604672 8089486000 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~ H3832 008 0 2021 HMSA Akamai Advantage Standard Plus (PPO) www.hmsa.com/advantage AMS, P.O. Box 860 Honolulu HI 96808 8006934672 8089486235 711 711 8006604672 8089486000 711 711 H3832 009 0 2021 HMSA Akamai Advantage Complete (PPO) www.hmsa.com/advantage AMS, P.O. Box 860 Honolulu HI 96808 8006934672 8089486235 711 711 8006604672 8089486000 711 711 This plan does not charge an annual deductible for all drugs. The $380.00 annual deductible only applies to drugs on certain tiers.~ H3832 010 0 2021 HMSA Akamai Advantage Complete Plus (PPO) www.hmsa.com/advantage AMS, P.O. Box 860 Honolulu HI 96808 8006934672 8089486235 711 711 8006604672 8089486000 711 711 H3832 011 0 2021 HMSA Akamai Advantage Dual Care (PPO D-SNP) www.hmsa.com/advantage AMS, PO Box 860 Honolulu HI 96808 8006934672 8089486235 711 711 8006604672 8089486000 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~This plan's deductible only applies to out-of-network services.~ H3832 801 0 2021 HMSA Akamai Advantage EGWP with Drug CY (PPO) www.hmsa.com/advantage AMS, P.O. Box 860 Honolulu HI 96808 8006934672 8089486235 711 711 8006604672 8089486000 711 711 H3832 802 0 2021 HMSA Akamai Advantage EGWP with Drug NCY (PPO) www.hmsa.com/advantage AMS, P.O. Box 860 Honolulu HI 96808 8006934672 8089486235 711 711 8006604672 8089486000 711 711 H3832 805 0 2021 HMSA Akamai Advantage EGWP CY (PPO) www.hmsa.com/advantage AMS, P.O. Box 860 Honolulu HI 96808 8006934672 8089486235 711 711 8006604672 8089486000 711 711 H3832 807 0 2021 HMSA Akamai Advantage Union Group Plan MAPD (PPO) www.hmsa.com/advantage AMS, P.O. Box 860 Honolulu HI 96808 8006934672 8089486235 711 711 8006604672 8089486000 711 711 H3864 002 0 2021 PacificSource Medicare Essentials 2 (HMO) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Avenue Bend OR 97701 8888633637 5413855315 8007352900 8007352900 8888633637 5413855315 8007352900 8007352900 H3864 006 0 2021 PacificSource Medicare Essentials Rx 6 (HMO) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Avenue Bend OR 97701 8888633637 5413855315 8007352900 8007352900 8888633637 5413855315 8007352900 8007352900 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3864 014 0 2021 PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Avenue Bend OR 97701 8888633637 5413855315 8007352900 8007352900 8888633637 5413855315 8007352900 8007352900 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H3864 021 0 2021 PacificSource Medicare Essentials Rx 21 (HMO) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Avenue Bend OR 97701 8888633637 2084334612 8007352900 8007352900 8888633637 2084334612 8007352900 8007352900 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3864 024 0 2021 PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Avenue Bend OR 97701 8888633637 2084334612 8007352900 8007352900 8888633637 2084334612 8007352900 8007352900 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H3864 027 0 2021 PacificSource Medicare Essentials Rx 27 (HMO) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Avenue Bend OR 97701 8888633637 5413855315 8007352900 8007352900 8888633637 5413855315 8007352900 8007352900 This plan does not charge an annual deductible for all drugs. The $399.00 annual deductible only applies to drugs on certain tiers.~ H3864 029 0 2021 PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Ave Bend OR 97701 8888633637 5413855315 8007352900 8007352900 8888633637 5413855315 8007352900 8007352900 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3864 030 0 2021 PacificSource Medicare MyCare 30 (HMO) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Ave Bend OR 97701 8888633637 5413855315 8007352900 8007352900 8888633637 5413855315 8007352900 8007352900 H3864 032 0 2021 PacificSource Medicare MyCare Rx 32 (HMO) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Avenue Bend OR 97701 8888633637 2084334612 8007352900 8007352900 8888633637 2084334612 8007352900 8007352900 H3864 033 0 2021 PacificSource Medicare MyCare Rx 33 (HMO) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Ave Bend OR 97701 8888633637 5413855315 8007352900 8007352900 8888633637 5413855315 8007352900 8007352900 H3864 034 0 2021 PacificSource Medicare MyCare Rx 34 (HMO) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Ave Bend OR 97701 8888633637 5413855315 8007352900 8007352900 8888633637 5413855315 8007352900 8007352900 H3864 035 0 2021 PacificSource Medicare MyCare 35 (HMO) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Avenue Bend OR 97701 8888633637 5413855315 8007352900 8007352900 8888633637 5413855315 8007352900 8007352900 H3864 036 0 2021 PacificSource Medicare Essentials Rx 36 (HMO) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Avenue Bend OR 97701 8888633637 5412253771 8007352900 8007352900 8888633637 5412253771 8007352900 8007352900 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3864 037 0 2021 PacificSource Medicare MyCare Rx 37 (HMO) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Ave Bend OR 97701 8888633637 5413855315 8007352900 8007352900 8888633637 5413855315 8007352900 8007352900 H3864 038 0 2021 PacificSource Medicare MyCare Rx 38 (HMO) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Ave Bend OR 97701 8888633637 5413855315 8007352900 8007352900 8888633637 5413855315 8007352900 8007352900 H3864 039 0 2021 PacificSource Medicare MyCare Rx 39 (HMO) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Ave Bend OR 97701 8888633637 5413855315 8007352900 8007352900 8888633637 5413855315 8007352900 8007352900 H3864 040 0 2021 PacificSource Medicare MyCare Rx 40 (HMO) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Ave Bend OR 97701 8888633637 5413855315 8007352900 8007352900 8888633637 5413855315 8007352900 8007352900 H3864 041 0 2021 PacificSource Medicare Essentials Rx 41 (HMO) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Avenue Bend OR 97701 8888633637 5412253771 8007352900 8007352900 8888633637 5412253771 8007352900 8007352900 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3864 801 0 2021 PacificSource Medicare Essentials 801 (HMO) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Avenue Bend OR 97701 8888633637 5413855315 8007352900 8007352900 8888633637 5413855315 8007352900 8007352900 H3864 803 0 2021 PacificSource Medicare Essentials Rx 803 (HMO) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Avenue Bend OR 97701 8888633637 5413855315 8007352900 8007352900 8888633637 5413855315 8007352900 8007352900 H3864 805 0 2021 PacificSource Medicare Essentials 805 (HMO-POS) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Avenue Bend OR 97701 8888633637 5413855315 8007352900 8007352900 8888633637 5413855315 8007352900 8007352900 H3864 806 0 2021 PacificSource Medicare Essentials Rx 806 (HMO-POS) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Avenue Bend OR 97701 8888633637 5413855315 8007352900 8007352900 8888633637 5413855315 8007352900 8007352900 H3890 001 0 2021 Johns Hopkins Advantage MD (PPO) www.hopkinsmedicare.com/ P.O. Box 3538 Scranton PA 18505 8884037682 8884037682 711 711 8772935325 8772935325 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H3890 002 0 2021 Johns Hopkins Advantage MD Plus (PPO) www.hopkinsmedicare.com/ P.O. Box 3538 Scranton PA 18505 8884037682 8884037682 711 711 8772935325 8772935325 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H3890 004 0 2021 Johns Hopkins Advantage MD Premier (PPO) www.hopkinsmedicare.com/ P.O. Box 3538 Scranton PA 18505 8884037682 8884037682 711 711 8772935325 8772935325 711 711 H3890 801 0 2021 Johns Hopkins Advantage MD Group Plan CY (PPO) www.hopkinsmedicare.com P.O. Box 3538 Scranton PA 18505 8884037682 8884037682 711 711 8772935325 8772935325 711 711 H3907 002 0 2021 UPMC for Life HMO No Rx (HMO) http://www.upmchealthplan.com/medicare upmchp@msx.upmc.edu 600 Grant Street Pittsburgh PA 15219 8773813765 8773813765 711 711 8775393080 8775393080 711 711 H3907 006 0 2021 UPMC for Life HMO Rx Enhanced (HMO) http://www.upmchealthplan.com/medicare upmchp@msx.upmc.edu 600 Grant Street Pittsburgh PA 15219 8773813765 8773813765 711 711 8775393080 8775393080 711 711 H3907 029 0 2021 UPMC for Life HMO Rx (HMO) http://www.upmchealthplan.com/medicare upmchp@msx.upmc.edu 600 Grant Street Pittsburgh PA 15219 8773813765 8773813765 711 711 8775393080 8775393080 711 711 H3907 037 0 2021 UPMC for Life HMO Deductible with Rx (HMO) http://www.upmchealthplan.com/medicare upmchp@msx.upmc.edu 600 Grant Street Pittsburgh PA 15219 8773813765 8773813765 711 711 8775393080 8775393080 711 711 H3907 045 0 2021 UPMC for Life HMO Premier Rx (HMO) http://www.upmchealthplan.com/medicare upmchp@msx.upmc.edu 600 Grant Street Pittsburgh PA 15219 8773813765 8773813765 711 711 8448702231 8448702231 711 711 H3907 046 0 2021 UPMC for Life HMO Premier Rx (HMO) http://www.upmchealthplan.com/medicare upmchp@msx.upmc.edu 600 Grant Street Pittsburgh PA 15219 8773813765 8773813765 711 711 8775393080 8775393080 711 711 H3907 047 0 2021 UPMC for Life HMO Rx (HMO) http://www.upmchealthplan.com/medicare upmchp@msx.upmc.edu 600 Grant Street Pittsburgh PA 15219 8773813765 8773813765 711 711 8448702231 8448702231 711 711 H3907 049 0 2021 UPMC for Life HMO Rx Choice (HMO) http://www.upmchealthplan.com/medicare upmchp@msx.upmc.edu 600 Grant Street Pittsburgh PA 15219 8773813765 8773813765 711 711 8775393080 8775393080 711 711 H3907 050 0 2021 UPMC for Life HMO Premier Rx (HMO) http://www.upmchealthplan.com/medicare upmchp@msx.upmc.edu 600 Grant Street Pittsburgh PA 15219 8773813765 8773813765 711 711 8775393080 8775393080 711 711 H3907 051 0 2021 UPMC for Life HMO Premier Rx (HMO) http://www.upmchealthplan.com/medicare upmchp@msx.upmc.edu 600 Grant Street Pittsburgh PA 15219 8773813765 8773813765 711 711 8775393080 8775393080 711 711 H3907 052 0 2021 UPMC for Life HMO Premier Rx (HMO) http://www.upmchealthplan.com/medicare upmchp@msx.upmc.edu 600 Grant Street Pittsburgh PA 15219 8773813765 8773813765 711 711 8775393080 8775393080 711 711 H3907 801 0 2021 UPMC Employer Group (HMO) http://www.upmchealthplan.com/medicare upmchp@msx.upmc.edu 600 Grant Street Pittsburgh PA 15219 8773813765 8773813765 711 711 8775393080 8775393080 711 711 H3907 802 0 2021 UPMC Employer Group Rx (HMO) http://www.upmchealthplan.com/medicare upmchp@msx.upmc.edu 600 Grant Street Pittsburgh PA 15219 8773813765 8773813765 711 711 8775393080 8775393080 711 711 H3907 803 0 2021 UPMC Employer Group Rx (HMO) http://www.upmchealthplan.com/medicare upmchp@msx.upmc.edu 600 Grant Street Pittsburgh PA 15219 8773813765 8773813765 711 711 8775393080 8775393080 711 711 H3909 001 0 2021 Personal Choice 65 Rx (PPO) www.ibxmedicare.com P.O Box 13713 Philadelphia PA 19101 8773936733 8773936733 711 711 8887183333 8887183333 711 711 H3909 007 0 2021 Personal Choice 65 Medical Only (PPO) www.ibxmedicare.com P.O. Box 13713 Philadelphia PA 19101 8773936733 8773936733 711 711 8887183333 8887183333 711 711 H3909 009 0 2021 Personal Choice 65 Rx (PPO) www.ibxmedicare.com P.O Box 13713 Philadelphia PA 19101 8773936733 8773936733 711 711 8887183333 8887183333 711 711 H3909 014 0 2021 Personal Choice 65 Prime Rx (PPO) www.ibxmedicare.com P.O Box 13713 Philadelphia PA 19101 8773936733 8773936733 711 711 8887183333 8887183333 711 711 H3909 015 0 2021 Personal Choice 65 Prime Rx (PPO) www.ibxmedicare.com P.O Box 13713 Philadelphia PA 19101 8773936733 8773936733 711 711 8887183333 8887183333 711 711 H3909 801 0 2021 Personal Choice 65 Group Medical Only (PPO) www.ibxmedicare.com P.O. Box 13713 Philadelphia PA 19101 8773936733 8773936733 711 711 8887183333 8887183333 711 711 H3909 802 0 2021 Personal Choice 65 Group Rx (PPO) www.ibxmedicare.com P.O Box 13713 Philadelphia PA 19101 8773936733 8773936733 711 711 8887183333 8887183333 711 711 H3916 001 0 2021 Freedom Blue PPO Classic (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Freedom Blue, P.O. Box 1068 Pittsburgh PA 15230 8667435478 8667435478 711 711 8005508722 8005508722 711 711 H3916 002 0 2021 Freedom Blue PPO Classic (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Freedom Blue, P.O. Box 1068 Pittsburgh PA 15230 8667435478 8667435478 711 711 8005508722 8005508722 711 711 H3916 005 0 2021 Freedom Blue PPO Deluxe (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Freedom Blue, P.O. Box 1068 Pittsburgh PA 15230 8667435478 8667435478 711 711 8005508722 8005508722 711 711 H3916 012 0 2021 Freedom Blue PPO Basic (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Freedom Blue, P.O. Box 1068 Pittsburgh PA 15230 8667435478 8667435478 711 711 8005508722 8005508722 711 711 H3916 015 0 2021 Freedom Blue PPO Standard (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Freedom Blue, P.O. Box 1068 Pittsburgh PA 15230 8667435478 8667435478 711 711 8005508722 8005508722 711 711 H3916 018 0 2021 Freedom Blue PPO ValueRx (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Freedom Blue, P.O. Box 1068 Pittsburgh PA 15230 8667435478 8667435478 711 711 8005508722 8005508722 711 711 H3916 022 0 2021 Freedom Blue PPO Select (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Freedom Blue, P.O. Box 1068 Pittsburgh PA 15230 8667435478 8667435478 711 711 8005508722 8005508722 711 711 H3916 024 0 2021 Freedom Blue PPO Select (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Freedom Blue, P.O. Box 1068 Pittsburgh PA 15230 8667435478 8667435478 711 711 8005508722 8005508722 711 711 H3916 032 0 2021 Freedom Blue PPO ValueRx (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Freedom Blue, P.O. Box 1068 Pittsburgh PA 15230 8667435478 8667435478 711 711 8005508722 8005508722 711 711 H3916 033 0 2021 Freedom Blue PPO ValueRx (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Freedom Blue, P.O. Box 1068 Pittsburgh PA 15230 8667435478 8667435478 711 711 8005508722 8005508722 711 711 H3916 034 1 2021 Community Blue Medicare PPO Distinct (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Community Blue Medicare, P.O. Box 1068 Pittsburgh PA 15230 8447851787 8447851787 711 711 8887572946 8887572946 711 711 H3916 034 3 2021 Community Blue Medicare PPO Distinct (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Community Blue Medicare, P.O. Box 1068 Pittsburgh PA 15230 8447851787 8447851787 711 711 8887572946 8887572946 711 711 H3916 034 4 2021 Community Blue Medicare PPO Distinct (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Community Blue Medicare, P.O. Box 1068 Pittsburgh PA 15230 8447851787 8447851787 711 711 8887572946 8887572946 711 711 H3916 034 5 2021 Community Blue Medicare PPO Distinct (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Community Blue Medicare, P.O. Box 1068 Pittsburgh PA 15230 8447851787 8447851787 711 711 8887572946 8887572946 711 711 H3916 035 1 2021 Complete Blue PPO Distinct (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Complete Blue PPO, P.O. Box 1068 Pittsburgh PA 15230 8335441060 8335441060 711 711 8332279375 8332279375 711 711 H3916 035 2 2021 Complete Blue PPO Distinct (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Complete Blue PPO, P.O. Box 1068 Pittsburgh PA 15230 8335441060 8335441060 711 711 8332279375 8332279375 711 711 H3916 036 0 2021 Community Blue Medicare Plus PPO Distinct (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Community Blue Medicare, P.O. Box 1068 Pittsburgh PA 15230 8447851787 8447851787 711 711 8887572946 8887572946 711 711 H3916 037 1 2021 Community Blue Medicare PPO Signature (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Community Blue Medicare, P.O. Box 1068 Pittsburgh PA 15230 8447851787 8447851787 711 711 8887572946 8887572946 711 711 H3916 037 2 2021 Community Blue Medicare PPO Signature (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Community Blue Medicare, P.O. Box 1068 Pittsburgh PA 15230 8447851787 8447851787 711 711 8887572946 8887572946 711 711 H3916 037 3 2021 Community Blue Medicare PPO Signature (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Community Blue Medicare, P.O. Box 1068 Pittsburgh PA 15230 8447851787 8447851787 711 711 8887572946 8887572946 711 711 H3916 037 4 2021 Community Blue Medicare PPO Signature (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Community Blue Medicare, P.O. Box 1068 Pittsburgh PA 15230 8447851787 8447851787 711 711 8887572946 8887572946 711 711 H3916 038 0 2021 Community Blue Medicare PPO Signature (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Community Blue Medicare, P.O. Box 1068 Pittsburgh PA 15230 8447851787 8447851787 711 711 8887572946 8887572946 711 711 H3916 039 0 2021 Community Blue Medicare Plus PPO Signature (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Community Blue Medicare, P.O. Box 1068 Pittsburgh PA 15230 8447851787 8447851787 711 711 8887572946 8887572946 711 711 H3916 801 0 2021 Freedom Blue PPO MA PA CALENDAR (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Freedom Blue, P.O. Box 1068 Pittsburgh PA 15230 8667435478 8667435478 711 711 8005508722 8005508722 711 711 H3916 802 0 2021 Freedom Blue PPO MAPD PA CALENDAR (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Freedom Blue, P.O. Box 1068 Pittsburgh PA 15230 8667435478 8667435478 711 711 8005508722 8005508722 711 711 H3916 804 0 2021 Freedom Blue PPO MAPD PA Non-Calendar (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Freedom Blue, P.O. Box 1068 Pittsburgh PA 15230 8667435478 8667435478 711 711 8005508722 8005508722 711 711 H3916 805 0 2021 Community Blue Medicare PPO MA PA Calendar (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Community Blue Medicare, P.O. Box 1068 Pittsburgh PA 15230 8447851787 8447851787 711 711 8887572946 8887572946 711 711 H3916 806 0 2021 Community Blue Medicare PPO PA MAPD Calendar (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Community Blue Medicare, P.O. Box 1068 Pittsburgh PA 15230 8447851787 8447851787 711 711 8887572946 8887572946 711 711 H3916 807 0 2021 Community Blue Medicare Plus PPO MAPD Calendar (PPO) medicare.highmark.com Chris.Scarnati@highmark.com Community Blue Medicare, P.O. Box 1068 Pittsburgh PA 15230 8447851787 8447851787 711 711 8887572946 8887572946 711 711 H3923 013 0 2021 BlueJourney Classic (PPO) www.capitalbluemedicare.com medicareadvantageppo@capbluecross.com 2500 Elmerton Avenue Harrisburg PA 17177 8009904201 8009904201 711 711 8669874213 8669874213 711 711 This plan's deductible only applies to out-of-network services.~ H3923 017 0 2021 BlueJourney Prime (PPO) www.capitalbluemedicare.com medicareadvantageppo@capbluecross.com 2500 Elmerton Avenue Harrisburg PA 17177 8009904201 8009904201 711 711 8669874213 8669874213 711 711 This plan's deductible only applies to out-of-network services.~ H3923 028 0 2021 BlueJourney Select (PPO) www.capitalbluemedicare.com medicareadvantageppo@capbluecross.com 2500 Elmerton Avenue Harrisburg PA 17177 8009904201 8009904201 711 711 8669874213 8669874213 711 711 This plan's deductible only applies to out-of-network services.~ H3923 801 0 2021 BlueJourney Group PPO Silver Rx (PPO) www.capitalbluemedicare.com medicareadvantageppo@capbluecross.com 2500 Elmerton Avenue Harrisburg PA 17177 8009904201 8009904201 711 711 8669874213 8669874213 711 711 H3923 802 0 2021 BlueJourney Group PPO Without Rx (PPO) www.capitalbluemedicare.com medicareadvantageppo@capbluecross.com 2500 Elmerton Avenue Harrisburg PA 17177 8009904201 8009904201 711 711 8669874213 8669874213 711 711 H3923 803 0 2021 BlueJourney Group PPO Bronze Rx FY (PPO) www.capitalbluemedicare.com medicareadvantageppo@capbluecross.com 2500 Elmerton Avenue Harrisburg PA 17177 8009904201 8009904201 711 711 8669874213 8669874213 711 711 H3923 817 0 2021 BlueJourney Group PPO Gold Rx (PPO) www.capitalbluemedicare.com medicareadvantageppo@capbluecross.com 2500 Elmerton Avenue Harrisburg PA 17177 8009904201 8009904201 711 711 8669874213 8669874213 711 711 H3923 818 0 2021 BlueJourney Group PPO Platinum Rx (PPO) www.capitalbluemedicare.com medicareadvantageppo@capbluecross.com 2500 Elmerton Avenue Harrisburg PA 17177 8009904201 8009904201 711 711 8669874213 8669874213 711 711 H3923 819 0 2021 BlueJourney Group PPO Bronze Rx (PPO) www.capitalbluemedicare.com medicareadvantageppo@capbluecross.com 2500 Elmerton Avenue Harrisburg PA 17177 8009904201 8009904201 711 711 8669874213 8669874213 711 711 H3923 820 0 2021 BlueJourney Group PPO Platinum Rx FY (PPO) www.capitalbluemedicare.com medicareadvantageppo@capbluecross.com 2500 Elmerton Avenue Harrisburg PA 17177 8009904201 8009904201 711 711 8669874213 8669874213 711 711 H3923 821 0 2021 BlueJourney Group PPO Gold Rx FY (PPO) www.capitalbluemedicare.com medicareadvantageppo@capbluecross.com 2500 Elmerton Avenue Harrisburg PA 17177 8009904201 8009904201 711 711 8669874213 8669874213 711 711 H3923 822 0 2021 BlueJourney Group PPO Silver Rx FY (PPO) www.capitalbluemedicare.com medicareadvantageppo@capbluecross.com 2500 Elmerton Avenue Harrisburg PA 17177 8009904201 8009904201 711 711 8669874213 8669874213 711 711 H3924 059 13 2021 Geisinger Gold Preferred Advantage Rx (PPO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3924 059 14 2021 Geisinger Gold Preferred Advantage Rx (PPO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3924 059 15 2021 Geisinger Gold Preferred Advantage Rx (PPO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3924 059 16 2021 Geisinger Gold Preferred Advantage Rx (PPO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3924 059 17 2021 Geisinger Gold Preferred Advantage Rx (PPO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3924 059 18 2021 Geisinger Gold Preferred Advantage Rx (PPO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3924 060 13 2021 Geisinger Gold Preferred Complete Rx (PPO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3924 060 14 2021 Geisinger Gold Preferred Complete Rx (PPO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3924 060 15 2021 Geisinger Gold Preferred Complete Rx (PPO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3924 060 16 2021 Geisinger Gold Preferred Complete Rx (PPO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3924 060 17 2021 Geisinger Gold Preferred Complete Rx (PPO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3924 060 18 2021 Geisinger Gold Preferred Complete Rx (PPO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3924 062 21 2021 Geisinger Gold Preferred Enhanced Rx (PPO) GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3924 062 22 2021 Geisinger Gold Preferred Enhanced Rx (PPO) GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3924 064 1 2021 Geisinger Gold Preferred 360 Rx (PPO) GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3924 064 2 2021 Geisinger Gold Preferred 360 Rx (PPO) GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3924 804 0 2021 Geisinger Gold Preferred Rx Employer Group Plan (PPO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3928 001 0 2021 Aetna Medicare Advantra Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3928 002 0 2021 Aetna Medicare Advantra Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3928 801 0 2021 Aetna Medicare Plan w/Rx (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H3928 803 0 2021 Aetna Medicare Plan (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H3931 004 0 2021 Aetna Medicare Premier Plus (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H3931 064 0 2021 Aetna Medicare Premier (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H3931 070 0 2021 Aetna Medicare Silver (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H3931 091 0 2021 Aetna Medicare PinnacleHealth Prime (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H3931 092 0 2021 Aetna Medicare Prime Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H3931 093 0 2021 Aetna Medicare Prime (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H3931 094 0 2021 Aetna Medicare Select Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H3931 095 0 2021 Aetna Medicare Standard Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3931 096 0 2021 Aetna Medicare Prime Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H3931 097 0 2021 Aetna Medicare Connect Plus (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $255.00 annual deductible only applies to drugs on certain tiers.~ H3931 098 0 2021 Aetna Medicare Select Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3931 099 0 2021 Aetna Medicare Select Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3931 100 0 2021 Aetna Medicare Select Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3931 101 0 2021 Aetna Medicare Select Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3931 102 0 2021 Aetna Medicare Premier Plus (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H3931 104 0 2021 Aetna Medicare Elite (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H3931 105 0 2021 Aetna Medicare Main Line Health Prime (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40724 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3931 107 0 2021 Aetna Medicare Value Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3931 108 0 2021 Aetna Medicare Value Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3931 109 0 2021 Aetna Medicare Value (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3931 112 0 2021 Aetna Medicare Elite (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3931 115 0 2021 Aetna Medicare Platinum Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H3931 118 0 2021 Aetna Medicare Value Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3931 124 0 2021 Aetna Medicare UVA Health System Prime (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H3931 126 0 2021 Aetna Medicare Value Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H3931 129 0 2021 Aetna Medicare Platinum Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H3931 130 0 2021 Aetna Medicare Platinum Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H3931 131 0 2021 Aetna Medicare Platinum Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H3931 133 0 2021 Aetna Medicare Value Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H3931 134 0 2021 Aetna Medicare Value Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3931 140 0 2021 Aetna Medicare Value Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3931 801 0 2021 Aetna Medicare Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H3931 804 0 2021 Aetna Medicare Plan w/Rx (HMO) www.aetnamedicare.com HicksJS@aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H3949 009 0 2021 Cigna TotalCare (HMO D-SNP) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8008567657 8008567657 711 711 8006683813 8006683813 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3949 013 0 2021 Cigna Preferred Plus Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8008567657 8008567657 711 711 8006683813 8006683813 711 711 H3949 016 0 2021 Cigna Traditions Medicare (HMO I-SNP) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8008567657 8008567657 711 711 8006683813 8006683813 711 711 H3949 024 0 2021 Cigna Achieve Medicare (HMO C-SNP) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8008567657 8008567657 711 711 8006683813 8006683813 711 711 H3949 026 0 2021 Cigna Fundamental Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8008567657 8008567657 711 711 8006683813 8006683813 711 711 H3949 030 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8008567657 8008567657 711 711 8006683813 8006683813 711 711 H3949 031 0 2021 Cigna Alliance Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8008567657 8008567657 711 711 8006683813 8006683813 711 711 H3949 032 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8008567657 8008567657 711 711 8006683813 8006683813 711 711 H3949 033 0 2021 Cigna Preferred Plus Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8008567657 8008567657 711 711 8006683813 8006683813 711 711 H3949 034 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8008567657 8008567657 711 711 8006683813 8006683813 711 711 H3949 035 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8008567657 8008567657 711 711 8006683813 8006683813 711 711 H3949 036 0 2021 Cigna TotalCare (HMO D-SNP) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8008567657 8008567657 711 711 8006683813 8006683813 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3949 804 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8882817867 8882817867 711 711 8882817867 8882817867 711 711 H3952 008 0 2021 Keystone 65 Preferred Medical Only (HMO) www.ibxmedicare.com P.O. Box 13713 Philadelphia PA 19101 8773936733 8773936733 711 711 8006453965 8006453965 711 711 H3952 020 0 2021 Keystone 65 Preferred Rx (HMO) www.ibxmedicare.com P.O. Box 13713 Philadelphia PA 19101 8773936733 8773936733 711 711 8006453965 8006453965 711 711 H3952 044 0 2021 Keystone 65 Preferred Medical Only (HMO) www.ibxmedicare.com P.O. Box 13713 Philadelphia PA 19101 8773936733 8773936733 711 711 8006453965 8006453965 711 711 H3952 045 0 2021 Keystone 65 Preferred Rx (HMO) www.ibxmedicare.com P.O. Box 13713 Philadelphia PA 19101 8773936733 8773936733 711 711 8006453965 8006453965 711 711 H3952 048 0 2021 Keystone 65 Select Medical Only (HMO) www.ibxmedicare.com P.O. Box 13713 Philadelphia PA 19101 8773936733 8773936733 711 711 8006453965 8006453965 711 711 H3952 049 0 2021 Keystone 65 Select Rx (HMO) www.ibxmedicare.com P.O. Box 13713 Philadelphia PA 19101 8773936733 8773936733 711 711 8006453965 8006453965 711 711 H3952 050 0 2021 Keystone 65 Select Medical Only (HMO) www.ibxmedicare.com P.O. Box 13713 Philadelphia PA 19101 8773936733 8773936733 711 711 8006453965 8006453965 711 711 H3952 051 0 2021 Keystone 65 Select Rx (HMO) www.ibxmedicare.com P.O. Box 13713 Philadelphia PA 19101 8773936733 8773936733 711 711 8006453965 8006453965 711 711 H3952 053 0 2021 Keystone 65 Focus Rx (HMO-POS) www.ibxmedicare.com P.O. Box 13713 Philadelphia PA 19101 8773936733 8773936733 711 711 8006453965 8006453965 711 711 H3952 054 0 2021 Keystone 65 Focus Rx (HMO-POS) www.ibxmedicare.com P.O. Box 13713 Philadelphia PA 19101 8773936733 8773936733 711 711 8006453965 8006453965 711 711 H3952 055 0 2021 Keystone 65 Basic Rx (HMO) www.ibxmedicare.com P.O. Box 13713 Philadelphia PA 19101 8773936733 8773936733 711 711 8006453965 8006453965 711 711 H3952 056 0 2021 Keystone 65 Basic Rx (HMO) www.ibxmedicare.com P.O. Box 13713 Philadelphia PA 19101 8773936733 8773936733 711 711 8006453965 8006453965 711 711 H3952 802 0 2021 Keystone 65 Group Medical Only (HMO) www.ibxmedicare.com P.O. Box 13713 Philadelphia PA 19101 8773936733 8773936733 711 711 8006453965 8006453965 711 711 H3952 804 0 2021 Keystone 65 Group Rx (HMO) www.ibxmedicare.com P.O. Box 13713 Philadelphia PA 19101 8773936733 8773936733 711 711 8006453965 8006453965 711 711 H3954 097 0 2021 Geisinger Gold Secure Rx (HMO D-SNP) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3954 156 13 2021 Geisinger Gold Classic Advantage (HMO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3954 156 14 2021 Geisinger Gold Classic Advantage (HMO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3954 156 15 2021 Geisinger Gold Classic Advantage (HMO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3954 156 16 2021 Geisinger Gold Classic Advantage (HMO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3954 156 17 2021 Geisinger Gold Classic Advantage (HMO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3954 156 18 2021 Geisinger Gold Classic Advantage (HMO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3954 157 13 2021 Geisinger Gold Classic Advantage Rx (HMO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3954 157 14 2021 Geisinger Gold Classic Advantage Rx (HMO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3954 157 15 2021 Geisinger Gold Classic Advantage Rx (HMO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3954 157 16 2021 Geisinger Gold Classic Advantage Rx (HMO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3954 157 17 2021 Geisinger Gold Classic Advantage Rx (HMO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3954 157 18 2021 Geisinger Gold Classic Advantage Rx (HMO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3954 158 13 2021 Geisinger Gold Classic Complete Rx (HMO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3954 158 14 2021 Geisinger Gold Classic Complete Rx (HMO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3954 158 15 2021 Geisinger Gold Classic Complete Rx (HMO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3954 158 16 2021 Geisinger Gold Classic Complete Rx (HMO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3954 158 17 2021 Geisinger Gold Classic Complete Rx (HMO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3954 158 18 2021 Geisinger Gold Classic Complete Rx (HMO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3954 159 13 2021 Geisinger Gold Classic Essential Rx (HMO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3954 159 14 2021 Geisinger Gold Classic Essential Rx (HMO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3954 159 15 2021 Geisinger Gold Classic Essential Rx (HMO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3954 159 16 2021 Geisinger Gold Classic Essential Rx (HMO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3954 159 17 2021 Geisinger Gold Classic Essential Rx (HMO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3954 159 18 2021 Geisinger Gold Classic Essential Rx (HMO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3954 160 0 2021 Geisinger Gold Classic 360 Rx (HMO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3954 801 0 2021 Geisinger Gold Classic (Employer Group) (HMO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3954 802 0 2021 Geisinger Gold Classic Rx (Employer Group) (HMO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3954 805 0 2021 Geisinger Gold Classic Rx EGWP New Jersey (HMO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H3957 031 0 2021 Security Blue HMO-POS ValueRx (HMO-POS) medicare.highmark.com Chris.Scarnati@highmark.com Security Blue, P.O. Box 1068 Pittsburgh PA 15230 8666705844 8666705844 711 711 8009352583 8009352583 711 711 H3957 039 0 2021 Community Blue Medicare HMO Prestige (HMO) medicare.highmark.com Chris.Scarnati@highmark.com Community Blue Medicare, P.O. Box 1068 Pittsburgh PA 15230 8666873182 8666873182 711 711 8882345397 8882345397 711 711 H3957 042 1 2021 Community Blue Medicare HMO Signature (HMO) medicare.highmark.com Chris.Scarnati@highmark.com Community Blue Medicare, P.O. Box 1068 Pittsburgh PA 15230 8666873182 8666873182 711 711 8882345397 8882345397 711 711 H3957 042 2 2021 Community Blue Medicare HMO Signature (HMO) medicare.highmark.com Chris.Scarnati@highmark.com Community Blue Medicare, P.O. Box 1068 Pittsburgh PA 15230 8666873182 8666873182 711 711 8882345397 8882345397 711 711 H3957 042 4 2021 Community Blue Medicare HMO Signature (HMO) medicare.highmark.com Chris.Scarnati@highmark.com Community Blue Medicare, P.O. Box 1068 Pittsburgh PA 15230 8666873182 8666873182 711 711 8882345397 8882345397 711 711 H3957 042 5 2021 Community Blue Medicare HMO Signature (HMO) medicare.highmark.com Chris.Scarnati@highmark.com Community Blue Medicare, P.O. Box 1068 Pittsburgh PA 15230 8666873182 8666873182 711 711 8882345397 8882345397 711 711 H3957 043 1 2021 Security Blue HMO-POS Basic (HMO-POS) medicare.highmark.com Chris.Scarnati@highmark.com Security Blue, P.O. Box 1068 Pittsburgh PA 15230 8666705844 8666705844 711 711 8009352583 8009352583 711 711 H3957 043 2 2021 Security Blue HMO-POS Basic (HMO-POS) medicare.highmark.com Chris.Scarnati@highmark.com Security Blue, P.O. Box 1068 Pittsburgh PA 15230 8666705844 8666705844 711 711 8009352583 8009352583 711 711 H3957 043 3 2021 Security Blue HMO-POS Basic (HMO-POS) medicare.highmark.com Chris.Scarnati@highmark.com Security Blue, P.O. Box 1068 Pittsburgh PA 15230 8666705844 8666705844 711 711 8009352583 8009352583 711 711 H3957 044 1 2021 Security Blue HMO-POS ValueRx (HMO-POS) medicare.highmark.com Chris.Scarnati@highmark.com Security Blue, P.O. Box 1068 Pittsburgh PA 15230 8666705844 8666705844 711 711 8009352583 8009352583 711 711 H3957 044 2 2021 Security Blue HMO-POS ValueRx (HMO-POS) medicare.highmark.com Chris.Scarnati@highmark.com Security Blue, P.O. Box 1068 Pittsburgh PA 15230 8666705844 8666705844 711 711 8009352583 8009352583 711 711 H3957 045 1 2021 Security Blue HMO-POS Standard (HMO-POS) medicare.highmark.com Chris.Scarnati@highmark.com Security Blue, P.O. Box 1068 Pittsburgh PA 15230 8666705844 8666705844 711 711 8009352583 8009352583 711 711 H3957 045 2 2021 Security Blue HMO-POS Standard (HMO-POS) medicare.highmark.com Chris.Scarnati@highmark.com Security Blue, P.O. Box 1068 Pittsburgh PA 15230 8666705844 8666705844 711 711 8009352583 8009352583 711 711 H3957 045 3 2021 Security Blue HMO-POS Standard (HMO-POS) medicare.highmark.com Chris.Scarnati@highmark.com Security Blue, P.O. Box 1068 Pittsburgh PA 15230 8666705844 8666705844 711 711 8009352583 8009352583 711 711 H3957 046 1 2021 Security Blue HMO-POS Deluxe (HMO-POS) medicare.highmark.com Chris.Scarnati@highmark.com Security Blue, P.O. Box 1068 Pittsburgh PA 15230 8666705844 8666705844 711 711 8009352583 8009352583 711 711 H3957 046 2 2021 Security Blue HMO-POS Deluxe (HMO-POS) medicare.highmark.com Chris.Scarnati@highmark.com Security Blue, P.O. Box 1068 Pittsburgh PA 15230 8666705844 8666705844 711 711 8009352583 8009352583 711 711 H3957 046 3 2021 Security Blue HMO-POS Deluxe (HMO-POS) medicare.highmark.com Chris.Scarnati@highmark.com Security Blue, P.O. Box 1068 Pittsburgh PA 15230 8666705844 8666705844 711 711 8009352583 8009352583 711 711 H3957 047 1 2021 Community Blue Medicare HMO Signature (HMO) medicare.highmark.com Chris.Scarnati@highmark.com Community Blue Medicare, P.O. Box 1068 Pittsburgh PA 15230 8666873182 8666873182 711 711 8882345397 8882345397 711 711 H3957 047 2 2021 Community Blue Medicare HMO Signature (HMO) medicare.highmark.com Chris.Scarnati@highmark.com Community Blue Medicare, P.O. Box 1068 Pittsburgh PA 15230 8666873182 8666873182 711 711 8882345397 8882345397 711 711 H3957 805 0 2021 Security Blue HMO MA Calendar (HMO) medicare.highmark.com Chris.Scarnati@highmark.com Security Blue, P.O. Box 1068 Pittsburgh PA 15230 8666705844 8666705844 711 711 8009352583 8009352583 711 711 H3957 806 0 2021 Security Blue HMO MA-PD Calendar (HMO) medicare.highmark.com Chris.Scarnati@highmark.com Security Blue, P.O. Box 1068 Pittsburgh PA 15230 8666705844 8666705844 711 711 8009352583 8009352583 711 711 H3957 808 0 2021 Security Blue HMO MA-PD Non-Calendar (HMO) medicare.highmark.com Chris.Scarnati@highmark.com Security Blue, P.O. Box 1068 Pittsburgh PA 15230 8666705844 8666705844 711 711 8009352583 8009352583 711 711 H3957 810 0 2021 Community Blue Medicare HMO MA Calendar (HMO) medicare.highmark.com Chris.Scarnati@highmark.com Community Blue Medicare, P.O. Box 1068 Pittsburgh PA 15230 8666873182 8666873182 711 711 8882345397 8882345397 711 711 H3957 811 0 2021 Community Blue Medicare HMO MA-PD Calendar (HMO) medicare.highmark.com Chris.Scarnati@highmark.com Community Blue Medicare, P.O. Box 1068 Pittsburgh PA 15230 8666873182 8666873182 711 711 8882345397 8882345397 711 711 H3957 812 0 2021 Community Blue Medicare HMO MA-PD Non-Calendar (HMO) medicare.highmark.com Chris.Scarnati@highmark.com Community Blue Medicare, P.O. Box 1068 Pittsburgh PA 15230 8666873182 8666873182 711 711 8882345397 8882345397 711 711 H3957 813 0 2021 Security Blue HMO-POS MA Calendar (HMO-POS) medicare.highmark.com Chris.Scarnati@highmark.com Security Blue, P.O. Box 1068 Pittsburgh PA 15230 8666705844 8666705844 711 711 8009352583 8009352583 711 711 H3957 814 0 2021 Security Blue HMO-POS MA-PD Calendar (HMO-POS) medicare.highmark.com Chris.Scarnati@highmark.com Security Blue, P.O. Box 1068 Pittsburgh PA 15230 8666705844 8666705844 711 711 8009352583 8009352583 711 711 H3957 815 0 2021 Security Blue HMO-POS MA-PD Non-Calendar (HMO-POS) medicare.highmark.com Chris.Scarnati@highmark.com Security Blue, P.O. Box 1068 Pittsburgh PA 15230 8666705844 8666705844 711 711 8009352583 8009352583 711 711 H3959 001 0 2021 Aetna Medicare Advantra Gold (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3959 002 0 2021 Aetna Medicare Advantra Gold (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3959 010 0 2021 Aetna Medicare Advantra Silver (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3959 011 0 2021 Aetna Medicare Advantra Silver (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3959 032 0 2021 Aetna Medicare Advantra Premier (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3959 033 0 2021 Aetna Medicare Advantra Premier (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3959 035 0 2021 Aetna Medicare Advantra Cares (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $130.00 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3959 036 0 2021 Aetna Medicare Advantra Cares (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $220.00 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H3959 037 0 2021 Aetna Medicare Advantra Gold (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3959 039 0 2021 Aetna Medicare Advantra Premier (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3959 041 0 2021 Aetna Medicare Advantra Eagle (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3959 045 0 2021 Aetna Medicare PennHighlands Prime (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3959 046 0 2021 Aetna Medicare Advantra Washington Prime (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3959 047 0 2021 Aetna Medicare Advantra Butler Prime (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3959 049 0 2021 Aetna Medicare Advantra Excela Prime (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3959 051 0 2021 Aetna Medicare Beaver Valley Prime (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3959 052 0 2021 Aetna Medicare Advantra Value (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3959 053 0 2021 Aetna Medicare Advantra Philly Prime (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H3959 055 0 2021 Aetna Medicare Advantra Value (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H3959 803 0 2021 Aetna Medicare Plan (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H3959 804 0 2021 Aetna Medicare Plan w/Rx (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H3962 001 0 2021 BlueJourney Premier (HMO) www.capitalbluemedicare.com medicareadvantagehmo@capbluecross.com 2500 Elmerton Avenue Harrisburg PA 17177 8009904201 8009904201 711 711 8007796962 8007796962 711 711 H3962 004 0 2021 BlueJourney Value (HMO) www.capitalbluemedicare.com medicareadvantagehmo@capbluecross.com 2500 Elmerton Avenue Harrisburg PA 17177 8009904201 8009904201 711 711 8007796962 8007796962 711 711 H3962 007 0 2021 BlueJourney Essential (HMO) www.capitalbluemedicare.com medicareadvantagehmo@capbluecross.com 2500 Elmerton Avenue Harrisburg PA 17177 8009904201 8009904201 711 711 8007796962 8007796962 711 711 H3962 801 0 2021 BlueJourney Group HMO Silver Rx (HMO) www.capitalbluemedicare.com medicareadvantagehmo@capbluecross.com 2500 Elmerton Avenue Harrisburg PA 17177 8009904201 8009904201 711 711 8007796962 8007796962 711 711 H3962 802 0 2021 BlueJourney Group HMO Without Rx (HMO) www.capitalbluemedicare.com medicareadvantagehmo@capbluecross.com 2500 Elmerton Avenue Harrisburg PA 17177 8009904201 8009904201 711 711 8007796962 8007796962 711 711 H3962 803 0 2021 BlueJourney Group HMO Bronze Rx FY (HMO) www.capitalbluemedicare.com medicareadvantagehmo@capbluecross.com 2500 Elmerton Avenue Harrisburg PA 17177 8009904201 8009904201 711 711 8007796962 8007796962 711 711 H3962 813 0 2021 BlueJourney Group HMO Gold Rx (HMO) www.capitalbluemedicare.com medicareadvantagehmo@capbluecross.com 2500 Elmerton Avenue Harrisburg PA 17177 8009904201 8009904201 711 711 8007796962 8007796962 711 711 H3962 814 0 2021 BlueJourney Group HMO Platinum Rx (HMO) www.capitalbluemedicare.com medicareadvantagehmo@capbluecross.com 2500 Elmerton Avenue Harrisburg PA 17177 8009904201 8009904201 711 711 8007796962 8007796962 711 711 H3962 815 0 2021 BlueJourney Group HMO Bronze Rx (HMO) www.capitalbluemedicare.com medicareadvantagehmo@capbluecross.com 2500 Elmerton Avenue Harrisburg PA 17177 8009904201 8009904201 711 711 8007796962 8007796962 711 711 H3962 816 0 2021 BlueJourney Group HMO Platinum Rx FY (HMO) www.capitalbluemedicare.com medicareadvantagehmo@capbluecross.com 2500 Elmerton Avenue Harrisburg PA 17177 8009904201 8009904201 711 711 8007796962 8007796962 711 711 H3962 817 0 2021 BlueJourney Group HMO Silver Rx FY (HMO) www.capitalbluemedicare.com medicareadvantagehmo@capbluecross.com 2500 Elmerton Avenue Harrisburg PA 17177 8009904201 8009904201 711 711 8007796962 8007796962 711 711 H3962 818 0 2021 BlueJourney Group HMO Gold Rx FY (HMO) www.capitalbluemedicare.com medicareadvantagehmo@capbluecross.com 2500 Elmerton Avenue Harrisburg PA 17177 8009904201 8009904201 711 711 8007796962 8007796962 711 711 H3975 001 0 2021 WellCare Premier (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H3979 001 0 2021 Blue Cross Medicare Advantage Basic (HMO) www.getblueok.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H3979 801 0 2021 Blue Cross Group Medicare Advantage Plan (HMO) getblueok.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H3979 803 0 2021 Blue Cross Group Medicare Advantage Plan (HMO) getblueok.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H3979 805 0 2021 Blue Cross Group Medicare Advantage Plan (HMO) getblueok.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H4003 009 0 2021 MMM Supremo (HMO C-SNP) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H4003 017 0 2021 MMM Diamante Platino (HMO D-SNP) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4003 019 0 2021 MMM Unico (HMO-POS) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H4003 034 0 2021 MMM Elite (HMO-POS) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H4003 044 0 2021 MMM Extra (HMO-POS) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H4003 047 0 2021 MMM Valor Platino (HMO D-SNP) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4003 049 0 2021 MMM Grande Platino (HMO D-SNP) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4003 050 0 2021 MMM Conectado Platino (HMO D-SNP) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4003 051 0 2021 MMM Dinamico (HMO-POS) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H4003 806 0 2021 MMM Group $0 Calendar (HMO-POS) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H4003 807 0 2021 MMM Group $25 Calendar (HMO-POS) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H4003 820 0 2021 MMM Group $50 Calendar (HMO-POS) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H4003 821 0 2021 MMM Group $100 Calendar (HMO-POS) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H4003 822 0 2021 MMM Group $0 Non-Calendar (HMO-POS) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H4003 823 0 2021 MMM Group $25 Non-Calendar (HMO-POS) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H4003 824 0 2021 MMM Group $50 Non-Calendar (HMO-POS) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H4003 825 0 2021 MMM Group $100 Non-Calendar (HMO-POS) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H4003 826 0 2021 MMM Group $144.60 Calendar (HMO-POS) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H4003 827 0 2021 MMM Group $144.60 Non-Calendar (HMO-POS) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H4004 048 0 2021 PMC Premier Platino (HMO D-SNP) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4004 056 0 2021 PMC Max (HMO-POS) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H4004 061 0 2021 MMM Relax Platino (HMO D-SNP) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4004 817 0 2021 PMC Group $0 Calendar (HMO-POS) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H4004 818 0 2021 PMC Group $25 Calendar (HMO-POS) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H4004 819 0 2021 PMC Group $50 Calendar (HMO-POS) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H4004 820 0 2021 PMC Group $100 Calendar (HMO-POS) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H4004 822 0 2021 PMC Group $0 Non-Calendar (HMO-POS) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H4004 823 0 2021 PMC Group $25 Non-Calendar (HMO-POS) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H4004 824 0 2021 PMC Group $50 Non-Calendar (HMO-POS) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H4004 825 0 2021 PMC Group $100 Non-Calendar (HMO-POS) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H4004 826 0 2021 PMC Group $144.60 Calendar (HMO-POS) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H4004 827 0 2021 PMC Group $144.60 Non-Calendar (HMO-POS) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H4005 001 0 2021 Óptimo (PPO) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 H4005 004 0 2021 Óptimo Plus (PPO) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 H4005 801 0 2021 Óptimo (PPO) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 H4005 802 0 2021 Óptimo Plus A (PPO) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 H4005 804 0 2021 Óptimo Plus B (PPO) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 H4005 807 0 2021 Óptimo Plus C (PPO) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 H4005 808 0 2021 Óptimo Plus D (PPO) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 H4007 012 0 2021 Humana Gold Plus H4007-012 (HMO) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8006813625 8006813625 711 711 8667735959 8667735959 711 711 H4007 013 0 2021 Humana Gold Plus H4007-013 (HMO) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8006813625 8006813625 711 711 8667735959 8667735959 711 711 H4007 016 0 2021 Humana Gold Plus SNP-DE H4007-016 (HMO D-SNP) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8006813625 8006813625 711 711 8667735959 8667735959 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4007 018 0 2021 Humana Gold Plus SNP-DE H4007-018 (HMO D-SNP) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8006813625 8006813625 711 711 8667735959 8667735959 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4007 019 0 2021 Humana Gold Plus SNP-DE H4007-019 (HMO D-SNP) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8006813625 8006813625 711 711 8667735959 8667735959 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4007 020 0 2021 Humana Gold Plus H4007-020 (HMO) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8006813625 8006813625 711 711 8667735959 8667735959 711 711 H4007 021 0 2021 Humana Gold Plus H4007-021 (HMO) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8006813625 8006813625 711 711 8667735959 8667735959 711 711 H4007 022 0 2021 Humana Gold Plus SNP-DE H4007-022 (HMO D-SNP) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8006813625 8006813625 711 711 8667735959 8667735959 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4007 023 0 2021 Humana Gold Plus SNP-DE H4007-023 (HMO D-SNP) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8006813625 8006813625 711 711 8667735959 8667735959 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4007 801 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8667735959 8667735959 711 711 8667735959 8667735959 711 711 H4007 802 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8667735959 8667735959 711 711 8667735959 8667735959 711 711 H4007 811 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8667735959 8667735959 711 711 8667735959 8667735959 711 711 H4007 812 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8667735959 8667735959 711 711 8667735959 8667735959 711 711 H4007 813 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8667735959 8667735959 711 711 8667735959 8667735959 711 711 H4007 814 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8667735959 8667735959 711 711 8667735959 8667735959 711 711 H4007 815 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8667735959 8667735959 711 711 8667735959 8667735959 711 711 H4007 816 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8667735959 8667735959 711 711 8667735959 8667735959 711 711 H4036 008 0 2021 Anthem MediBlue Access (PPO) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790545 8556790545 711 711 8556907802 8556907802 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H4036 009 0 2021 Anthem MediBlue Access (PPO) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790545 8556790545 711 711 8556907802 8556907802 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H4036 010 1 2021 Anthem MediBlue Access (PPO) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790545 8556790545 711 711 8556907801 8556907801 711 711 This plan's deductible only applies to out-of-network services.~ H4036 010 2 2021 Anthem MediBlue Access (PPO) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790545 8556790545 711 711 8556907801 8556907801 711 711 This plan's deductible only applies to out-of-network services.~ H4036 016 0 2021 Anthem MediBlue Access Core (PPO) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790545 8556790545 711 711 8556907802 8556907802 711 711 This plan's deductible only applies to out-of-network services.~ H4036 017 0 2021 Anthem MediBlue Access Plus (PPO) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790545 8556790545 711 711 8556907801 8556907801 711 711 This plan does not charge an annual deductible for all drugs. The $40.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H4036 020 0 2021 Anthem MediBlue Access Plus (PPO) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790545 8556790545 711 711 8556907802 8556907802 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H4036 801 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H4036 802 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H4036 803 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H4036 805 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H4036 807 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H4036 811 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H4036 812 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H4036 813 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H4036 814 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8334981580 8334981580 711 711 8334981581 8334981581 711 711 H4091 001 0 2021 Simpra Advantage (PPO I-SNP) www.simpra.com PO Box 2190 Glen Allen VA 23058 8446374770 8446374770 711 711 8446374770 8446374770 711 711 This plan's deductible only applies to out-of-network services.~ H4091 002 0 2021 Simpra Advantage (PPO D-SNP) www.simpra.com PO Box 2190 Glen Allen VA 23058 8446374770 8446374770 711 711 8446374770 8446374770 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~This plan's deductible only applies to out-of-network services.~ H4091 003 0 2021 Simpra Advantage Premier (PPO I-SNP) www.simpra.com PO Box 2190 Glen Allen VA 23058 8446374770 8446374770 711 711 8446374770 8446374770 711 711 H4093 001 0 2021 Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) www.pphealthplan.com info@pphealthplan.com 785 Elkridge Landing Rd, Suite 300 Linthicum Heights MD 21090 8004059681 8004059681 711 711 8004059681 8004059681 711 711 H4093 004 0 2021 Provider Partners Pennsylvania Community Plan (HMO I-SNP) www.pphealthplan.com info@pphealthplan.com 785 Elkridge Landing Rd, Suite 300 Linthicum Heights MD 21090 8004059681 8004059681 711 711 8004059681 8004059681 711 711 H4094 001 0 2021 UnitedHealthcare Dual Complete (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8448559776 8448559776 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4140 001 0 2021 DrMax (HMO-POS) www.doctorshcp.com 2020 Ponce De Leon Blvd, PH 1 Coral Gables FL 33134 8336393427 7864203427 711 711 8333427463 7864603427 711 711 H4140 002 0 2021 DrPlus (HMO-POS D-SNP) www.doctorshcp.com 2020 Ponce De Leon Blvd, PH 1 Coral Gables FL 33134 8336393427 7864203427 711 711 8333427463 7864603427 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4140 003 0 2021 DrCare (HMO-POS C-SNP) www.doctorshcp.com meduran@doctorshcp.com 2020 Ponce de Leon Blvd, PH 1 Coral Gables FL 33134 8336393427 7864203427 711 711 8333427463 7864603427 711 711 H4140 004 0 2021 DrExtra (HMO-POS C-SNP) www.doctorshcp.com meduran@doctorshcp.com 2020 Ponce de Leon Blvd, PH 1 Coral Gables FL 33134 8336393427 7864203427 711 711 8333427463 7864603427 711 711 H4140 005 0 2021 DrValue (HMO-POS) www.doctorshcp.com meduran@doctorshcp.com 2020 Ponce de Leon Blvd, PH 1 Coral Gables FL 33134 8336393427 7864203427 711 711 8333427463 7864603427 711 711 H4140 006 0 2021 DrFirst (HMO-POS) www.doctorshcp.com meduran@doctorshcp.com 2020 Ponce De Leon Blvd, PH 1 Coral Gables FL 33134 8336393427 7864203427 711 711 8333427463 7864603427 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H4140 007 0 2021 DrChoice (HMO-POS) www.doctorshcp.com meduran@doctorshcp.com 2020 Ponce De Leon Blvd, PH 1 Coral Gables FL 33134 8336393427 7864203427 711 711 8333427463 7864603427 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H4141 003 0 2021 Humana Gold Plus SNP-DE H4141-003 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4141 015 0 2021 Humana Gold Plus H4141-015 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H4141 017 3 2021 Humana Gold Plus H4141-017 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H4141 017 4 2021 Humana Gold Plus H4141-017 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H4141 017 5 2021 Humana Gold Plus H4141-017 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H4141 801 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H4141 802 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H4141 805 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H4141 806 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H4152 004 0 2021 BlueCHiP for Medicare Core (HMO) www.BCBSRI.com/Medicare 500 Exchange Street Providence RI 02903 8005052583 4013512583 711 711 8002670439 4012772958 711 711 H4152 005 0 2021 BlueCHiP for Medicare Plus (HMO) www.BCBSRI.com/Medicare 500 Exchange Street Providence RI 02903 8005052583 4013512583 711 711 8002670439 4012772958 711 711 H4152 007 0 2021 BlueCHiP for Medicare Preferred (HMO-POS) www.BCBSRI.com/Medicare 500 Exchange Street Providence RI 02903 8005052583 4013512583 711 711 8002670439 4012772958 711 711 H4152 013 0 2021 BlueCHiP for Medicare Standard with Drugs (HMO) www.BCBSRI.com/Medicare 500 Exchange Street Providence RI 02903 8005052583 4013512583 711 711 8002670439 4012772958 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H4152 017 0 2021 BlueCHiP for Medicare Advance (HMO) www.BCBSRI.com/Medicare 500 Exchange Street Providence RI 02903 8005052583 4013512583 711 711 8002670439 4012772958 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H4152 018 0 2021 BlueCHiP for Medicare Extra (HMO-POS) www.BCBSRI.com/Medicare 500 Exchange Street Providence RI 02903 8005052583 4013512583 711 711 8002670439 4012772958 711 711 H4152 020 0 2021 BlueCHiP for Medicare Value (HMO-POS) www.BCBSRI.com/Medicare 500 Exchange Street Providence RI 02903 8005052583 4013512583 711 711 8002670439 4012772958 711 711 H4152 815 0 2021 BlueCHiP for Medicare Group Preferred (HMO-POS) www.BCBSRI.com/Medicare 500 Exchange Street Providence RI 02903 8005052583 4013512583 711 711 8002670439 4012772958 711 711 H4152 817 0 2021 BlueCHiP for Medicare Group Plus (HMO) www.BCBSRI.com/Medicare 500 Exchange Street Providence RI 02903 8005052583 4013512583 711 711 8002670439 4012772958 711 711 H4172 001 0 2021 NHC Advantage (HMO I-SNP) www.nhcadvantageplan.com PO Box 5849 Glen Allen VA 23058 8448546886 8448546886 711 711 8448546886 8448546886 711 711 H4172 002 0 2021 NHC Advantage Gold (HMO I-SNP) www.nhcadvantageplan.com PO Box 5849 Glen Allen VA 23058 8448546886 8448546886 711 711 8448546886 8448546886 711 711 H4198 001 0 2021 Advantage Choice (HMO) www.ccokadvantage.com ccare@ccok.com Two W 2nd Street, Suite 100 Tulsa OK 74103 8003333275 9185945202 8007220353 8007220353 8003333275 9185945202 8007220353 8007220353 H4198 003 0 2021 Advantage Premier (HMO) www.ccokadvantage.com ccare@ccok.com Two W 2nd Street, Suite 100 Tulsa OK 74103 8003333275 9185945202 8007220353 8007220353 8003333275 9185945202 8007220353 8007220353 H4198 005 0 2021 Advantage Choice Plus (HMO) www.ccokadvantage.com ccare@ccok.com Two W 2nd Street, Suite 100 Tulsa OK 74103 8003333275 9185945202 8007220353 8007220353 8003333275 9185945202 8007220353 8007220353 H4213 016 1 2021 BlueMedicare Value (PFFS) www.arkansasbluecross.com/medicare P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8772337022 8772337022 711 711 H4213 016 3 2021 BlueMedicare Value (PFFS) www.arkansasbluecross.com/medicare P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8772337022 8772337022 711 711 H4213 016 4 2021 BlueMedicare Value (PFFS) www.arkansasbluecross.com/medicare P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8772337022 8772337022 711 711 H4213 017 1 2021 BlueMedicare Preferred (PFFS) www.arkansasbluecross.com/medicare P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8772337022 8772337022 711 711 This plan does not charge an annual deductible for all drugs. The $420.00 annual deductible only applies to drugs on certain tiers.~ H4213 017 5 2021 BlueMedicare Preferred (PFFS) www.arkansasbluecross.com/medicare P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8772337022 8772337022 711 711 This plan does not charge an annual deductible for all drugs. The $420.00 annual deductible only applies to drugs on certain tiers.~ H4213 017 6 2021 BlueMedicare Preferred (PFFS) www.arkansasbluecross.com/medicare P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8772337022 8772337022 711 711 This plan does not charge an annual deductible for all drugs. The $420.00 annual deductible only applies to drugs on certain tiers.~ H4227 001 0 2021 Keystone First VIP Choice (HMO D-SNP) www.keystonefirstvipchoice.com 200 Stevens Drive Philadelphia PA 19113 8552413648 8552413648 711 711 8004501166 8004501166 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4227 002 0 2021 AmeriHealth Caritas VIP Care (HMO D-SNP) www.amerihealthcaritasvipcare.com 200 Stevens Drive Philadelphia PA 19113 8552413648 8552413648 711 711 8665335490 8665335490 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4232 001 0 2021 American Health Advantage of Utah (HMO I-SNP) ut.amhealthplans.com MemberServices@AmHealthPlans.com 201 Jordan Road, Suite 200 Franklin TN 37067 8555210627 8555210627 711 711 8555210627 8555210627 711 711 H4279 001 0 2021 UPMC for Life Complete Care (HMO D-SNP) www.upmchealthplan.com/snp upmchp@msx.upmc.edu 600 Grant Street Pittsburgh PA 15219 8664058762 8664058762 711 711 8006068648 8006068648 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4279 004 0 2021 UPMC for Life Complete Care (HMO D-SNP) http://www.upmchealthplan.com/snp upmchp@msx.upmc.edu 600 Grant Street Pittsburgh PA 15219 8664058762 8664058762 711 711 8006068648 8006068648 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4304 001 0 2021 Advantage U Signature (PPO) www.AdvantageUMedicare.com PO Box 3117 Scranton PA 18505 8552750374 8552750374 711 711 8552750374 8552750374 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H4304 801 0 2021 Advantage U CY EWGP (PPO) www.AdvantageUMedicare.com PO Box 3117 Scranton PA 18505 8552750374 8552750374 711 711 8552750374 8552750374 711 711 H4304 802 0 2021 Advantage U BY EWGP (PPO) www.AdvantageUMedicare.com PO Box 3117 Scranton PA 18505 8552750374 8552750374 711 711 8552750374 8552750374 711 711 H4304 803 0 2021 Advantage U EWGP MA ONLY (PPO) www.AdvantageUMedicare.com PO Box 3117 Scranton PA 18505 8552750374 8552750374 711 711 8552750374 8552750374 711 711 H4343 001 0 2021 Ascension Complete St. Vincent's Reward (HMO) ascensioncomplete.com PO Box 10420 Van Nuys CA 91410 8449420038 8449420038 711 711 8336230771 8336230771 711 711 This plan does not charge an annual deductible for all drugs. The $390.00 annual deductible only applies to drugs on certain tiers.~ H4343 002 0 2021 Ascension Complete Providence Reward (HMO) ascensioncomplete.com PO Box 10420 Van Nuys CA 91410 8449420038 8449420038 711 711 8336230771 8336230771 711 711 This plan does not charge an annual deductible for all drugs. The $390.00 annual deductible only applies to drugs on certain tiers.~ H4343 003 0 2021 Ascension Complete St. Vincent's Secure (HMO) ascensioncomplete.com PO Box 10420 Van Nuys CA 91410 8449420038 8449420038 711 711 8336230771 8336230771 711 711 H4343 004 0 2021 Ascension Complete Providence Secure (HMO) ascensioncomplete.com PO Box 10420 Van Nuys CA 91410 8449420038 8449420038 711 711 8336230771 8336230771 711 711 H4346 001 0 2021 Anthem MediBlue Value Plus (HMO) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8556790546 8556790546 711 711 8004992793 8004992793 711 711 H4346 005 0 2021 Anthem MediBlue Lung Care (HMO C-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8556790547 8556790547 711 711 8004992793 8004992793 711 711 H4346 006 0 2021 Anthem MediBlue Diabetes Care (HMO C-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8556790547 8556790547 711 711 8004992793 8004992793 711 711 H4346 008 0 2021 Anthem MediBlue Heart Care (HMO C-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8556790547 8556790547 711 711 8004992793 8004992793 711 711 H4346 009 0 2021 Anthem MediBlue StartSmart Plus (HMO) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8556790546 8556790546 711 711 8004992793 8004992793 711 711 H4346 010 0 2021 Anthem MediBlue Care On Site (HMO I-SNP) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8556790548 8556790548 711 711 8004992793 8004992793 711 711 H4346 011 0 2021 Anthem MediBlue Connect Plus (HMO) https://shop.anthem.com/medicare 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8556790546 8556790546 711 711 8004992793 8004992793 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H4346 012 0 2021 Anthem MediBlue Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8556790546 8556790546 711 711 8883460095 8883460095 711 711 H4346 013 0 2021 Anthem MediBlue Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8556790546 8556790546 711 711 8883460095 8883460095 711 711 H4346 014 0 2021 Anthem MediBlue Dual Advantage (HMO D-SNP) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8556790549 8556790549 711 711 8446647175 8446647175 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4346 017 0 2021 Anthem MediBlue Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8556790546 8556790546 711 711 8444691759 8444691759 711 711 H4346 018 0 2021 Anthem MediBlue Coordination Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8556790546 8556790546 711 711 8444691761 8444691761 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H4346 019 0 2021 Anthem MediBlue Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8556790546 8556790546 711 711 8444691759 8444691759 711 711 H4346 022 0 2021 Anthem MediBlue Diabetes Care (HMO C-SNP) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8556790547 8556790547 711 711 8442861319 8442861319 711 711 H4346 023 0 2021 Anthem MediBlue Care On Site (HMO I-SNP) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8556790548 8556790548 711 711 8442096346 8442096346 711 711 H4346 024 0 2021 Anthem MediBlue Plus (HMO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8556790546 8556790546 711 711 8444691759 8444691759 711 711 H4346 025 0 2021 Anthem MediBlue Dual Advantage (HMO D-SNP) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8556790549 8556790549 711 711 8337131303 8337131303 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4346 026 0 2021 Anthem MediBlue Connect (HMO D-SNP) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8556790549 8556790549 711 711 8444691759 8444691759 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4346 802 0 2021 Anthem EGWP MAPD (HMO) caremore.com 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8443096995 8443096995 711 711 8004992793 8004992793 711 711 H4346 805 0 2021 Anthem MediBlue (HMO) www.anthem.com/co/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H4346 809 0 2021 Anthem MediBlue (HMO) www.anthem.com/co/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H4346 811 0 2021 Anthem MediBlue (HMO) www.anthem.com/co/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H4346 812 0 2021 Anthem MediBlue (HMO) www.anthem.com/co/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H4346 823 0 2021 Anthem MediBlue (HMO) www.Anthem.com/Medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H4346 824 0 2021 Anthem MediBlue (HMO) www.Anthem.com/Medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H4346 825 0 2021 Anthem MediBlue (HMO) www.Anthem.com/Medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H4346 826 0 2021 Anthem MediBlue (HMO) www.anthem.com/Medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H4407 004 0 2021 Cigna TotalCare (HMO D-SNP) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8557077116 8557077116 711 711 8006683813 8006683813 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4407 011 0 2021 Cigna Fundamental Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8557077116 8557077116 711 711 8006683813 8006683813 711 711 H4407 026 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8557077116 8557077116 711 711 8006683813 8006683813 711 711 H4407 027 0 2021 Cigna Preferred Plus Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8557077116 8557077116 711 711 8006683813 8006683813 711 711 H4461 004 0 2021 Humana Honor (HMO-POS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H4461 022 0 2021 Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4461 025 0 2021 Humana Gold Plus H4461-025 (HMO-POS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H4461 029 0 2021 Humana Gold Plus H4461-029 (HMO-POS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H4461 030 1 2021 Humana Gold Plus H4461-030 (HMO-POS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H4461 030 2 2021 Humana Gold Plus H4461-030 (HMO-POS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H4461 030 3 2021 Humana Gold Plus H4461-030 (HMO-POS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H4461 031 1 2021 Humana Gold Plus H4461-031 (HMO-POS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H4461 031 2 2021 Humana Gold Plus H4461-031 (HMO-POS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H4461 031 3 2021 Humana Gold Plus H4461-031 (HMO-POS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H4461 034 0 2021 Humana Gold Plus H4461-034 (HMO-POS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H4461 035 0 2021 Humana Gold Plus H4461-035 (HMO-POS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H4461 036 0 2021 Humana Gold Plus H4461-036 (HMO-POS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H4461 037 0 2021 Humana Gold Plus H4461-037 (HMO-POS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H4461 806 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H4461 807 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H4461 810 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H4461 811 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H4490 001 0 2021 American Health Advantage of Missouri (HMO I-SNP) mo.AmHealthPlans.com MemberServices@AmHealthPlans.com 201 Jordan Road, Suite 200 Franklin TN 37067 8442287934 8442287934 711 711 8442287934 8442287934 711 711 H4490 002 0 2021 American Health Advantage Plus of Missouri (HMO I-SNP) mo.AmHealthPlans.com MemberServices@AmHealthPlans.com 201 Jordan Road, Suite 200 Franklin TN 37067 8442287934 8442287934 711 711 8442287934 8442287934 711 711 H4497 001 1 2021 MedMutual Advantage Select (PPO) medmutual.com/planfinder PO BOX 94563 Cleveland OH 44101 8773680081 8773680081 711 711 8009823117 8009823117 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H4497 001 2 2021 MedMutual Advantage Select (PPO) medmutual.com/planfinder PO BOX 94563 Cleveland OH 44101 8773680081 8773680081 711 711 8009823117 8009823117 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H4497 001 3 2021 MedMutual Advantage Select (PPO) medmutual.com/planfinder PO BOX 94563 Cleveland OH 44101 8773680081 8773680081 711 711 8009823117 8009823117 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H4497 002 1 2021 MedMutual Advantage Preferred (PPO) medmutual.com/planfinder PO BOX 94563 Cleveland OH 44101 8773680081 8773680081 711 711 8009823117 8009823117 711 711 This plan does not charge an annual deductible for all drugs. The $55.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H4497 002 2 2021 MedMutual Advantage Preferred (PPO) medmutual.com/planfinder PO BOX 94563 Cleveland OH 44101 8773680081 8773680081 711 711 8009823117 8009823117 711 711 This plan does not charge an annual deductible for all drugs. The $55.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H4497 002 3 2021 MedMutual Advantage Preferred (PPO) medmutual.com/planfinder PO BOX 94563 Cleveland OH 44101 8773680081 8773680081 711 711 8009823117 8009823117 711 711 This plan does not charge an annual deductible for all drugs. The $55.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H4497 003 1 2021 MedMutual Advantage Premium (PPO) medmutual.com/planfinder PO BOX 94563 Cleveland OH 44101 8773680081 8773680081 711 711 8009823117 8009823117 711 711 This plan does not charge an annual deductible for all drugs. The $55.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H4497 003 2 2021 MedMutual Advantage Premium (PPO) medmutual.com/planfinder PO BOX 94563 Cleveland OH 44101 8773680081 8773680081 711 711 8009823117 8009823117 711 711 This plan does not charge an annual deductible for all drugs. The $55.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H4497 003 3 2021 MedMutual Advantage Premium (PPO) medmutual.com/planfinder PO BOX 94563 Cleveland OH 44101 8773680081 8773680081 711 711 8009823117 8009823117 711 711 This plan does not charge an annual deductible for all drugs. The $55.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H4497 801 0 2021 MedMutual Advantage EGWP (Calendar Year) (PPO) medmutual.com/magroup PO BOX 94563 Cleveland OH 44101 8664068777 8664068777 711 711 8008014823 8008014823 711 711 H4497 802 0 2021 MedMutual Advantage EGWP (Non-Calendar Year) (PPO) medmutual.com/magroup PO BOX 94563 Cleveland OH 44101 8664068777 8664068777 711 711 8008014823 8008014823 711 711 H4497 803 0 2021 MedMutual Advantage EGWP (MA-Only) (PPO) medmutual.com/magroup PO BOX 94563 Cleveland OH 44101 8664068777 8664068777 711 711 8008014823 8008014823 711 711 H4506 003 0 2021 WellCare TexanPlus Classic (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H4506 010 0 2021 WellCare TexanPlus Value (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H4506 029 0 2021 WellCare TexanPlus Choice (HMO-POS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H4506 801 0 2021 H4506 - Retiree - MA-PD non-CY (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H4506 806 0 2021 City of Houston Group Retirees (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8665309495 8662302513 711 711 H4506 808 0 2021 H4506 - Retiree - MA (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H4506 810 0 2021 City of Houston Group Retirees (HMO-POS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H4513 009 0 2021 Cigna Fundamental Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826174 8559826174 711 711 8006683813 8006683813 711 711 H4513 026 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826174 8559826174 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $190.00 annual deductible only applies to drugs on certain tiers.~ H4513 027 0 2021 Cigna TotalCare (HMO D-SNP) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826174 8559826174 711 711 8006683813 8006683813 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4513 028 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826174 8559826174 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $190.00 annual deductible only applies to drugs on certain tiers.~ H4513 029 0 2021 Cigna TotalCare (HMO D-SNP) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826174 8559826174 711 711 8006683813 8006683813 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4513 030 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H4513 033 0 2021 Cigna Fundamental Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H4513 034 0 2021 Cigna TotalCare (HMO D-SNP) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4513 035 0 2021 Cigna Primary Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H4513 036 0 2021 Cigna Premier Medicare (HMO-POS) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H4513 037 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H4513 038 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H4513 039 0 2021 Cigna TotalCare (HMO D-SNP) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4513 040 0 2021 Cigna TotalCare (HMO D-SNP) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4513 042 0 2021 Cigna Alliance Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H4513 043 0 2021 Cigna Preferred Plus Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H4513 045 0 2021 Cigna Fundamental Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8557077116 8557077116 711 711 8006683813 8006683813 711 711 H4513 046 1 2021 Cigna Preferred AL Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8557077116 8557077116 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H4513 046 2 2021 Cigna Preferred AL Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8557077116 8557077116 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H4513 047 0 2021 Cigna Preferred Plus Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8557077116 8557077116 711 711 8006683813 8006683813 711 711 H4513 048 0 2021 Cigna Preferred Plus Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8557077116 8557077116 711 711 8006683813 8006683813 711 711 H4513 049 1 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H4513 049 2 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H4513 050 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H4513 051 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H4513 052 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H4513 053 0 2021 Cigna Primary Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H4513 054 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8557077116 8557077116 711 711 8006683813 8006683813 711 711 H4513 055 0 2021 Cigna TotalCare (HMO D-SNP) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8557077116 8557077116 711 711 8006683813 8006683813 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4513 056 1 2021 Cigna TotalCare AL (HMO D-SNP) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8557077116 8557077116 711 711 8006683813 8006683813 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4513 056 2 2021 Cigna TotalCare AL (HMO D-SNP) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8557077116 8557077116 711 711 8006683813 8006683813 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4513 057 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8557077116 8557077116 711 711 8006683813 8006683813 711 711 H4513 059 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H4513 060 1 2021 Cigna TotalCare (HMO D-SNP) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826174 8559826174 711 711 8006683813 8006683813 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4513 060 2 2021 Cigna TotalCare (HMO D-SNP) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826174 8559826174 711 711 8006683813 8006683813 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4513 060 3 2021 Cigna TotalCare (HMO D-SNP) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826174 8559826174 711 711 8006683813 8006683813 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4513 061 1 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826174 8559826174 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $190.00 annual deductible only applies to drugs on certain tiers.~ H4513 061 2 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826174 8559826174 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $190.00 annual deductible only applies to drugs on certain tiers.~ H4513 061 3 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826174 8559826174 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $190.00 annual deductible only applies to drugs on certain tiers.~ H4513 062 0 2021 Cigna Fundamental Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826174 8559826174 711 711 8006683813 8006683813 711 711 H4513 804 0 2021 Cigna Preferred Medicare (HMO) www.cignahealthspring.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H4513 815 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H4513 817 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H4513 819 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H4513 820 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H4513 821 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H4514 007 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H4514 013 1 2021 UnitedHealthcare Dual Complete (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30769 Salt Lake City UT 84130 8888343721 8888343721 711 711 8669444983 8669444983 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4514 013 2 2021 UnitedHealthcare Dual Complete (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30769 Salt Lake City UT 84130 8888343721 8888343721 711 711 8669444983 8669444983 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4514 013 3 2021 UnitedHealthcare Dual Complete (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30769 Salt Lake City UT 84130 8888343721 8888343721 711 711 8669444983 8669444983 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4514 801 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H4514 803 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H4514 806 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H4523 001 0 2021 Aetna Medicare Premier Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H4523 015 0 2021 Aetna Medicare Premier Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H4523 020 0 2021 Aetna Medicare Prime Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H4523 021 0 2021 Aetna Medicare Prime Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H4523 024 0 2021 Aetna Medicare Prime Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H4523 801 0 2021 Aetna Medicare Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H4523 802 0 2021 Aetna Medicare Plan w/Rx (HMO) www.aetnamedicare.com HicksJS@aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H4527 001 0 2021 AARP Medicare Advantage (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8665504736 8665504736 711 711 H4527 002 0 2021 AARP Medicare Advantage (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8665504736 8665504736 711 711 H4527 003 0 2021 UnitedHealthcare Dual Complete Focus (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30769 Salt Lake City UT 84130 8888343721 8888343721 711 711 8664801086 8664801086 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4527 004 0 2021 UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30769 Salt Lake City UT 84130 8888343721 8888343721 711 711 8664801086 8664801086 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4527 005 0 2021 AARP Medicare Advantage (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8665504736 8665504736 711 711 H4527 006 0 2021 UnitedHealthcare Dual Complete (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30769 Salt Lake City UT 84130 8888343721 8888343721 711 711 8664801086 8664801086 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4527 013 0 2021 AARP Medicare Advantage (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8665504736 8665504736 711 711 H4527 015 0 2021 UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30769 Salt Lake City UT 84130 8888343721 8888343721 711 711 8664801086 8664801086 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4527 024 0 2021 AARP Medicare Advantage Patriot (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8665504736 8665504736 711 711 H4527 037 0 2021 AARP Medicare Advantage Plan 1 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8665504736 8665504736 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H4527 039 0 2021 UnitedHealthcare Chronic Complete (HMO C-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H4527 040 0 2021 UnitedHealthcare Chronic Complete (HMO C-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H4527 041 0 2021 UnitedHealthcare Chronic Complete (HMO C-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H4527 042 0 2021 UnitedHealthcare Chronic Complete (HMO C-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H4527 801 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H4527 802 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H4527 803 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H4544 001 0 2021 Peoples Health Choices (PPO) www.peopleshealth.com PHN.member@peopleshealth.com Three Lakeway Center, 3838 N Causeway Blvd, Suite 2200 Metairie LA 70002 8005555757 8005555757 711 711 8002228600 8002228600 8008465277 8008465277 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H4544 002 0 2021 Peoples Health Patriot (PPO) www.peopleshealth.com PHN.member@peopleshealth.com Three Lakeway Center, 3838 N Causeway Blvd, Suite 2200 Metairie LA 70002 8005555757 8005555757 711 711 8002228600 8002228600 8008465277 8008465277 H4556 999 0 2021 Consolidated Assoc Of Railroad Employees Hc H4590 010 0 2021 AARP Medicare Advantage SecureHorizons (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 H4590 012 0 2021 AARP Medicare Advantage SecureHorizons Plan 1 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 H4590 020 0 2021 UnitedHealthcare Dual Complete (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30769 Salt Lake City UT 84130 8888343721 8888343721 711 711 8664802064 8664802064 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4590 022 0 2021 UnitedHealthcare Dual Complete (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30769 Salt Lake City UT 84130 8888343721 8888343721 711 711 8664802064 8664802064 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4590 025 0 2021 AARP Medicare Advantage SecureHorizons (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 This plan does not charge an annual deductible for all drugs. The $355.00 annual deductible only applies to drugs on certain tiers.~ H4590 027 0 2021 AARP Medicare Advantage Patriot (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 H4590 029 0 2021 AARP Medicare Advantage Patriot (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 H4590 033 0 2021 UnitedHealthcare Dual Complete Plan 2 (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30769 Salt Lake City UT 84130 8888343721 8888343721 711 711 8664802064 8664802064 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4590 037 0 2021 UnitedHealthcare Chronic Complete (HMO C-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8668462762 8668462762 711 711 H4590 041 0 2021 AARP Medicare Advantage SecureHorizons Plan 2 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 H4590 042 0 2021 AARP Medicare Advantage (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H4590 043 0 2021 AARP Medicare Advantage (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 H4590 044 0 2021 UnitedHealthcare Medicare Advantage Ally (HMO-POS C-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8009509355 8009509355 711 711 H4590 801 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H4590 803 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H4590 804 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H4604 003 0 2021 AARP Medicare Advantage Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H4604 005 0 2021 AARP Medicare Advantage Patriot (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H4604 011 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H4604 012 0 2021 AARP Medicare Advantage (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H4604 013 0 2021 AARP Medicare Advantage Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H4604 014 0 2021 AARP Medicare Advantage Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H4604 015 0 2021 AARP Medicare Advantage Focus (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H4604 016 0 2021 AARP Medicare Advantage (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H4604 017 0 2021 UnitedHealthcare Medicare Advantage Assist (HMO C-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H4604 018 0 2021 AARP Medicare Advantage Walgreens (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H4604 019 0 2021 AARP Medicare Advantage Patriot (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H4604 020 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H4604 801 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H4604 803 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H4604 805 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H4605 001 0 2021 Regence Valiance (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8005418981 8005418981 711 711 H4605 002 0 2021 Regence MedAdvantage + Rx Classic (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8005418981 8005418981 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H4605 004 0 2021 Regence MedAdvantage + Rx Enhanced (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8005418981 8005418981 711 711 H4605 007 0 2021 Regence MedAdvantage + Rx Primary (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8005418981 8005418981 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H4605 008 0 2021 Regence MedAdvantage + Rx Primary (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8005418981 8005418981 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H4605 009 0 2021 Regence MedAdvantage + Rx Classic (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8005418981 8005418981 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H4605 801 0 2021 Regence MedAdvantage (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883198904 8883198904 711 711 8883198904 8883198904 711 711 H4605 802 0 2021 Regence MedAdvantage + Rx (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883198904 8883198904 711 711 8883198904 8883198904 711 711 H4605 803 0 2021 Regence MedAdvantage + Rx 02 (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883198904 8883198904 711 711 8883198904 8883198904 711 711 H4605 804 0 2021 Regence MedAdvantage + Rx 03 (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883198904 8883198904 711 711 8883198904 8883198904 711 711 H4623 001 0 2021 Humana Gold Plus H4623-001 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H4623 002 0 2021 Humana Community HMO H4623-002 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H4624 001 0 2021 Zing Choice IL (HMO) myzinghealth.com member.services@myzinghealth.com 303 West Madison Street, Suite 800 Chicago IL 60606 8669464458 8669464458 711 711 8669464458 8669464458 711 711 H4624 002 0 2021 Zing Open Access IL (HMO-POS) myzinghealth.com member.services@myzinghealth.com 303 West Madison Street, Suite 800 Chicago IL 60606 8669464458 8669464458 711 711 8669464458 8669464458 711 711 H4624 003 0 2021 Zing Choice IN (HMO) myzinghealth.com member.services@myzinghealth.com 303 West Madison Street, Suite 800 Chicago IL 60606 8669464458 8669464458 711 711 8669464458 8669464458 711 711 H4624 004 0 2021 Zing Choice IN (HMO) myzinghealth.com member.services@myzinghealth.com 303 West Madison Street, Suite 800 Chicago IL 60606 8669464458 8669464458 711 711 8669464458 8669464458 711 711 H4624 005 0 2021 Zing Choice IN (HMO) myzinghealth.com member.services@myzinghealth.com 303 West Madison Street, Suite 800 Chicago IL 60606 8669464458 8669464458 711 711 8669464458 8669464458 711 711 H4624 006 0 2021 Zing Choice MI (HMO) myzinghealth.com member.services@myzinghealth.com 303 West Madison Street, Suite 800 Chicago IL 60606 8669464458 8669464458 711 711 8669464458 8669464458 711 711 H4624 007 0 2021 Zing Open Access MI (HMO-POS) myzinghealth.com member.services@myzinghealth.com 303 West Madison Street, Suite 800 Chicago IL 60606 8669464458 8669464458 711 711 8669464458 8669464458 711 711 H4624 010 0 2021 Zing Essential Wellness IL (HMO C-SNP) myzinghealth.com member.services@myzinghealth.com 303 West Madison Street, Suite 800 Chicago IL 60606 8669464458 8669464458 711 711 8669464458 8669464458 711 711 H4624 011 0 2021 Zing Essential Wellness IN (HMO C-SNP) myzinghealth.com member.services@myzinghealth.com 303 West Madison Street, Suite 800 Chicago IL 60606 8669464458 8669464458 711 711 8669464458 8669464458 711 711 H4624 012 0 2021 Zing Essential Wellness MI (HMO C-SNP) myzinghealth.com member.services@myzinghealth.com 303 West Madison Street, Suite 800 Chicago IL 60606 8669464458 8669464458 711 711 8669464458 8669464458 711 711 H4624 801 0 2021 Zing EGWP CY (HMO) myzinghealth.com member.services@myzinghealth.com 303 West Madison Street, Suite 800 Chicago IL 60606 8669464458 8669464458 711 711 8669464458 8669464458 711 711 H4624 802 0 2021 Zing EGWP NCY (HMO) myzinghealth.com member.services@myzinghealth.com 303 West Madison Street, Suite 800 Chicago IL 60606 8669464458 8669464458 711 711 8669464458 8669464458 711 711 H4624 803 0 2021 Zing EGWP MA Only CY (HMO) myzinghealth.com member.services@myzinghealth.com 303 West Madison Street, Suite 800 Chicago IL 60606 8669464458 8669464458 711 711 8669464458 8669464458 711 711 H4624 804 0 2021 Zing EGWP MA Only NCY (HMO) myzinghealth.com member.services@myzinghealth.com 303 West Madison Street, Suite 800 Chicago IL 60606 8669464458 8669464458 711 711 8669464458 8669464458 711 711 H4652 999 0 2021 Union Pacific Railroad Employes Health Systems www.uphealth.com H4675 001 0 2021 Braven Medicare Plus (HMO) www.bravenhealth.com 3 Penn Plaza East, PP- 12F Newark NJ 07105 8337131313 8337131313 711 711 8332728360 8332728360 711 711 H4675 801 0 2021 Braven Medicare Access Group (HMO-POS) www.bravenhealth.com 3 Penn Plaza East, PP- 12F Newark NJ 07105 9731231234 711 711 8001231234 9731231234 711 711 H4675 802 0 2021 Braven Medicare Access Group w/Rx (HMO-POS) www.bravenhealth.com 3 Penn Plaza East, PP- 12F Newark NJ 07105 9731231234 711 711 8001231234 9731231234 711 711 H4675 803 0 2021 Braven Medicare Access Group w/Rx Value (HMO-POS) www.bravenhealth.com 3 Penn Plaza East, PP- 12F Newark NJ 07105 9731231234 711 711 8001231234 9731231234 711 711 H4676 001 0 2021 Troy Medicare (HMO) www.troymedicare.com contact@troymedicare.com P.O. Box 30516 Charlotte NC 28230 8884948769 8884948769 711 711 8884948769 8884948769 711 711 H4676 002 0 2021 Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) www.troymedicare.com contact@troymedicare.com P.O. Box 30516 Charlotte NC 28230 8884948769 8884948769 711 711 8884948769 8884948769 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4699 001 0 2021 WellCare Premier (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H4699 002 0 2021 WellCare Absolute (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H4699 003 0 2021 WellCare Imperial (PPO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4709 001 0 2021 Bright Advantage Health Dollars (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H4709 003 0 2021 Bright Advantage Health Dollars (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H4709 011 0 2021 Bright Advantage Health Dollars (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H4709 024 0 2021 Bright Advantage Health Dollars (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H4709 025 0 2021 Bright Advantage Health Dollars (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H4711 001 0 2021 Aetna Medicare Premier Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H4711 002 0 2021 Aetna Medicare Prime Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H4711 005 0 2021 Aetna Medicare Premier Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H4711 006 0 2021 Aetna Medicare Elite Prime (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 Lexington KY 40512 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H4711 007 0 2021 Aetna Medicare Elite Prime (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 Lexington KY 40512 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H4711 008 0 2021 Aetna Medicare Prime 1 (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 Lexington KY 40512 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H4711 009 0 2021 Aetna Medicare Prime 1 (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 Lexington KY 40512 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H4711 010 0 2021 Aetna Medicare Eagle Prime (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 Lexington KY 40512 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H4711 011 0 2021 Aetna Medicare Prime Plan (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4711 801 0 2021 Aetna Medicare Plan (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H4711 802 0 2021 Aetna Medicare Plan w/Rx (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H4754 004 0 2021 PacificSource Medicare Explorer Rx 4 (PPO) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Avenue Bend OR 97701 8888633637 5413855315 8007352900 8007352900 8888633637 5413855315 8007352900 8007352900 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H4754 006 0 2021 PacificSource Medicare Explorer 6 (PPO) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Avenue Bend OR 97701 8888633637 2084334612 8007352900 8007352900 8888633637 2084334612 8007352900 8007352900 H4754 007 0 2021 PacificSource Medicare Explorer Rx 7 (PPO) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Avenue Bend OR 97701 8888633637 5412253771 8007352900 8007352900 8888633637 5412253771 8007352900 8007352900 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H4754 008 0 2021 PacificSource Medicare Explorer 8 (PPO) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Avenue Bend OR 97701 8888633637 5412253771 8007352900 8007352900 8888633637 5412253771 8007352900 8007352900 H4754 009 0 2021 PacificSource Medicare Explorer Rx 9 (PPO) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Avenue Bend OR 97701 8888633637 2084334612 8007352900 8007352900 8888633637 2084334612 8007352900 8007352900 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H4754 011 0 2021 PacificSource Medicare Explorer Rx 11 (PPO) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Avenue Bend OR 97701 8888633637 2084334612 8007352900 8007352900 8888633637 2084334612 8007352900 8007352900 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H4754 012 0 2021 PacificSource Medicare Explorer 12 (PPO) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Avenue Bend OR 97701 8888633637 2084334612 8007352900 8007352900 8888633637 2084334612 8007352900 8007352900 H4754 016 0 2021 PacificSource Medicare Explorer 16 (PPO) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Ave Bend OR 97701 8888633637 5413855315 8007352900 8007352900 8888633637 5413855315 8007352900 8007352900 H4754 017 0 2021 PacificSource Medicare Explorer Rx 17 (PPO) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Ave Bend OR 97701 8888633637 5413855315 8007352900 8007352900 8888633637 5413855315 8007352900 8007352900 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H4754 801 0 2021 PacificSource Medicare Explorer 801 (PPO) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Avenue Bend OR 97701 8888633637 5413855315 8007352900 8007352900 8888633637 5413855315 8007352900 8007352900 H4754 802 0 2021 PacificSource Medicare Explorer Rx 802 (PPO) www.Medicare.PacificSource.com MedicareCS@PacificSource.com 2965 NE Conners Avenue Bend OR 97701 8888633637 5413855315 8007352900 8007352900 8888633637 5413855315 8007352900 8007352900 H4829 002 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 H4829 003 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H4829 004 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448084553 8448084553 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H4835 001 0 2021 Aetna Medicare Prime Plus Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H4835 002 0 2021 Aetna Medicare Premier Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H4835 003 0 2021 Aetna Medicare Premier Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H4835 004 0 2021 Aetna Medicare Premier Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H4835 005 0 2021 Aetna Medicare Premier Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H4835 006 0 2021 Aetna Medicare Premier Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H4835 801 0 2021 Aetna Medicare Plan (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H4835 802 0 2021 Aetna Medicare Plan w/Rx (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H4847 001 0 2021 WellCare Elite (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H4847 002 0 2021 WellCare Elite (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H4847 003 0 2021 WellCare Plus (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H4847 004 0 2021 WellCare Access (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4847 005 0 2021 WellCare Compass (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H4847 006 0 2021 WellCare Patriot (HMO-POS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H4853 001 0 2021 Bright Advantage (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H4853 002 0 2021 Bright Advantage Assist (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H4853 014 0 2021 Bright Advantage Plus (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H4868 002 0 2021 WellCare Liberty (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4868 003 0 2021 WellCare Patriot (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H4868 004 0 2021 WellCare Access (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4868 010 0 2021 WellCare Preferred (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H4868 014 0 2021 WellCare Access (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4868 016 0 2021 WellCare Compass (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H4868 018 0 2021 WellCare Value (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H4868 019 0 2021 WellCare Value (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H4868 020 0 2021 WellCare Choice (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H4868 022 0 2021 WellCare Element (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H4875 016 1 2021 PriorityMedicare Merit (PPO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 H4875 016 2 2021 PriorityMedicare Merit (PPO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 H4875 016 3 2021 PriorityMedicare Merit (PPO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 H4875 016 4 2021 PriorityMedicare Merit (PPO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 H4875 016 5 2021 PriorityMedicare Merit (PPO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 H4875 017 1 2021 PriorityMedicare Select (PPO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 H4875 017 2 2021 PriorityMedicare Select (PPO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 H4875 017 3 2021 PriorityMedicare Select (PPO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 H4875 017 4 2021 PriorityMedicare Select (PPO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 H4875 017 5 2021 PriorityMedicare Select (PPO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 H4875 018 1 2021 PriorityMedicare Ideal (PPO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 This plan does not charge an annual deductible for all drugs. The $125.00 annual deductible only applies to drugs on certain tiers.~ H4875 018 2 2021 PriorityMedicare Ideal (PPO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 This plan does not charge an annual deductible for all drugs. The $125.00 annual deductible only applies to drugs on certain tiers.~ H4875 018 3 2021 PriorityMedicare Ideal (PPO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 This plan does not charge an annual deductible for all drugs. The $125.00 annual deductible only applies to drugs on certain tiers.~ H4875 018 4 2021 PriorityMedicare Ideal (PPO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 This plan does not charge an annual deductible for all drugs. The $125.00 annual deductible only applies to drugs on certain tiers.~ H4875 018 5 2021 PriorityMedicare Ideal (PPO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 This plan does not charge an annual deductible for all drugs. The $125.00 annual deductible only applies to drugs on certain tiers.~ H4875 020 1 2021 PriorityMedicare Edge (PPO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 H4875 020 2 2021 PriorityMedicare Edge (PPO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 H4875 020 3 2021 PriorityMedicare Edge (PPO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 H4875 021 1 2021 PriorityMedicare Compass (PPO) www.prioritymedicare.com 1231 East Beltline Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H4875 021 2 2021 PriorityMedicare Compass (PPO) www.prioritymedicare.com 1231 East Beltline Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H4875 022 1 2021 PriorityMedicare Vital (PPO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H4875 022 2 2021 PriorityMedicare Vital (PPO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H4875 022 5 2021 PriorityMedicare Vital (PPO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8883841695 6164648850 711 711 8883896648 6164648820 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H4875 803 0 2021 PriorityMedicare PPO EG Non-Calendar Year (PPO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8887729596 6164648850 711 711 8883896648 6164648820 711 711 H4875 804 0 2021 PriorityMedicare PPO EG Calendar Year (PPO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8887729596 6164648850 711 711 8883896648 6164648820 711 711 H4875 805 0 2021 PriorityMedicare PPO No RX EGWP Calendar (PPO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8887729596 6164648850 711 711 8883896648 6164648820 711 711 H4875 806 0 2021 PriorityMedicare PPO No RX EGWP Non-Calendar (PPO) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8887729596 6164648850 711 711 8883896648 6164648820 711 711 H4882 001 0 2021 HealthPartners Journey Stride (PPO) healthpartners.com/medicare 8170 33rd Avenue South Bloomington MN 55425 8443638979 9528835090 711 711 8662338734 9528836655 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H4882 002 0 2021 HealthPartners Journey Pace (PPO) healthpartners.com/medicare 8170 33rd Avenue South Bloomington MN 55425 8443638979 9528835090 711 711 8662338734 9528836655 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H4882 003 0 2021 HealthPartners Journey Steady (PPO) healthpartners.com/medicare 8170 33rd Avenue South Bloomington MN 55425 8443638979 9528835090 711 711 8662338734 9528836655 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H4882 004 0 2021 HealthPartners Robin Birch (PPO) healthpartners.com/medicare 8170 33rd Avenue South Bloomington MN 55425 8332567046 8332567046 711 711 8662338734 8662338734 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H4882 005 0 2021 HealthPartners Robin Maple (PPO) healthpartners.com/medicare 8170 33rd Avenue South Bloomington MN 55425 8332567046 8332567046 711 711 8662338734 8662338734 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H4882 006 0 2021 HealthPartners Journey Dash (PPO) healthpartners.com/medicare 8170 33rd Avenue South Bloomington MN 55425 8443638979 9528835090 711 711 8662338734 9528836655 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H4882 801 0 2021 HealthPartners Group MAPD Calendar Year (PPO) healthpartners.com/medicare 8170 33rd Avenue South Bloomington MN 55425 8443638979 9528835090 711 711 8662338734 9528836655 711 711 H4882 803 0 2021 HealthPartners Group MA Only (PPO) healthpartners.com/medicare 8170 33rd Avenue South Bloomington MN 55425 8443638979 9528835090 711 711 8662338734 9528836655 711 711 H4882 804 0 2021 HealthPartners Group II MAPD Calendar Year (PPO) healthpartners.com/medicare 8170 33rd Avenue South Bloomington MN 55425 8443638979 9528835090 711 711 8662338734 9528836655 711 711 H4882 805 0 2021 HealthPartners Group II MA Only (PPO) healthpartners.com/medicare 8170 33rd Avenue South Bloomington MN 55425 8443638979 9528835090 711 711 8662338734 9528836655 711 711 H4906 999 0 2021 C and O Employees' Hospital Association www.coeha.com H4909 014 0 2021 Anthem MediBlue Access (PPO) shop.anthem.com/medicare P.O. Box 14046 Roanoke VA 24038 8556790550 8556790550 711 711 8668279866 8668279866 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H4909 015 0 2021 Anthem MediBlue Access (PPO) shop.anthem.com/medicare 1351 William Howard Taft, CN14B-818 Cincinnati OH 45206 8556790550 8556790550 711 711 8556907798 8556907798 711 711 H4909 016 0 2021 Anthem MediBlue Access Basic (PPO) shop.anthem.com/medicare 1351 William Howard Taft, CN14B-818 Cincinnati OH 45206 8556790550 8556790550 711 711 8556907798 8556907798 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H4909 018 0 2021 Anthem MediBlue Dual Access (PPO D-SNP) shop.anthem.com/medicare P.O. Box 14046 Roanoke VA 24038 8556790551 8556790551 711 711 8337131081 8337131081 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4909 804 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H4909 805 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H4909 806 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H4909 811 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H4909 812 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H4909 816 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H4909 817 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H4909 818 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H4922 003 0 2021 AgeWell New York FeelWell (HMO D-SNP) www.agewellnewyork.com 1991 Marcus Ave, Suite M201 Lake Success NY 11042 8662373210 8662373210 8006621220 8006621220 8662373210 8662373210 8006621220 8006621220 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4922 004 0 2021 AgeWell New York CareWell (HMO I-SNP) www.agewellnewyork.com 1991 Marcus Ave, Suite M201 Lake Success NY 11042 8662373210 8662373210 8006621220 8006621220 8662373210 8662373210 8006621220 8006621220 H4922 010 0 2021 AgeWell New York Advantage Plus (HMO D-SNP) www.agewellnewyork.com 1991 Marcus Ave, Suite M201 Lake Success NY 11042 8662373210 8662373210 8006621220 8006621220 8662373210 8662373210 8006621220 8006621220 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4922 011 0 2021 AgeWell New York LiveWell (HMO) www.agewellnewyork.com 1991 Marcus Ave, Suite M201 Lake Success NY 11042 8662373210 8662373210 8006621220 8006621220 8662373210 8662373210 8006621220 8006621220 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H4931 001 0 2021 Banner - University Care Advantage (HMO D-SNP) www.banneruca.com 2701 E. Elvira Rd. Tucson AZ 85756 8778743938 5208743938 711 711 8778743930 5208743930 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4931 006 0 2021 Banner - University Care Advantage (HMO D-SNP) www.banneruca.com 2701 E. Elvira Rd. Tucson AZ 85756 8778743938 5208743938 711 711 8778743930 5208743930 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4931 007 0 2021 Banner - University Care Advantage (HMO D-SNP) www.banneruca.com 2701 E. Elvira Rd. Tucson AZ 85756 8778743938 5208743938 711 711 8778743930 5208743930 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4931 008 0 2021 Banner - University Care Advantage (HMO D-SNP) www.banneruca.com 2701 E. Elvira Rd. Tucson AZ 85756 8778743938 5208743938 711 711 8778743930 5208743930 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4931 013 0 2021 Banner - University Care Advantage (HMO D-SNP) www.banneruca.com 2701 E. Elvira Rd. Tucson AZ 85756 8778743938 5208743938 711 711 8778743930 5208743930 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4931 014 0 2021 Banner - University Care Advantage (HMO D-SNP) www.banneruca.com 2701 E. Elvira Rd. Tucson AZ 85756 8778743938 5208743938 711 711 8778743930 5208743930 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4931 015 0 2021 Banner - University Care Advantage (HMO D-SNP) www.banneruca.com 2701 E. Elvira Rd. Tucson AZ 85756 8778743938 5208743938 711 711 8778743930 5208743930 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4931 016 0 2021 Banner - University Care Advantage (HMO D-SNP) www.banneruca.com 2701 E. Elvira Rd. Tucson AZ 85756 8778743938 5208743938 711 711 8778743930 5208743930 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4937 001 0 2021 Blue Shield Inspire (PPO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland HIlls CA 91367 8885108074 8885108074 711 711 8007764466 8007764466 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H4937 801 0 2021 Blue Shield Medicare (PPO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland HIlls CA 91367 8007764466 8007764466 711 711 8007764466 8007764466 711 711 H4937 802 0 2021 Blue Shield Medicare (PPO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland HIlls CA 91367 8007764466 8007764466 711 711 8007764466 8007764466 711 711 H4961 001 0 2021 My Choice (PPO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H4961 002 0 2021 My Choice (PPO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H4961 003 0 2021 My Choice (PPO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H4961 004 0 2021 My Choice (PPO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H4961 006 0 2021 Balance (PPO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H4961 801 0 2021 Retiree Options (PPO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H4961 802 0 2021 Retiree Options (PPO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 1 3237287232 6 711 711 8666342247 3237287232 5550 711 711 H4982 001 0 2021 Aetna Medicare Plus Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H4982 002 0 2021 Aetna Medicare Plus Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H4982 003 0 2021 Aetna Medicare Plus Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H4982 004 0 2021 Aetna Medicare Plus Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H4982 005 0 2021 Aetna Medicare Plus Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H4982 006 0 2021 Aetna Medicare Plus Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H4982 007 0 2021 Aetna Medicare Plus Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H4982 008 0 2021 Aetna Medicare Preferred Plan (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4982 009 0 2021 Aetna Medicare Preferred Plan (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H4982 010 0 2021 Aetna Medicare Plus Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H4982 011 0 2021 Aetna Medicare Plus Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H4982 012 0 2021 Aetna Medicare Plus Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H4982 013 0 2021 Aetna Medicare Eagle Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H4982 015 0 2021 Aetna Medicare Plus Plan 2 (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $220.00 annual deductible only applies to drugs on certain tiers.~ H4982 801 0 2021 Aetna Medicare Plan (HMO) www.aetnamedicare.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H4982 802 0 2021 Aetna Medicare Plan w/Rx (HMO) www.aetnamedicare.com HicksJS@aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H5008 001 0 2021 UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H5008 002 0 2021 UnitedHealthcare Dual Complete (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8669444984 8669444984 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5008 010 0 2021 UnitedHealthcare Dual Complete (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8662630627 8662630627 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5008 011 0 2021 UnitedHealthcare Dual Complete (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8662631164 8662631164 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5009 001 0 2021 Regence Valiance (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8005418981 8005418981 711 711 H5009 002 0 2021 Regence MedAdvantage + Rx Enhanced (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8005418981 8005418981 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5009 008 0 2021 Regence MedAdvantage + Rx Classic (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8005418981 8005418981 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5009 009 0 2021 Regence MedAdvantage + Rx Primary (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8005418981 8005418981 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H5009 801 0 2021 Regence MedAdvantage (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883198904 8883198904 711 711 8883198904 8883198904 711 711 H5009 802 0 2021 Regence MedAdvantage + Rx (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883198904 8883198904 711 711 8883198904 8883198904 711 711 H5009 803 0 2021 Regence MedAdvantage + Rx 02 (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883198904 8883198904 711 711 8883198904 8883198904 711 711 H5009 804 0 2021 Regence MedAdvantage + Rx 03 (PPO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883198904 8883198904 711 711 8883198904 8883198904 711 711 H5010 001 0 2021 Asuris Esteem (PPO) www.asuris.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693172 8883693172 711 711 8005418981 8005418981 711 711 H5010 002 0 2021 Asuris TruAdvantage + Rx Classic (PPO) www.asuris.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693172 8883693172 711 711 8005418981 8005418981 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5010 004 0 2021 Asuris TruAdvantage + Rx Enhanced (PPO) www.asuris.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693172 8883693172 711 711 8005418981 8005418981 711 711 H5010 007 0 2021 Asuris TruAdvantage + Rx Primary (PPO) www.asuris.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693172 8883693172 711 711 8005418981 8005418981 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H5015 001 0 2021 Texas Independence Health Plan, Inc. (HMO I-SNP) www.txindependencehealthplan.com info@pphealthplan.com 785 Elkridge Landing Rd, Suite 300 Linthicum Heights MD 21090 8004059681 8004059681 711 711 8004059681 8004059681 711 711 H5042 009 0 2021 CDPHP Vital Rx (PPO) www.cdphp.com info@cdphp.com 500 patroon creek blvd Albany NY 12206 8885194455 5186413400 711 711 8882486522 5186413950 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H5042 011 0 2021 CDPHP Flex Rx (PPO) http://www.CDPHP.com/medicare info@cdphp.com 500 patroon creek blvd Albany NY 12206 8885194455 5186413400 711 711 8882486522 5186413950 711 711 H5042 012 0 2021 CDPHP Flex (PPO) http://www.CDPHP.com/medicare info@cdphp.com 500 patroon creek blvd Albany NY 12206 8885194455 5186413400 711 711 8882486522 5186413950 711 711 H5042 801 0 2021 CDPHP Group Medicare Rx (PPO) http://www.CDPHP.com/medicare info@cdphp.com 500 Patroon Creek Blvd. Albany NY 12206 8885194455 5186413400 711 711 8882486522 5186413950 711 711 H5042 802 0 2021 CDPHP Group Medicare Rx (PPO) http://www.CDPHP.com/medicare info@cdphp.com 500 Patroon Creek Blvd. Albany NY 12206 8885194455 5186413400 711 711 8882486522 5186413950 711 711 H5042 803 0 2021 CDPHP Group Medicare (PPO) http://www.CDPHP.com/medicare info@cdphp.com 500 Patroon Creek Blvd. Albany NY 12206 8885194455 5186413400 711 711 8882486522 5186413950 711 711 H5050 001 0 2021 Kaiser Permanente Medicare Advantage Basic (HMO) kp.org/wa/medicare 1300 SW 27th St. Renton WA 98057 8005982296 8005982296 711 711 8889014600 2066304600 711 711 H5050 004 0 2021 Kaiser Permanente Medicare Advantage Optimal (HMO) kp.org/wa/medicare 1300 SW 27th St. Renton WA 98057 8005982296 8005982296 711 711 8889014600 2066304600 711 711 H5050 009 0 2021 Kaiser Permanente Medicare Advantage Essential (HMO) kp.org/wa/medicare 1300 SW 27th St. Renton WA 98057 8005982296 8005982296 711 711 8889014600 2066304600 711 711 H5050 013 0 2021 Kaiser Permanente Medicare Advantage Vital (HMO) kp.org/wa/medicare 1300 SW 27th St. Renton WA 98057 8005982296 8005982296 711 711 8889014600 2066304600 711 711 H5050 017 0 2021 Kaiser Permanente Medicare Advantage Harbor (HMO) kp.org/wa/medicare 1300 SW 27th St. Renton WA 98057 8005982296 8005982296 711 711 8889014600 2066304600 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5050 019 0 2021 Kaiser Permanente Medicare Advantage Columbia (HMO) kp.org/wa/medicare 1300 SW 27th St. Renton WA 98057 8005982296 8005982296 711 711 8889014600 2066304600 711 711 H5050 021 0 2021 Kaiser Permanente Medicare Advantage Centennial (HMO) kp.org/wa/medicare 1300 SW 27th St. Renton WA 98057 8005982296 8005982296 711 711 8889014600 2066304600 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5050 022 0 2021 Kaiser Permanente Medicare Advantage Key (HMO) kp.org/wa/medicare 1300 SW 27th St. Renton WA 98057 8005982296 8005982296 711 711 8889014600 2066304600 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H5050 023 0 2021 Kaiser Permanente Medicare Advantage Anchor (HMO) kp.org/wa/medicare 1300 SW 27th St. Renton WA 98057 8005982296 8005982296 711 711 8889014600 2066304600 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5050 801 0 2021 Kaiser Permanente Medicare Advantage Group [AB] (HMO) kp.org/wa/medicare 1300 SW 27th St. Renton WA 98057 8005982296 8005982296 711 711 8889014600 2066304600 711 711 H5050 802 0 2021 Kaiser Permanente Medicare Advantage Group [ABD] (HMO) kp.org/wa/medicare 1300 SW 27th St. Renton WA 98057 8005982296 8005982296 711 711 8889014600 2066304600 711 711 H5087 001 0 2021 WellCare Freedom (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com PO Box 31685, Attn: Pre Enrollment Tampa FL 33631 8665270056 8665270056 711 711 8669993945 8669993945 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5087 002 0 2021 WellCare Plus (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com PO Box 31685, Attn: Pre Enrollment Tampa FL 33631 8665270056 8665270056 711 711 8669993945 8669993945 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5087 005 0 2021 WellCare Best (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com PO Box 31685, Attn: Pre Enrollment Tampa FL 33631 8665270056 8665270056 711 711 8669993945 8669993945 711 711 H5087 016 0 2021 WellCare Best (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com PO Box 31685, Attn: Pre Enrollment Tampa FL 33631 8665270056 8665270056 711 711 8669993945 8669993945 711 711 H5087 017 0 2021 WellCare Plus (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com PO Box 31685, Attn: Pre Enrollment Tampa FL 33631 8665270056 8665270056 711 711 8669993945 8669993945 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5087 024 0 2021 WellCare Best (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com PO Box 31685, Attn: Pre Enrollment Tampa FL 33631 8665270056 8665270056 711 711 8669993945 8669993945 711 711 H5087 025 0 2021 WellCare Dividend (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com PO Box 31685, Attn: Pre Enrollment Tampa FL 33631 8665270056 8665270056 711 711 8669993945 8669993945 711 711 H5087 026 0 2021 WellCare Best (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com PO Box 31685, Attn: Pre Enrollment Tampa FL 33631 8665270056 8665270056 711 711 8669993945 8669993945 711 711 H5106 013 0 2021 Freedom Blue PPO Standard (PPO) medicare.highmark.com Chris.Scarnati@highmark.com PO Box 1908 Parkersburg WV 26102 8667391899 8667391899 711 711 8884594020 8884594020 711 711 H5106 029 1 2021 Freedom Blue PPO Distinct (PPO) medicare.highmark.com Chris.Scarnati@highmark.com PO Box 1908, P.O. Box 1068 Parkersburg WV 26102 8667391899 8667391899 711 711 8884594020 8884594020 711 711 H5106 029 2 2021 Freedom Blue PPO Distinct (PPO) medicare.highmark.com Chris.Scarnati@highmark.com PO Box 1908, P.O. Box 1068 Parkersburg WV 26102 8667391899 8667391899 711 711 8884594020 8884594020 711 711 H5106 806 0 2021 Freedom Blue PPO MAPD WV NON-CALENDAR (PPO) medicare.highmark.com Chris.Scarnati@highmark.com PO Box 1908 Parkersburg WV 26102 8667391899 8667391899 711 711 8884594020 8884594020 711 711 H5106 807 0 2021 Freedom Blue PPO MA WV Calendar (PPO) medicare.highmark.com Chris.Scarnati@highmark.com PO Box 1908 Parkersburg WV 26102 8667391899 8667391899 711 711 8884594020 8884594020 711 711 H5106 808 0 2021 Freedom Blue PPO MAPD WV CALENDAR (PPO) medicare.highmark.com Chris.Scarnati@highmark.com PO Box 1908 Parkersburg WV 26102 8667391899 8667391899 711 711 8884594020 8884594020 711 711 H5117 003 0 2021 Allwell Medicare (HMO) allwell.louisianahealthconnect.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661572 8557661572 711 711 H5117 004 0 2021 Allwell Dual Medicare (HMO D-SNP) allwell.louisianahealthconnect.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8335410767 8335410767 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5117 005 0 2021 Allwell Dual Medicare Essentials (HMO D-SNP) allwell.louisianahealthconnect.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8335410767 8335410767 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5117 006 0 2021 Allwell Medicare Simple (HMO) allwell.louisianahealthconnect.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661572 8557661572 711 711 H5117 801 0 2021 Allwell Group (HMO) allwell.louisianahealthconnect.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661572 8557661572 711 711 H5117 802 0 2021 Allwell Group (HMO) allwell.louisianahealthconnect.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661572 8557661572 711 711 H5117 803 0 2021 Allwell Group (HMO) allwell.louisianahealthconnect.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661572 8557661572 711 711 H5126 001 0 2021 Oscar Easy Care (HMO) www.hioscar.com/medicare PO Box 62045 Phoenix AZ 85082 8556722710 8556722710 711 711 8556722720 8556722720 711 711 H5140 001 0 2021 BlueJourney (PPO) azbluemedicare.com ContactAdvantage@azblue.com 13985 W. Grand Ave, Suite 200 Surprise AZ 85374 8004220761 8004220761 711 711 8004468331 8004468331 711 711 H5140 002 0 2021 BlueJourney (PPO) azbluemedicare.com ContactAdvantage@azblue.com 13985 W. Grand Ave, Suite 200 Surprise AZ 85374 8004220761 8004220761 711 711 8004468331 8004468331 711 711 H5141 001 0 2021 Clover Health Choice (PPO) www.cloverhealth.com 30 Montgomery Street, 15th Floor Jersey City NJ 07302 8884665044 2014259257 711 711 8887781478 2014149690 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~ H5141 004 0 2021 Clover Health Choice (PPO) www.cloverhealth.com 30 Montgomery Street, 15th Floor Jersey City NJ 07302 8884665044 2014259257 711 711 8887781478 2014149690 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~ H5141 007 0 2021 Clover Health Choice Value (PPO) www.cloverhealth.com 30 Montgomery Street, 15th Floor Jersey City NJ 07302 8884665044 2014259257 711 711 8887781478 2014149690 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5141 025 0 2021 Clover Health Choice (PPO) www.cloverhealth.com 30 Montgomery Street, 15th Floor Jersey City NJ 07302 8884665044 2105263962 711 711 8887781478 2105263962 711 711 H5141 026 0 2021 Clover Health Choice (PPO) www.cloverhealth.com 30 Montgomery Street, 15th Floor Jersey City NJ 07302 8884665044 9128053269 711 711 8887781478 9128053271 711 711 H5141 032 0 2021 Clover Health Choice (PPO) www.cloverhealth.com 30 Montgomery Street, 15th Floor Jersey City NJ 07302 8884665044 2014259257 711 711 8887781478 2014149690 711 711 H5141 033 0 2021 Clover Health Choice (PPO) www.cloverhealth.com 30 Montgomery Street, 15th Floor Jersey City NJ 07302 8884665044 2014259257 711 711 8887781478 2014149690 711 711 H5141 034 0 2021 Clover Health Choice Value (PPO) www.cloverhealth.com 30 Montgomery Street, 15th Floor Jersey City NJ 07302 8884665044 2014259257 711 711 8887781478 2014149690 711 711 H5141 035 0 2021 Clover Health Choice (PPO) www.cloverhealth.com 30 Montgomery Street, 15th Floor Jersey City NJ 07302 8884665044 2014259257 711 711 8887781478 2014149690 711 711 H5141 036 0 2021 Clover Health Choice (PPO) www.cloverhealth.com 30 Montgomery Street, 15th Floor Jersey City NJ 07302 8884665044 2014259257 711 711 8887781478 2014149690 711 711 H5141 037 0 2021 Clover Health Choice Value (PPO) www.cloverhealth.com 30 Montgomery Street, 15th Floor Jersey City NJ 07302 8884665044 2014259257 711 711 8887781478 2014149690 711 711 H5141 038 0 2021 Clover Health Choice (PPO) www.cloverhealth.com 30 Montgomery Street, 15th Floor Jersey City NJ 07302 8884665044 2014259257 711 711 8887781478 2014149690 711 711 H5141 039 0 2021 Clover Health Choice Value (PPO) www.cloverhealth.com 30 Montgomery Street, 15th Floor Jersey City NJ 07302 8884665044 2014259257 711 711 8887781478 2014149690 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5141 040 0 2021 Clover Health Choice (PPO) www.cloverhealth.com 30 Montgomery Street, 15th Floor Jersey City NJ 07302 8884665044 2014259257 711 711 8887781478 2014149690 711 711 H5141 042 0 2021 Clover Health Choice Value (PPO) www.cloverhealth.com 30 Montgomery Street, 15th Floor Jersey City NJ 07302 8884665044 2014259257 711 711 8887781478 2014149690 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5141 045 0 2021 Clover Health Choice Value (PPO) www.cloverhealth.com 30 Montgomery Street, 15th Floor Jersey City NJ 07302 8884665044 9128053269 711 711 8887781478 9128053271 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5141 046 0 2021 Clover Health Choice (PPO) www.cloverhealth.com 30 Montgomery Street, 15th Floor Jersey City NJ 07302 8884665044 9128053269 711 711 8887781478 9128053271 711 711 H5141 047 0 2021 Clover Health Choice Value (PPO) www.cloverhealth.com 30 Montgomery Street, 15th Floor Jersey City NJ 07302 8884665044 9128053269 711 711 8887781478 9128053271 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5141 048 0 2021 LiveHealthy: Clover Powered, Walmart Enhanced (PPO) www.cloverhealth.com 30 Montgomery Street, 15th Floor Jersey City NJ 07302 8884665044 9128053269 711 711 8887781478 9128053271 711 711 H5141 049 0 2021 LiveHealthy LI: Clover Powered, Walmart Enhanced (PPO) www.cloverhealth.com 30 Montgomery Street, 15th Floor Jersey City NJ 07302 8884665044 9128053269 711 711 8887781478 9128053271 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5141 050 0 2021 Clover Health Choice (PPO) www.cloverhealth.com 30 Montgomery Street, 15th Floor Jersey City NJ 07302 8884665044 2014259257 711 711 8887781478 2014149690 711 711 H5141 051 0 2021 Clover Health Choice Value (PPO) www.cloverhealth.com 30 Montgomery Street, 15th Floor Jersey City NJ 07302 8884665044 2014259257 711 711 8887781478 2014149690 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5141 801 0 2021 Clover Health Employer Group Plan (PPO) www.cloverhealth.com 30 Montgomery Street, 15th Floor Jersey City NJ 07302 8884665044 2014259257 711 711 8887781478 2014149690 711 711 H5172 002 0 2021 CommuniCare Advantage Cal MediConnect Plan (Medicare-Medicaid Plan) www.chgsd.com 2420 Fenton Street, Suite 100 Chula Vista CA 91914 8882444430 6194220422 8552664584 8552664584 8882444430 6194220422 8552664584 8552664584 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H5178 001 0 2021 Humana Gold Plus H5178-001 (HMO) www.humana.com/medicare 500 West Main St. Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5190 001 0 2021 Allwell Dual Medicare (HMO D-SNP) allwell.sunshinehealth.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8779358022 8779358022 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5190 002 0 2021 Allwell Dual Medicare (HMO D-SNP) allwell.sunshinehealth.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8779358022 8779358022 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5190 003 0 2021 Allwell Dual Medicare (HMO D-SNP) allwell.sunshinehealth.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8779358022 8779358022 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5190 004 0 2021 Allwell Dual Medicare (HMO D-SNP) allwell.sunshinehealth.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8779358022 8779358022 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5190 005 0 2021 Allwell Medicare Nurture (HMO D-SNP) allwell.sunshinehealth.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8779358022 8779358022 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5190 006 0 2021 Allwell Medicare Nurture (HMO D-SNP) allwell.sunshinehealth.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8779358022 8779358022 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5199 007 0 2021 WellCare Premier (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5199 008 0 2021 WellCare Premier (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5199 010 0 2021 WellCare Prime (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H5199 012 0 2021 WellCare Premier (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H5199 013 0 2021 WellCare Prime (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H5199 014 0 2021 WellCare Premier (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~ H5199 015 0 2021 WellCare Premier (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H5209 002 0 2021 My Choice Wisconsin Partnership Plan (HMO D-SNP) www.mychoicewi.org Care Wisconsin Health Plan, Inc., 1617 Sherman Ave. Madison WI 53704 8009630035 6082400035 8009473529 8009473529 8009630035 6082400035 8009473529 8009473529 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5209 004 0 2021 My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) www.mychoicewi.org Care Wisconsin Health Plan, Inc., 1617 Sherman Ave. Madison WI 53704 8009630035 6082400035 8009473529 8009473529 8009630035 6082400035 8009473529 8009473529 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5211 001 0 2021 Spirit (HMO-POS) www.securityhealth.org/medicareadvantage shpcsweb@securityhealth.org 1515 North Saint Joseph Avenue, PO Box 8000 Marshfield WI 54449 8779980998 7152219897 711 711 8779980998 7152219897 711 711 H5211 002 0 2021 Essence Rx (HMO-POS) www.securityhealth.org/medicareadvantage shpcsweb@securityhealth.org 1515 North Saint Joseph Avenue, PO Box 8000 Marshfield WI 54449 8779980998 7152219897 711 711 8779980998 7152219897 711 711 This plan does not charge an annual deductible for all drugs. The $330.00 annual deductible only applies to drugs on certain tiers.~ H5211 003 0 2021 Essence (HMO-POS) www.securityhealth.org/medicareadvantage shpcsweb@securityhealth.org 1515 North Saint Joseph Avenue, PO Box 8000 Marshfield WI 54449 8779980998 7152219897 711 711 8779980998 7152219897 711 711 H5211 004 0 2021 Spirit Rx (HMO-POS) www.securityhealth.org/medicareadvantage shpcsweb@securityhealth.org 1515 North Saint Joseph Avenue, PO Box 8000 Marshfield WI 54449 8779980998 7152219897 711 711 8779980998 7152219897 711 711 H5211 007 0 2021 Assurance Rx (HMO-POS) www.securityhealth.org/medicareadvantage shpcsweb@securityhealth.org 1515 North Saint Joseph Avenue, PO Box 8000 Marshfield WI 54449 8779980998 7152219897 711 711 8779980998 7152219897 711 711 This plan does not charge an annual deductible for all drugs. The $330.00 annual deductible only applies to drugs on certain tiers.~ H5211 008 0 2021 Surety Rx (HMO-POS) www.securityhealth.org/medicareadvantage shpcsweb@securityhealth.org 1515 North Saint Joseph Avenue, PO Box 8000 Marshfield WI 54449 8779980998 7152219897 711 711 8779980998 7152219897 711 711 This plan does not charge an annual deductible for all drugs. The $330.00 annual deductible only applies to drugs on certain tiers.~ H5211 009 0 2021 Promise Rx (HMO-POS) www.securityhealth.org/medicareadvantage shpcsweb@securityhealth.org 1515 North Saint Joseph Avenue, PO Box 8000 Marshfield WI 54449 8779980998 7152219897 711 711 8779980998 7152219897 711 711 This plan does not charge an annual deductible for all drugs. The $270.00 annual deductible only applies to drugs on certain tiers.~ H5211 010 0 2021 Ally Rx (HMO D-SNP) www.securityhealth.org/medicareadvantage shpcsweb@securityhealth.org 1515 North Saint Joseph Avenue, PO Box 8000 Marshfield WI 54449 8779980998 7152219897 711 711 8779980998 7152219897 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5211 012 0 2021 Esteem Rx (HMO-POS) www.securityhealth.org/medicareadvantage shpcsweb@securityhealth.org 1515 North Saint Joseph Avenue, PO Box 8000 Marshfield WI 54449 8779980998 7152219897 711 711 8779980998 7152219897 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5211 013 0 2021 Ascend Rx (HMO-POS) www.securityhealth.org/medicareadvantage shpcsweb@securityhealth.org 1515 North Saint Joseph Avenue, PO Box 8000 Marshfield WI 54449 8779980998 7152219897 711 711 8779980998 7152219897 711 711 This plan does not charge an annual deductible for all drugs. The $330.00 annual deductible only applies to drugs on certain tiers.~ H5215 001 0 2021 Network PlatinumPlus (PPO) https://networkhealth.com/ 1570 Midway Place, P.O. Box 120 Menasha WI 54952 8009837587 9207201280 8009473529 8009473529 8003785234 9207201345 8009473529 8009473529 H5215 002 0 2021 Network PlatinumPlus Pharmacy (PPO) https://networkhealth.com/ 1570 Midway Place, P.O. Box 120 Menasha WI 54952 8009837587 9207201280 8009473529 8009473529 8003785234 9207201345 8009473529 8009473529 This plan does not charge an annual deductible for all drugs. The $260.00 annual deductible only applies to drugs on certain tiers.~ H5215 005 0 2021 Network PlatinumPremier Pharmacy (PPO) https://networkhealth.com/ 1570 Midway Place, P.O. Box 120 Menasha WI 54952 8009837587 9207201280 8009473529 8009473529 8003785234 9207201345 8009473529 8009473529 This plan does not charge an annual deductible for all drugs. The $260.00 annual deductible only applies to drugs on certain tiers.~ H5215 006 0 2021 Network PlatinumPremier (PPO) https://networkhealth.com/ 1570 Midway Place, P.O. Box 120 Menasha WI 54952 8009837587 9207201280 8009473529 8009473529 8003785234 9207201345 8009473529 8009473529 H5215 007 0 2021 NetworkCares (PPO D-SNP) https://networkhealth.com/ 1570 Midway Place, P.O. Box 120 Menasha WI 54952 8009837587 9207201280 8009473529 8009473529 8003785234 9207201345 8009473529 8009473529 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~This plan's deductible only applies to out-of-network services.~ H5215 008 0 2021 Network PlatinumSelect (PPO) https://networkhealth.com/ 1570 Midway Place, P.O. Box 120 Menasha WI 54952 8009837587 9207201280 8009473529 8009473529 8003785234 9207201345 8009473529 8009473529 This plan does not charge an annual deductible for all drugs. The $395.00 annual deductible only applies to drugs on certain tiers.~ H5215 009 0 2021 Network Health Medicare Go (PPO) https://networkhealth.com/ 1570 Midway Place, P.O. Box 120 Menasha WI 54952 8009837587 9207201280 8009473529 8009473529 8003785234 9207201345 8009473529 8009473529 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H5215 010 0 2021 Network Health Medicare Anywhere (PPO) https://networkhealth.com/ 1570 Midway Place, P.O. Box 120 Menasha WI 54952 8009837587 9207201280 8009473529 8009473529 8003785234 9207201345 8009473529 8009473529 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5215 011 0 2021 Network PlatinumChoice (PPO) https://networkhealth.com/ 1570 Midway Place, P.O. Box 120 Menasha WI 54952 8009837587 9207201280 8009473529 8009473529 8003785234 9207201345 8009473529 8009473529 This plan does not charge an annual deductible for all drugs. The $260.00 annual deductible only applies to drugs on certain tiers.~ H5215 806 0 2021 Network PlatinumPlus Pharmacy EGP (PPO) https://networkhealth.com/ 1570 Midway Place, P.O. Box 120 Menasha WI 54952 8009837587 9207201280 8009473529 8009473529 8003785234 9207201345 8009473529 8009473529 H5215 807 0 2021 Network PlatinumPremier EGP (PPO) https://networkhealth.com/ 1570 Midway Place, P.O. Box 120 Menasha WI 54952 8009837587 9207201280 8009473529 8009473529 8003785234 9207201345 8009473529 8009473529 H5215 808 0 2021 Network PlatinumPremier Pharmacy EGP (PPO) https://networkhealth.com/ 1570 Midway Place, P.O. Box 120 Menasha WI 54952 8009837587 9207201280 8009473529 8009473529 8003785234 9207201345 8009473529 8009473529 H5216 001 0 2021 HumanaChoice H5216-001 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5216 006 0 2021 HumanaChoice H5216-006 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5216 009 0 2021 HumanaChoice H5216-009 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 011 0 2021 HumanaChoice H5216-011 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 013 0 2021 HumanaChoice H5216-013 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 014 0 2021 HumanaChoice H5216-014 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H5216 017 0 2021 HumanaChoice H5216-017 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $265.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 018 0 2021 HumanaChoice H5216-018 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 019 0 2021 HumanaChoice H5216-019 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 021 0 2021 HumanaChoice H5216-021 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 022 0 2021 HumanaChoice H5216-022 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H5216 023 0 2021 HumanaChoice H5216-023 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H5216 024 0 2021 HumanaChoice H5216-024 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 027 0 2021 HumanaChoice H5216-027 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $215.00 annual deductible only applies to drugs on certain tiers.~ H5216 028 0 2021 HumanaChoice H5216-028 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $265.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 029 0 2021 HumanaChoice H5216-029 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $265.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 032 0 2021 HumanaChoice H5216-032 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 033 1 2021 HumanaChoice H5216-033 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan's deductible only applies to out-of-network services.~ H5216 033 2 2021 HumanaChoice H5216-033 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 034 0 2021 HumanaChoice H5216-034 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 036 0 2021 HumanaChoice H5216-036 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 037 0 2021 HumanaChoice H5216-037 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 039 0 2021 HumanaChoice H5216-039 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 042 0 2021 HumanaChoice H5216-042 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~ H5216 043 1 2021 HumanaChoice H5216-043 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 043 2 2021 HumanaChoice H5216-043 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 044 0 2021 HumanaChoice H5216-044 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5216 046 0 2021 Humana Honor (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 047 0 2021 HumanaChoice H5216-047 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $320.00 annual deductible only applies to drugs on certain tiers.~ H5216 048 0 2021 HumanaChoice H5216-048 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $320.00 annual deductible only applies to drugs on certain tiers.~ H5216 050 0 2021 HumanaChoice H5216-050 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 051 0 2021 HumanaChoice H5216-051 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 052 1 2021 HumanaChoice H5216-052 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H5216 052 2 2021 HumanaChoice H5216-052 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H5216 053 0 2021 HumanaChoice H5216-053 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 054 0 2021 HumanaChoice H5216-054 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 055 0 2021 HumanaChoice H5216-055 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 057 0 2021 HumanaChoice H5216-057 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 058 0 2021 HumanaChoice H5216-058 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H5216 059 0 2021 Humana Honor (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 061 0 2021 HumanaChoice Florida H5216-061 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H5216 062 0 2021 HumanaChoice Florida H5216-062 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5216 063 0 2021 HumanaChoice H5216-063 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5216 064 0 2021 HumanaChoice H5216-064 (PPO) www.humana.com/medicare 500 W Main St Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan's deductible only applies to out-of-network services.~ H5216 065 0 2021 HumanaChoice H5216-065 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 068 0 2021 HumanaChoice Florida H5216-068 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5216 070 0 2021 HumanaChoice Florida H5216-070 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~ H5216 071 0 2021 HumanaChoice H5216-071 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 072 0 2021 HumanaChoice Florida H5216-072 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5216 073 0 2021 HumanaChoice H5216-073 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $360.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 074 0 2021 HumanaChoice Florida H5216-074 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 075 0 2021 HumanaChoice H5216-075 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8335022012 8335022012 711 711 This plan does not charge an annual deductible for all drugs. The $340.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 077 0 2021 HumanaChoice H5216-077 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 078 1 2021 HumanaChoice H5216-078 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 078 2 2021 HumanaChoice H5216-078 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H5216 080 1 2021 HumanaChoice H5216-080 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H5216 080 2 2021 HumanaChoice H5216-080 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H5216 080 3 2021 HumanaChoice H5216-080 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H5216 081 0 2021 HumanaChoice H5216-081 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H5216 083 0 2021 HumanaChoice H5216-083 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 086 0 2021 Humana Honor (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 088 0 2021 HumanaChoice H5216-088 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H5216 089 0 2021 HumanaChoice H5216-089 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H5216 092 0 2021 HumanaChoice H5216-092 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H5216 093 0 2021 HumanaChoice H5216-093 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 096 0 2021 HumanaChoice H5216-096 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 097 0 2021 HumanaChoice H5216-097 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 098 0 2021 HumanaChoice H5216-098 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 099 0 2021 HumanaChoice H5216-099 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 100 0 2021 HumanaChoice H5216-100 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan's deductible only applies to out-of-network services.~ H5216 103 0 2021 HumanaChoice H5216-103 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5216 105 0 2021 HumanaChoice H5216-105 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 106 0 2021 HumanaChoice H5216-106 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $125.00 annual deductible only applies to drugs on certain tiers.~ H5216 107 0 2021 HumanaChoice H5216-107 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 109 0 2021 HumanaChoice H5216-109 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5216 111 0 2021 HumanaChoice H5216-111 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H5216 112 0 2021 HumanaChoice H5216-112 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 114 0 2021 HumanaChoice H5216-114 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H5216 115 0 2021 Humana Value Plus H5216-115 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $425.00 annual deductible only applies to drugs on certain tiers.~ H5216 116 0 2021 HumanaChoice H5216-116 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 117 0 2021 Humana Value Plus H5216-117 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $420.00 annual deductible only applies to drugs on certain tiers.~ H5216 120 0 2021 HumanaChoice H5216-120 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 124 0 2021 HumanaChoice H5216-124 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 125 0 2021 Humana Value Plus H5216-125 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5216 127 0 2021 Humana Honor (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan's deductible only applies to out-of-network services.~ H5216 128 0 2021 Humana Honor (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan's deductible only applies to out-of-network services.~ H5216 129 0 2021 Humana Honor (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan's deductible only applies to out-of-network services.~ H5216 131 0 2021 HumanaChoice H5216-131 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5216 132 0 2021 HumanaChoice H5216-132 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5216 133 0 2021 HumanaChoice H5216-133 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5216 136 0 2021 HumanaChoice H5216-136 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $320.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 137 0 2021 HumanaChoice H5216-137 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 138 0 2021 HumanaChoice H5216-138 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H5216 139 0 2021 HumanaChoice H5216-139 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 140 0 2021 Humana Honor (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 141 0 2021 HumanaChoice H5216-141 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $365.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 142 1 2021 HumanaChoice H5216-142 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5216 142 2 2021 HumanaChoice H5216-142 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 143 0 2021 HumanaChoice H5216-143 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $75.00 annual deductible only applies to drugs on certain tiers.~ H5216 144 0 2021 HumanaChoice H5216-144 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $265.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 149 0 2021 HumanaChoice H5216-149 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5216 152 0 2021 HumanaChoice H5216-152 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 154 0 2021 HumanaChoice H5216-154 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 157 0 2021 HumanaChoice H5216-157 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 158 0 2021 HumanaChoice H5216-158 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 160 0 2021 Humana Value Plus H5216-160 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $435.00 annual deductible only applies to drugs on certain tiers.~ H5216 161 0 2021 Humana Value Plus H5216-161 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $425.00 annual deductible only applies to drugs on certain tiers.~ H5216 163 0 2021 HumanaChoice H5216-163 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 164 0 2021 HumanaChoice SNP-DE H5216-164 (PPO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5216 165 0 2021 Humana Value Plus H5216-165 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H5216 166 0 2021 Humana Value Plus H5216-166 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H5216 167 0 2021 HumanaChoice H5216-167 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H5216 168 0 2021 HumanaChoice H5216-168 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5216 169 0 2021 HumanaChoice H5216-169 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H5216 170 0 2021 HumanaChoice H5216-170 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5216 171 0 2021 Humana Value Plus H5216-171 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $305.00 annual deductible only applies to drugs on certain tiers.~ H5216 172 0 2021 HumanaChoice H5216-172 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H5216 173 0 2021 Humana Value Plus H5216-173 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $230.00 annual deductible only applies to drugs on certain tiers.~ H5216 174 0 2021 Humana Honor (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 175 0 2021 HumanaChoice H5216-175 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5216 176 0 2021 Humana Value Plus H5216-176 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $230.00 annual deductible only applies to drugs on certain tiers.~ H5216 177 0 2021 HumanaChoice H5216-177 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 179 0 2021 HumanaChoice H5216-179 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $360.00 annual deductible only applies to drugs on certain tiers.~ H5216 180 0 2021 HumanaChoice H5216-180 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H5216 181 0 2021 HumanaChoice H5216-181 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H5216 182 0 2021 HumanaChoice H5216-182 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H5216 185 0 2021 HumanaChoice H5216-185 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 186 0 2021 HumanaChoice H5216-186 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5216 188 0 2021 HumanaChoice H5216-188 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 189 0 2021 HumanaChoice H5216-189 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5216 190 0 2021 Humana Honor (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 192 0 2021 HumanaChoice H5216-192 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5216 193 0 2021 Humana Value Plus H5216-193 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $260.00 annual deductible only applies to drugs on certain tiers.~ H5216 194 0 2021 HumanaChoice H5216-194 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $365.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 195 0 2021 Humana Value Plus H5216-195 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $435.00 annual deductible only applies to drugs on certain tiers.~ H5216 196 1 2021 HumanaChoice H5216-196 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan's deductible only applies to out-of-network services.~ H5216 196 2 2021 HumanaChoice H5216-196 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan's deductible only applies to out-of-network services.~ H5216 197 0 2021 Humana Value Plus H5216-197 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $435.00 annual deductible only applies to drugs on certain tiers.~ H5216 198 0 2021 HumanaChoice H5216-198 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H5216 199 0 2021 Humana Value Plus H5216-199 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $435.00 annual deductible only applies to drugs on certain tiers.~ H5216 200 0 2021 Humana Honor (PPO) www.humana.com/medicare 500 W. Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan's deductible only applies to out-of-network services.~ H5216 201 0 2021 Humana Honor (PPO) www.humana.com/medicare 500 W. Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan's deductible only applies to out-of-network services.~ H5216 202 0 2021 HumanaChoice H5216-202 (PPO) www.humana.com/medicare 500 W. Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 203 1 2021 HumanaChoice H5216-203 (PPO) www.humana.com/medicare 500 West Main St. Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 203 2 2021 HumanaChoice H5216-203 (PPO) www.humana.com/medicare 500 West Main St. Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 205 0 2021 HumanaChoice SNP-DE H5216-205 (PPO D-SNP) www.humana.com/medicare 500 West Main St. Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5216 206 0 2021 HumanaChoice SNP-DE H5216-206 (PPO D-SNP) www.humana.com/medicare 500 West Main St. Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5216 207 0 2021 HumanaChoice H5216-207 (PPO) www.humana.com/medicare 500 West Main St. Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $75.00 annual deductible only applies to drugs on certain tiers.~ H5216 209 0 2021 HumanaChoice H5216-209 (PPO) www.humana.com/medicare 500 West Main St. Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 210 0 2021 HumanaChoice H5216-210 (PPO) www.humana.com/medicare 500 West Main St. Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 211 0 2021 HumanaChoice H5216-211 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $160.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 212 0 2021 HumanaChoice H5216-212 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 213 0 2021 Humana Honor (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 214 1 2021 HumanaChoice H5216-214 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5216 214 2 2021 HumanaChoice H5216-214 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 214 3 2021 HumanaChoice H5216-214 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 215 0 2021 HumanaChoice H5216-215 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H5216 216 0 2021 Humana Honor (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan's deductible only applies to out-of-network services.~ H5216 217 0 2021 Humana Honor (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 218 0 2021 Humana Honor (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 219 0 2021 HumanaChoice SNP-DE H5216-219 (PPO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5216 220 0 2021 HumanaChoice SNP-DE H5216-220 (PPO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5216 221 0 2021 Humana Honor (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 222 0 2021 HumanaChoice H5216-222 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5216 223 0 2021 HumanaChoice H5216-223 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 224 0 2021 HumanaChoice H5216-224 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H5216 225 0 2021 Humana Honor (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 226 0 2021 HumanaChoice H5216-226 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H5216 227 0 2021 HumanaChoice SNP-DE H5216-227 (PPO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5216 228 0 2021 HumanaChoice SNP-DE H5216-228 (PPO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5216 229 0 2021 HumanaChoice H5216-229 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H5216 230 0 2021 HumanaChoice H5216-230 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 231 0 2021 HumanaChoice H5216-231 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 232 1 2021 HumanaChoice H5216-232 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5216 232 2 2021 HumanaChoice H5216-232 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5216 233 1 2021 HumanaChoice H5216-233 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H5216 233 2 2021 HumanaChoice H5216-233 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H5216 234 0 2021 Humana Honor (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan's deductible only applies to out-of-network services.~ H5216 235 0 2021 Humana Honor (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan's deductible only applies to out-of-network services.~ H5216 236 0 2021 Humana Honor (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan's deductible only applies to out-of-network services.~ H5216 237 1 2021 HumanaChoice H5216-237 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 237 2 2021 HumanaChoice H5216-237 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5216 238 1 2021 HumanaChoice H5216-238 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 238 2 2021 HumanaChoice H5216-238 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 239 0 2021 Humana Care Extra (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 240 0 2021 Humana Care Extra (PPO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5216 241 0 2021 HumanaChoice H5216-241 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5216 242 0 2021 Humana Together in Health (PPO I-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $420.00 annual deductible only applies to drugs on certain tiers.~ H5216 243 0 2021 Humana Together in Health (PPO I-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H5216 244 0 2021 HumanaChoice - Diabetes (PPO C-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $145.00 annual deductible only applies to drugs on certain tiers.~ H5216 245 0 2021 HumanaChoice - Diabetes and Heart (PPO C-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5216 246 0 2021 HumanaChoice - Diabetes (PPO C-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $145.00 annual deductible only applies to drugs on certain tiers.~ H5216 247 0 2021 HumanaChoice H5216-247 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~ H5216 248 1 2021 HumanaChoice H5216-248 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 248 2 2021 HumanaChoice H5216-248 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 249 0 2021 HumanaChoice H5216-249 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H5216 250 0 2021 HumanaChoice H5216-250 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5216 251 0 2021 HumanaChoice H5216-251 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5216 252 0 2021 HumanaChoice H5216-252 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H5216 253 0 2021 HumanaChoice H5216-253 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H5216 254 0 2021 HumanaChoice H5216-254 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5216 255 0 2021 HumanaChoice H5216-255 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $325.00 annual deductible only applies to drugs on certain tiers.~ H5216 256 0 2021 Humana Honor (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 257 0 2021 Humana Honor (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 258 0 2021 Humana Honor (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5216 805 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H5216 806 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H5216 811 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H5216 812 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H5216 813 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H5216 814 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H5216 815 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H5216 816 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H5232 001 0 2021 Paramount Elite - Preferred PPO (PPO) www.paramounthealthcare.com/medicareplans brianna.eighmey@promedica.org P.O. Box 928 Toledo OH 43697 8004623589 4198872525 8887405670 8887405670 8004623589 4198872525 8887405670 8887405670 This plan's deductible only applies to out-of-network services.~ H5253 004 0 2021 AARP Medicare Advantage (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5253 007 0 2021 UnitedHealthcare Nursing Home Plan 1 (HMO-POS I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H5253 011 0 2021 AARP Medicare Advantage (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $245.00 annual deductible only applies to drugs on certain tiers.~ H5253 021 0 2021 AARP Medicare Advantage Patriot Plan 2 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H5253 024 0 2021 UnitedHealthcare Dual Complete LP (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003961942 8003961942 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5253 030 0 2021 AARP Medicare Advantage (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H5253 033 0 2021 AARP Medicare Advantage Value (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H5253 034 0 2021 AARP Medicare Advantage Value (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $355.00 annual deductible only applies to drugs on certain tiers.~ H5253 035 0 2021 AARP Medicare Advantage Plus (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H5253 036 0 2021 AARP Medicare Advantage (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $245.00 annual deductible only applies to drugs on certain tiers.~ H5253 037 0 2021 AARP Medicare Advantage Plan 1 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $50.00 annual deductible only applies to drugs on certain tiers.~ H5253 038 0 2021 AARP Medicare Advantage Plan 2 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H5253 039 0 2021 AARP Medicare Advantage Plan 2 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $170.00 annual deductible only applies to drugs on certain tiers.~ H5253 040 0 2021 AARP Medicare Advantage Patriot (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H5253 041 0 2021 UnitedHealthcare Dual Complete (HMO-POS D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8664801086 8664801086 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5253 042 0 2021 UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H5253 043 0 2021 UnitedHealthcare Assisted Living Plan (HMO-POS I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5253 047 0 2021 AARP Medicare Advantage Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H5253 048 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H5253 049 0 2021 AARP Medicare Advantage Plan 7 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~ H5253 050 0 2021 AARP Medicare Advantage Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5253 051 0 2021 AARP Medicare Advantage Plan 3 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H5253 052 0 2021 AARP Medicare Advantage Plan 6 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H5253 059 0 2021 UnitedHealthcare Dual Complete LP (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8669443488 8669443488 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5253 060 0 2021 UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H5253 061 0 2021 UnitedHealthcare Assisted Living Plan (HMO-POS I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5253 062 0 2021 AARP Medicare Advantage Plan 5 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H5253 064 0 2021 UnitedHealthcare Assisted Living Plan (HMO-POS I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5253 067 0 2021 AARP Medicare Advantage Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5253 072 0 2021 AARP Medicare Advantage Value (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $355.00 annual deductible only applies to drugs on certain tiers.~ H5253 073 0 2021 AARP Medicare Advantage (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $245.00 annual deductible only applies to drugs on certain tiers.~ H5253 079 0 2021 AARP Medicare Advantage Plan 2 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $170.00 annual deductible only applies to drugs on certain tiers.~ H5253 080 0 2021 AARP Medicare Advantage Plan 1 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H5253 081 0 2021 AARP Medicare Advantage Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H5253 082 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H5253 083 0 2021 AARP Medicare Advantage Plan 1 (HMO) www.AARPMedicarePlans.com memberservices@mypreferredcare.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H5253 084 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H5253 087 0 2021 AARP Medicare Advantage Plan 1 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H5253 088 0 2021 AARP Medicare Advantage Plan 2 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H5253 089 0 2021 AARP Medicare Advantage (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H5253 091 0 2021 AARP Medicare Advantage Plan 3 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H5253 097 0 2021 AARP Medicare Advantage Value (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $405.00 annual deductible only applies to drugs on certain tiers.~ H5253 099 0 2021 AARP Medicare Advantage Plan 1 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H5253 100 0 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5253 102 0 2021 AARP Medicare Advantage Plan 1 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H5253 103 0 2021 AARP Medicare Advantage Plan 2 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $170.00 annual deductible only applies to drugs on certain tiers.~ H5253 104 0 2021 AARP Medicare Advantage Plan 1 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H5253 105 0 2021 AARP Medicare Advantage Walgreens (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $435.00 annual deductible only applies to drugs on certain tiers.~ H5253 107 1 2021 AARP Medicare Advantage Plan 2 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H5253 107 2 2021 AARP Medicare Advantage Plan 2 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H5253 108 1 2021 AARP Medicare Advantage (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H5253 108 2 2021 AARP Medicare Advantage (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H5253 108 3 2021 AARP Medicare Advantage (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H5253 109 1 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5253 109 2 2021 AARP Medicare Advantage Plan 2 (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5253 110 0 2021 AARP Medicare Advantage Walgreens (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $435.00 annual deductible only applies to drugs on certain tiers.~ H5253 111 1 2021 AARP Medicare Advantage Plan 1 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5253 111 2 2021 AARP Medicare Advantage Plan 1 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5253 112 1 2021 AARP Medicare Advantage Plan 2 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H5253 112 2 2021 AARP Medicare Advantage Plan 2 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H5253 113 0 2021 AARP Medicare Advantage Patriot (HMO) www.AARPMedicarePlans.com memberservices@mypreferredcare.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H5253 801 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H5253 802 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H5253 805 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H5253 810 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H5253 811 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H5253 812 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H5253 813 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H5253 814 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H5253 815 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H5253 818 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H5253 819 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H5253 820 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H5253 821 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H5253 822 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H5253 823 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H5253 824 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H5253 825 0 2021 UnitedHealthcare Group Medicare Advantage (HMO) www.UHCMedicareSolutions.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 H5256 001 0 2021 Medical Associates SmartPlan (Cost) www.mahealthplans.com memberservices@mahealthcare.com 1605 Associates Drive Dubuque IA 52002 8007478900 5635568070 8007352942 8007352942 8668211365 5635844885 8007352942 8007352942 H5256 002 0 2021 Medical Associates Community Plan (Cost) www.mahealthplans.com memberservices@mahealthcare.com 1605 Associates Drive Dubuque IA 52002 8007478900 5635568070 8007352942 8007352942 8668211365 5635844885 8007352942 8007352942 H5256 004 0 2021 Medical Associates Freedom Plan (Cost) www.mahealthplans.com memberservices@mahealthcare.com 1605 Associates Drive Dubuque IA 52002 8007478900 5635568070 8007352942 8007352942 8668211365 5635844885 8007352942 8007352942 H5262 001 0 2021 Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO) quartzbenefits.com/medicareadvantage customerservice@quartzbenefits.com 840 Carolina Street Sauk City WI 53583 8003945566 6088818275 8008778973 711 8003945566 6088818275 8008778973 711 H5262 003 0 2021 Gundersen Quartz Med Advantage Value D (w/Rx) (HMO) quartzbenefits.com/medicareadvantage customerservice@quartzbenefits.com 840 Carolina Street Sauk City WI 53583 8003945566 6088818275 8008778973 711 8003945566 6088818275 8008778973 711 H5262 004 0 2021 Gundersen Quartz Med Advantage Value (HMO) quartzbenefits.com/medicareadvantage customerservice@quartzbenefits.com 840 Carolina Street Sauk City WI 53583 8003945566 6088818275 8008778973 711 8003945566 6088818275 8008778973 711 H5262 005 0 2021 Gundersen Quartz Med Advantage Elite (HMO) quartzbenefits.com/medicareadvantage customerservice@quartzbenefits.com 840 Carolina Street Sauk City WI 53583 8003945566 6088818275 8008778973 711 8003945566 6088818275 8008778973 711 H5262 007 0 2021 UW Health Quartz Med Advantage Elite D (w/Rx) (HMO) quartzbenefits.com/medicareadvantage customerservice@quartzbenefits.com 840 Carolina Street Sauk City WI 53583 8003945566 6088818275 8008778973 711 8003945566 6088818275 8008778973 711 H5262 008 0 2021 UW Health Quartz Med Advantage Value D (w/Rx) (HMO) quartzbenefits.com/medicareadvantage customerservice@quartzbenefits.com 840 Carolina Street Sauk City WI 53583 8003945566 6088818275 8008778973 711 8003945566 6088818275 8008778973 711 H5262 009 0 2021 UW Health Quartz Med Advantage Value (HMO) quartzbenefits.com/medicareadvantage customerservice@quartzbenefits.com 840 Carolina Street Sauk City WI 53583 8003945566 6088818275 8008778973 711 8003945566 6088818275 8008778973 711 H5262 010 0 2021 UW Health Quartz Med Advantage Elite (HMO) quartzbenefits.com/medicareadvantage customerservice@quartzbenefits.com 840 Carolina Street Sauk City WI 53583 8003945566 6088818275 8008778973 711 8003945566 6088818275 8008778973 711 H5262 011 0 2021 Aurora Health Quartz Med Advantage Value D (w/Rx) (HMO) quartzbenefits.com/medicareadvantage customerservice@quartzbenefits.com 840 Carolina Street Sauk City WI 53583 8003945566 6088818275 8008778973 711 8003945566 6088818275 8008778973 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5262 012 0 2021 Aurora Health Quartz Med Advantage Core D (w/Rx) (HMO) quartzbenefits.com/medicareadvantage customerservice@quartzbenefits.com 840 Carolina Street Sauk City WI 53583 8003945566 6088818275 8008778973 711 8003945566 6088818275 8008778973 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5262 013 0 2021 Aurora Health Quartz Med Advantage Value (HMO) quartzbenefits.com/medicareadvantage customerservice@quartzbenefits.com 840 Carolina Street Sauk City WI 53583 8003945566 6088818275 8008778973 711 8003945566 6088818275 8008778973 711 H5262 018 0 2021 SwedishAmerican Quartz Med Advantage Value D(w/Rx) (HMO) quartzbenefits.com/medicareadvantage customerservice@quartzbenefits.com 840 Carolina Street Sauk City WI 53583 8003945566 6088818275 8008778973 711 8003945566 6088818275 8008778973 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5262 019 0 2021 SwedishAmerican Quartz Med Advantage Core D (w/Rx) (HMO) quartzbenefits.com/medicareadvantage customerservice@quartzbenefits.com 840 Carolina Street Sauk City WI 53583 8003945566 6088818275 8008778973 711 8003945566 6088818275 8008778973 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5262 020 0 2021 SwedishAmerican Quartz Med Advantage Value (HMO) quartzbenefits.com/medicareadvantage customerservice@quartzbenefits.com 840 Carolina Street Sauk City WI 53583 8003945566 6088818275 8008778973 711 8003945566 6088818275 8008778973 711 H5262 021 0 2021 Gundersen Quartz Med Advantage Core D (w/Rx) (HMO) quartzbenefits.com/medicareadvantage customerservice@quartzbenefits.com 840 Carolina Street Sauk City WI 53583 8003945566 6088818275 8008778973 711 8003945566 6088818275 8008778973 711 H5262 023 0 2021 UW Health Quartz Med Advantage Core D (w/Rx) (HMO) quartzbenefits.com/medicareadvantage customerservice@quartzbenefits.com 840 Carolina Street Sauk City WI 53583 8003945566 6088818275 8008778973 711 8003945566 6088818275 8008778973 711 H5262 024 0 2021 Aurora Health Quartz Med Advantage Elite D (w/Rx) (HMO) quartzbenefits.com/medicareadvantage customerservice@quartzbenefits.com 840 Carolina Street Sauk City WI 53583 8003945566 6088818275 8008778973 711 8003945566 6088818275 8008778973 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5262 025 0 2021 Aurora Health Quartz Med Advantage Elite (HMO) quartzbenefits.com/medicareadvantage customerservice@quartzbenefits.com 840 Carolina Street Sauk City WI 53583 8003945566 6088818275 8008778973 711 8003945566 6088818275 8008778973 711 H5262 026 0 2021 SwedishAmerican Quartz Med Advantage Elite D(w/Rx) (HMO) quartzbenefits.com/medicareadvantage customerservice@quartzbenefits.com 840 Carolina Street Sauk City WI 53583 8003945566 6088818275 8008778973 711 8003945566 6088818275 8008778973 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5262 027 0 2021 SwedishAmerican Quartz Med Advantage Elite (HMO) quartzbenefits.com/medicareadvantage customerservice@quartzbenefits.com 840 Carolina Street Sauk City WI 53583 8003945566 6088818275 8008778973 711 8003945566 6088818275 8008778973 711 H5262 801 0 2021 Employer Group Quartz Medicare Advantage D (w/Rx) (HMO) quartzbenefits.com/medicareadvantage customerservice@quartzbenefits.com 840 Carolina Street Sauk City WI 53583 8003945566 6088818275 8008778973 711 8003945566 6088818275 8008778973 711 H5262 802 0 2021 Employer Group Quartz Medicare Advantage (HMO) quartzbenefits.com/medicareadvantage customerservice@quartzbenefits.com 840 Carolina Street Sauk City WI 53583 8003945566 6088818275 8008778973 711 8003945566 6088818275 8008778973 711 H5264 002 0 2021 DeanCare Gold Enhanced (Cost) deancare.com/medicare 1277 Deming Way Madison WI 53717 8884223326 6088274372 711 711 8884223326 6088274372 711 711 H5264 003 0 2021 DeanCare Gold Basic (Cost) deancare.com/medicare 1277 Deming Way Madison WI 53717 8884223326 6088274372 711 711 8884223326 6088274372 711 711 H5264 005 0 2021 DeanCare Gold Shared Value (Cost) deancare.com/medicare 1277 Deming Way Madison WI 53717 8884223326 6088274372 711 711 8884223326 6088274372 711 711 H5273 001 0 2021 CarePartners of CT CareAdvantage Preferred (HMO) www.carepartnersct.com Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8332702728 8332702728 711 711 8883411507 8883411507 711 711 H5273 002 0 2021 CarePartners of CT CareAdvantage Prime (HMO) www.carepartnersct.com Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8332702728 8332702728 711 711 8883411507 8883411507 711 711 H5273 003 0 2021 CarePartners of CT CareAdvantage Premier (HMO) www.carepartnersct.com Michael_Fopiano@tufts-health.com 705 Mt. Auburn Street Watertown MA 02472 8332702728 8332702728 711 711 8883411507 8883411507 711 711 H5280 001 0 2021 Molina Dual Options – MyCareOhio (Medicare-Medicaid Plan) www.molinahealthcare.com/duals 3000 Corporate Exchange Drive Columbus OH 43231 8668568295 8668568295 711 711 8556654623 8556654623 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H5294 010 0 2021 Allwell Medicare Nurture (HMO D-SNP) allwell.superiorhealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8779358023 8779358023 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5294 011 0 2021 Allwell Medicare (HMO) allwell.superiorhealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8447966811 8447966811 711 711 H5294 012 0 2021 Allwell Medicare Boost (HMO) allwell.superiorhealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8447966811 8447966811 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5294 013 0 2021 Allwell Medicare Complement (HMO) allwell.superiorhealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8447966811 8447966811 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5294 014 0 2021 Allwell Medicare Simple (HMO) allwell.superiorhealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8447966811 8447966811 711 711 H5294 015 0 2021 Allwell Dual Medicare Harmony (HMO D-SNP) allwell.superiorhealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8779358023 8779358023 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5294 016 0 2021 Allwell Medicare Complement (HMO) allwell.superiorhealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8447966811 8447966811 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5294 017 0 2021 Allwell Medicare (HMO) allwell.superiorhealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8447966811 8447966811 711 711 H5294 018 0 2021 Allwell Medicare (HMO) allwell.superiorhealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8447966811 8447966811 711 711 H5296 001 0 2021 NC Premier (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 8889792247 711 711 8666342247 8666342247 711 711 H5296 002 0 2021 NCPlus (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 8889792247 711 711 8666342247 8666342247 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5296 003 0 2021 Platinum (HMO-POS) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 8889792247 711 711 8666342247 8666342247 711 711 H5302 011 0 2021 Aetna Medicare Advantra Platinum Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5302 012 0 2021 Aetna Medicare Dual Preferred Plan (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $220.00 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5302 013 0 2021 Aetna Medicare Dual Preferred Plan (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $130.00 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5302 014 0 2021 Aetna Medicare Dual Preferred Plan (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $130.00 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5302 809 0 2021 Aetna Medicare Plan (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H5302 810 0 2021 Aetna Medicare w/Rx Plan (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H5322 001 0 2021 UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H5322 003 0 2021 UnitedHealthcare Nursing Home Plan (HMO I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8668184270 8668184270 711 711 H5322 004 0 2021 UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8003930993 8003930993 711 711 H5322 025 0 2021 UnitedHealthcare Dual Complete (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30769 Salt Lake City UT 84130 8888343721 8888343721 711 711 8669444983 8669444983 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5322 026 0 2021 UnitedHealthcare Dual Complete Plan 2 (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30769 Salt Lake City UT 84130 8888343721 8888343721 711 711 8664801086 8664801086 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5322 028 0 2021 UnitedHealthcare Dual Complete (HMO-POS D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8669443488 8669443488 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5322 029 0 2021 UnitedHealthcare Dual Complete LP (HMO-POS D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8662629947 8662629947 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5322 030 0 2021 UnitedHealthcare Dual Complete (HMO-POS D-SNP) www.UHCCommunityPlan.com P.O. Box 30769 Salt Lake City UT 84130 8888343721 8888343721 711 711 8664801086 8664801086 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5322 031 0 2021 UnitedHealthcare Dual Complete LP (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8443687150 8443687150 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5325 001 0 2021 Aetna Medicare Assure (HMO D-SNP) www.aetnamedicare.com HicksJS@Aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5325 002 0 2021 Aetna Medicare Assure (HMO D-SNP) www.aetnamedicare.com HicksJS@Aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5325 003 0 2021 Aetna Medicare Assure (HMO D-SNP) www.aetnamedicare.com HicksJS@Aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5325 004 0 2021 Aetna Medicare Assure (HMO D-SNP) www.aetnamedicare.com HicksJS@Aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5325 005 0 2021 Aetna Medicare Assure Gold Prime (HMO D-SNP) www.aetnamedicare.com HicksJS@Aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5325 006 0 2021 Aetna Medicare Assure (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5337 001 0 2021 Aetna Medicare Assure (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $130.00 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5355 001 0 2021 IEHP DualChoice (Medicare-Medicaid Plan) www.iehp.org P.O. Box 1800 Rancho Cucamonga CA 91729 8007414347 8007414347 8007184347 8007184347 8772734347 8772734347 8007184347 8007184347 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H5373 001 0 2021 ProMedica Medicare Plan Essential Medical and Drug (HMO) www.promedicahealthplan.com/medicare brianna.eighmey@promedica.org P.O. Box 928 Toledo OH 43697 8004623589 4198872525 8887405670 8887405670 8004623589 4198872525 8887405670 8887405670 H5374 001 0 2021 Longevity Health Plan (HMO I-SNP) www.longevityhealthplan.com PO Box 5850 Glen Allen VA 23058 8883125196 8883125196 711 711 8883125196 8883125196 711 711 H5377 001 0 2021 Humana Gold Plus H5377-001 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $190.00 annual deductible only applies to drugs on certain tiers.~ H5386 003 0 2021 Sharp Direct Advantage Gold Card (HMO) sharpmedicareadvantage.com 8520 Tech Way, Suite 201 San Diego CA 92123 8555628853 8584998050 711 711 8555628853 8584998050 711 711 H5386 004 0 2021 Sharp Direct Advantage Platinum Card (HMO) sharpmedicareadvantage.com 8520 Tech Way, Suite 201 San Diego CA 92123 8555628853 8584998050 711 711 8555628853 8584998050 711 711 H5386 801 0 2021 Sharp Direct Advantage Calendar Year (HMO) sharpmedicareadvantage.com 8520 Tech Way, Suite 201 San Diego CA 92123 8555628853 8584998050 711 711 8555628853 8584998050 711 711 H5386 802 0 2021 Sharp Direct Advantage Non-Calendar Year (HMO) sharpmedicareadvantage.com 8520 Tech Way, Suite 201 San Diego CA 92123 8555628853 8584998050 711 711 8555628853 8584998050 711 711 H5386 803 0 2021 Sharp Direct Advantage MA Only (HMO) sharpmedicareadvantage.com 8520 Tech Way, Suite 201 San Diego CA 92123 8555628853 8584998050 711 711 8555628853 8584998050 711 711 H5398 001 0 2021 Ascension Complete Via Christi Reward (HMO) ascensioncomplete.com PO Box 10420 Van Nuys CA 91410 8449420038 8449420038 711 711 8338166623 8338166623 711 711 This plan does not charge an annual deductible for all drugs. The $380.00 annual deductible only applies to drugs on certain tiers.~ H5398 002 0 2021 Ascension Complete Via Christi Secure (HMO) ascensioncomplete.com PO Box 10420 Van Nuys CA 91410 8449420038 8449420038 711 711 8338166623 8338166623 711 711 H5410 001 0 2021 Leon Medicare (HMO) www.lmchealthplans.com PO Box 669440 Miami FL 33166 8663935366 8663935366 711 711 8663935366 3055595366 711 711 H5410 004 0 2021 Cigna Fundamental Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8557077116 8557077116 711 711 8006683813 8006683813 711 711 H5410 013 0 2021 Cigna TotalCare (HMO D-SNP) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8557077116 8557077116 711 711 8006683813 8006683813 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5410 018 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8557077116 8557077116 711 711 8006683813 8006683813 711 711 H5410 024 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559803046 8559803046 711 711 8006683813 8006683813 711 711 H5410 025 0 2021 Cigna TotalCare (HMO D-SNP) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559803046 8559803046 711 711 8006683813 8006683813 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5410 026 0 2021 Cigna Preferred Savings Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559803046 8559803046 711 711 8006683813 8006683813 711 711 H5410 027 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559803046 8559803046 711 711 8006683813 8006683813 711 711 H5410 028 0 2021 Cigna Preferred Savings Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559803046 8559803046 711 711 8006683813 8006683813 711 711 H5410 029 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559803046 8559803046 711 711 8006683813 8006683813 711 711 H5410 030 0 2021 Cigna Preferred Savings Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559803046 8559803046 711 711 8006683813 8006683813 711 711 H5410 031 0 2021 Cigna TotalCare (HMO D-SNP) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559803046 8559803046 711 711 8006683813 8006683813 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5410 032 0 2021 Cigna TotalCare (HMO D-SNP) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559803046 8559803046 711 711 8006683813 8006683813 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5410 033 0 2021 Cigna Primary Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559803046 8559803046 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5410 034 0 2021 Cigna Primary Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559803046 8559803046 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5410 035 0 2021 Cigna Primary Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559803046 8559803046 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5410 036 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559803046 8559803046 711 711 8006683813 8006683813 711 711 H5410 807 0 2021 Leon Medicare Group Plan (HMO) www.cignahealthspring.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TN 77092 8888212508 8888212508 711 711 8882817867 8882817867 711 711 H5410 808 0 2021 Cigna Preferred Medicare (HMO) www.cignahealthspring.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8882817867 8882817867 711 711 8882817867 8882817867 711 711 H5420 001 0 2021 Medica HealthCare Plans MedicareMax (HMO) www.Medicaplans.com P.O. Box 30770 Salt Lake City UT 84130 8005070544 8005070544 711 711 8004079069 8004079069 711 711 H5420 003 0 2021 Medica HealthCare Plans MedicareMax (HMO) www.Medicaplans.com P.O. Box 30770 Salt Lake City UT 84130 8005070544 8005070544 711 711 8004079069 8004079069 711 711 H5420 006 0 2021 Medica HealthCare Plans MedicareMax Plus (HMO D-SNP) www.Medicaplans.com P.O. Box 30770 Salt Lake City UT 84130 8005070544 8005070544 711 711 8004079069 8004079069 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5422 007 0 2021 Anthem MediBlue Dual Advantage (HMO D-SNP) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790552 8556790552 711 711 8448876355 8448876355 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5422 008 0 2021 Anthem MediBlue Essential (HMO) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790553 8556790553 711 711 8556907797 8556907797 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H5422 011 0 2021 Anthem MediBlue Plus (HMO) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790553 8556790553 711 711 8556907797 8556907797 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5422 013 0 2021 Anthem MediBlue Extra (HMO) www.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790553 8556790553 711 711 8556907797 8556907797 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5422 014 0 2021 Anthem MediBlue Core (HMO) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790553 8556790553 711 711 8556907797 8556907797 711 711 H5422 803 0 2021 BlueValue (HMO) www.bcbsga.com/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H5422 804 0 2021 BlueValue (HMO) www.bcbsga.com/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H5422 808 0 2021 BlueValue (HMO) www.anthem.com/ga/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H5422 809 0 2021 BlueValue (HMO) www.anthem.com/ga/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H5425 001 0 2021 SCAN Classic (HMO) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 H5425 004 0 2021 Scripps Signature offered by SCAN Health Plan (HMO) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 H5425 005 0 2021 Scripps Classic offered by SCAN Health Plan (HMO) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 H5425 006 0 2021 SCAN Classic (HMO) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 H5425 007 0 2021 SCAN Classic (HMO) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 H5425 008 0 2021 SCAN Classic (HMO) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 H5425 009 0 2021 SCAN Classic (HMO) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 H5425 010 0 2021 SCAN Connections (HMO D-SNP) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8667226725 8667226725 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5425 019 0 2021 SCAN Classic (HMO) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 H5425 020 0 2021 SCAN Classic (HMO) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 H5425 028 0 2021 SCAN Heart First (HMO C-SNP) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 H5425 030 0 2021 SCAN Connections at Home (HMO D-SNP) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8667226725 8667226725 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5425 033 0 2021 SCAN Heart First (HMO C-SNP) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 H5425 034 0 2021 SCAN Balance (HMO C-SNP) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 H5425 040 0 2021 Scripps Plus offered by SCAN Health Plan (HMO) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5425 045 0 2021 SCAN Plus (HMO) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5425 052 0 2021 SCAN Classic (HMO) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 H5425 053 0 2021 SCAN Heart First (HMO C-SNP) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 H5425 054 0 2021 SCAN Balance (HMO C-SNP) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 H5425 055 0 2021 Scripps Heart First offered by SCAN Health Plan (HMO C-SNP) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 H5425 064 0 2021 SCAN Classic II (HMO) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 H5425 065 0 2021 SCAN Prime (HMO) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 H5425 066 0 2021 SCAN Prime (HMO) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 H5425 067 0 2021 SCAN Prime (HMO) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 H5425 068 0 2021 SCAN Prime (HMO) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 H5425 069 0 2021 SCAN Classic (HMO) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 H5425 070 0 2021 SCAN Balance (HMO C-SNP) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 H5425 071 0 2021 SCAN Plus (HMO) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5425 072 0 2021 SCAN Plus (HMO) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5425 073 0 2021 SCAN Options (HMO) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 H5425 074 0 2021 SCAN Compass (HMO) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 H5425 803 0 2021 SCAN Retiree Group (HMO) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 H5425 804 0 2021 SCAN Retiree Group (HMO) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 H5427 052 0 2021 Freedom Savings Plan (HMO) www.FreedomHealth.com member_services@freedomh.com 5403 N. Church Ave. Tampa FL 33614 8883009318 8135066133 711 711 8004012740 8004012740 711 711 H5427 059 0 2021 Freedom Medicare Plan Rx (HMO) www.FreedomHealth.com member_services@freedomh.com 5403 N. Church Ave. Tampa FL 33614 8883009318 8135066133 711 711 8004012740 8004012740 711 711 H5427 060 0 2021 Freedom Medicare Plan Rx (HMO) www.FreedomHealth.com member_services@freedomh.com 5403 N. Church Ave. Tampa FL 33614 8883009318 8135066133 711 711 8004012740 8004012740 711 711 H5427 070 0 2021 Freedom VIP Care (HMO C-SNP) www.FreedomHealth.com member_services@freedomh.com 5403 N. Church Ave. Tampa FL 33614 8883009318 8135066133 711 711 8004012740 8004012740 711 711 H5427 072 0 2021 Freedom VIP Savings (HMO C-SNP) www.FreedomHealth.com member_services@freedomh.com 5403 N. Church Ave. Tampa FL 33614 8883009318 8135066133 711 711 8004012740 8004012740 711 711 H5427 077 0 2021 Freedom VIP Savings COPD (HMO C-SNP) www.FreedomHealth.com member_services@freedomh.com 5403 N. Church Ave. Tampa FL 33614 8883009318 8135066133 711 711 8004012740 8004012740 711 711 H5427 078 0 2021 Freedom Medi-Medi Partial (HMO D-SNP) www.FreedomHealth.com member_services@freedomh.com 5403 N. Church Ave. Tampa FL 33614 8883009318 8135066133 711 711 8004012740 8004012740 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5427 082 0 2021 Freedom VIP Savings (HMO C-SNP) www.FreedomHealth.com member_services@freedomh.com 5403 N. Church Ave. Tampa FL 33614 8883009318 8135066133 711 711 8004012740 8004012740 711 711 H5427 083 0 2021 Freedom VIP Savings COPD (HMO C-SNP) www.FreedomHealth.com member_services@freedomh.com 5403 N. Church Ave. Tampa FL 33614 8883009318 8135066133 711 711 8004012740 8004012740 711 711 H5427 087 0 2021 Freedom Medi-Medi Full (HMO D-SNP) www.FreedomHealth.com member_services@freedomh.com 5403 N. Church Ave. Tampa FL 33614 8883009318 8135066133 711 711 8004012740 8004012740 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5427 088 0 2021 Freedom Platinum Plan Rx (HMO) http://www.FreedomHealth.com member_services@freedomh.com 5403 N. Church Ave. Tampa FL 33614 8883009318 8135066133 711 711 8004012740 8004012740 711 711 H5427 089 0 2021 Freedom Platinum Plan Rx (HMO) http://www.FreedomHealth.com member_services@freedomh.com 5403 N. Church Ave. Tampa FL 33614 8883009318 8135066133 711 711 8004012740 8004012740 711 711 H5427 091 0 2021 Freedom Platinum Plan Rx (HMO) http://www.FreedomHealth.com member_services@freedomh.com 5403 N. Church Ave. Tampa FL 33614 8883009318 8135066133 711 711 8004012740 8004012740 711 711 H5427 092 0 2021 Freedom Platinum Plan Rx (HMO) http://www.FreedomHealth.com member_services@freedomh.com 5403 N. Church Ave. Tampa FL 33614 8883009318 8135066133 711 711 8004012740 8004012740 711 711 H5427 093 0 2021 Freedom Platinum Plan Rx (HMO) http://www.FreedomHealth.com member_services@freedomh.com 5403 N. Church Ave. Tampa FL 33614 8883009318 8135066133 711 711 8004012740 8004012740 711 711 H5427 094 0 2021 Freedom Platinum Plan Rx (HMO) http://www.FreedomHealth.com member_services@freedomh.com 5403 N. Church Ave. Tampa FL 33614 8883009318 8135066133 711 711 8004012740 8004012740 711 711 H5427 096 0 2021 Freedom Platinum Rewards Plan Rx (HMO) http://www.FreedomHealth.com member_services@freedomh.com 5403 N. Church Ave. Tampa FL 33614 8883009318 8135066133 711 711 8004012740 8004012740 711 711 H5427 098 0 2021 Freedom Platinum Plan Rx (HMO) www.FreedomHealth.com member_services@freedomh.com 5403 N. Church Ave. Tampa FL 33614 8883009318 8135066133 711 711 8004012740 8004012740 711 711 H5427 099 0 2021 Freedom VIP Rewards (HMO C-SNP) www.FreedomHealth.com member_services@freedomh.com 5403 N. Church Ave. Tampa FL 33614 8883009318 8135066133 711 711 8004012740 8004012740 711 711 H5427 102 0 2021 Freedom Platinum Rewards Plan Rx (HMO) http://www.FreedomHealth.com member_services@freedomh.com 5403 N. Church Ave. Tampa FL 33614 8883009318 8135066133 711 711 8004012740 8004012740 711 711 H5427 103 0 2021 Freedom Platinum Rewards Plan Rx (HMO) http://www.FreedomHealth.com member_services@freedomh.com 5403 N. Church Ave. Tampa FL 33614 8883009318 8135066133 711 711 8004012740 8004012740 711 711 H5430 001 0 2021 WellCare Liberty (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5431 001 0 2021 HealthSun HealthAdvantage Plan (HMO) www.HealthSun.com HSComplianceTeam@Healthsun.com 9250 W. Flagler Street, Suite 600 Miami FL 33174 8555730370 8555730370 711 711 8773362069 3054474458 8772060500 8772060500 H5431 006 0 2021 HealthSun MediMax (HMO) www.HealthSun.com HSComplianceTeam@HealthSun.com 9250 W. Flagler Street, Suite 600 Miami FL 33174 8555730370 8555730370 711 711 8773362069 3054474458 8772060500 8772060500 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5431 012 0 2021 HealthSun HealthAdvantage Plan (HMO) www.HealthSun.com HSComplianceTeam@HealthSun.com 9250 W. Flagler Street, Suite 600 Miami FL 33174 8555730370 8555730370 711 711 8773362069 3054474458 8772060500 8772060500 H5431 013 0 2021 HealthSun HealthAdvantage Plan (HMO) www.HealthSun.com cms_compliance@Healthsun.com 9250 W. Flagler Street, Suite 600 Miami FL 33174 8555730370 8555730370 711 711 8773362069 3054474458 8772060500 8772060500 H5431 014 0 2021 HealthSun MediMax (HMO) www.HealthSun.com HSComplianceTeam@HealthSun.com 9250 W. Flagler Street, Suite 600 Miami FL 33174 8555730370 8555730370 711 711 8773362069 3054474458 8772060500 8772060500 This plan does not charge an annual deductible for all drugs. The $435.00 annual deductible only applies to drugs on certain tiers.~ H5431 015 0 2021 HealthSun MediSun Plus (HMO D-SNP) www.HealthSun.com HSComplianceTeam@HealthSun.com 9250 W. Flagler Street, Suite 600 Miami FL 33174 8555730368 8555730368 711 711 8773362069 3054474458 8772060500 8772060500 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5431 016 0 2021 HealthSun MediSun Plus (HMO D-SNP) www.HealthSun.com HSComplianceTeam@HealthSun.com 9250 W. Flagler Street, Suite 600 Miami FL 33174 8555730368 8555730368 711 711 8773362069 3054474458 8772060500 8772060500 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5433 001 0 2021 OneCare (HMO D-SNP) https://www.caloptima.org/en/ForMembers/OneCare 505 City Parkway West Orange CA 92868 8774122734 8774122734 711 711 8774122734 8774122734 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5434 002 0 2021 BlueMedicare Select (PPO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 This plan does not charge an annual deductible for all drugs. The $305.00 annual deductible only applies to drugs on certain tiers.~ H5434 023 0 2021 BlueMedicare Value (PPO) FloridaBlue.com/Medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5434 024 0 2021 BlueMedicare Value (PPO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5434 025 0 2021 BlueMedicare Value (PPO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5434 026 0 2021 BlueMedicare Value (PPO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5434 030 0 2021 BlueMedicare Value (PPO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5434 031 0 2021 BlueMedicare Value (PPO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5434 032 0 2021 BlueMedicare Value (PPO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 This plan's deductible only applies to out-of-network services.~ H5434 033 0 2021 BlueMedicare Value (PPO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5434 034 0 2021 BlueMedicare Value (PPO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5434 035 0 2021 BlueMedicare Value (PPO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5434 036 0 2021 BlueMedicare Value (PPO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5434 038 0 2021 BlueMedicare Patriot (PPO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 H5434 801 0 2021 BlueMedicare Group PPO (PPO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 200 / 4th Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 H5434 802 0 2021 BlueMedicare Group PPO (PPO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 200 / 4th Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 H5435 001 0 2021 UnitedHealthcare MedicareDirect Patriot (PFFS) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8665798774 8665798774 711 711 H5435 024 0 2021 UnitedHealthcare MedicareDirect Rx (PFFS) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8665798774 8665798774 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H5439 010 0 2021 Health Net Aqua (PPO) or.healthnetadvantage.com OR_MemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8884458913 8884458913 711 711 H5439 011 0 2021 Health Net Violet 1 (PPO) or.healthnetadvantage.com OR_MemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8884458913 8884458913 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H5439 015 0 2021 Health Net Violet 3 (PPO) or.healthnetadvantage.com OR_MemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8884458913 8884458913 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5439 017 0 2021 Health Net Violet 4 (PPO) or.healthnetadvantage.com OR_MemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8884458913 8884458913 711 711 This plan does not charge an annual deductible for all drugs. The $125.00 annual deductible only applies to drugs on certain tiers.~ H5439 018 0 2021 Health Net Violet 2 (PPO) or.healthnetadvantage.com OR_MemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8884458913 8884458913 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5439 019 0 2021 Health Net Violet 2 (PPO) or.healthnetadvantage.com OR_MemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8884458913 8884458913 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5439 801 0 2021 Health Net Medicare Advantage Employer (PPO) or.healthnetadvantage.com OR_MemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8884458913 8884458913 711 711 H5439 802 0 2021 Health Net Medicare Advantage Employer (PPO) or.healthnetadvantage.com OR_MemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8884458913 8884458913 711 711 H5439 803 0 2021 Health Net Medicare Advantage Employer (PPO) or.healthnetadvantage.com OR_MemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8884458913 8884458913 711 711 H5439 804 0 2021 Allwell Medicare (PPO) or.healthnetadvantage.com OR_MemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8884458913 8884458913 711 711 H5439 805 0 2021 Allwell Medicare (PPO) or.healthnetadvantage.com OR_MemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8884458913 8884458913 711 711 H5447 001 0 2021 CFHP Medicare Advantage with Part D Standard Plan (HMO) https://communityfirstmedicare.com/ 12238 Silicon Drive, Suite 100 San Antonio TX 78249 8334342347 2103586386 8003901175 2103586080 8334342347 2103586386 8003901175 2103586080 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H5447 002 0 2021 CFHP Medicare Advantage D-SNP Standard Plan (HMO D-SNP) https://www.CFHP.com/ 12238 Silicon Drive, Suite 100 San Antonio TX 78249 8334342347 2103586386 8003901175 2103586080 8334342347 2103586386 8003901175 2103586080 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5454 001 0 2021 Clear Spring Health Essential (HMO) www.clearspringhealthcare.com P.O. Box 278530 Miramar FL 33027 8773644566 8773644566 711 711 8773644566 8773644566 711 711 H5454 002 0 2021 Clear Spring Health Essential (HMO) www.clearspringhealthcare.com P.O. Box 278530 Miramar FL 33027 8773644566 8773644566 711 711 8773644566 8773644566 711 711 H5471 064 0 2021 Simply Complete (HMO D-SNP) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790554 8556790554 711 711 8775770115 8775770115 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5471 065 0 2021 Simply More (HMO) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790556 8556790556 711 711 8775770115 8775770115 711 711 H5471 066 0 2021 Simply Complete (HMO D-SNP) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790554 8556790554 711 711 8775770115 8775770115 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5471 067 0 2021 Simply Care (HMO I-SNP) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790557 8556790557 711 711 8775770115 8775770115 711 711 H5471 068 0 2021 Simply Comfort (HMO I-SNP) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790557 8556790557 711 711 8775770115 8775770115 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5471 069 0 2021 Simply Level (HMO C-SNP) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790558 8556790558 711 711 8775770115 8775770115 711 711 H5471 070 0 2021 Simply Level (HMO C-SNP) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790558 8556790558 711 711 8775770115 8775770115 711 711 H5471 071 0 2021 Simply More (HMO) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790556 8556790556 711 711 8775770115 8775770115 711 711 H5471 072 0 2021 Simply Complete (HMO D-SNP) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790554 8556790554 711 711 8775770115 8775770115 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5471 073 0 2021 Simply Level (HMO C-SNP) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790558 8556790558 711 711 8775770115 8775770115 711 711 H5471 074 0 2021 Simply More (HMO) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790556 8556790556 711 711 8775770115 8775770115 711 711 H5471 075 0 2021 Simply Level (HMO C-SNP) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790558 8556790558 711 711 8775770115 8775770115 711 711 H5471 076 0 2021 Simply Complete (HMO D-SNP) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790554 8556790554 711 711 8775770115 8775770115 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5471 077 0 2021 Simply More (HMO) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790556 8556790556 711 711 8775770115 8775770115 711 711 H5471 078 0 2021 Simply More (HMO) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790556 8556790556 711 711 8775770115 8775770115 711 711 H5471 079 0 2021 Simply Care (HMO I-SNP) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790557 8556790557 711 711 8775770115 8775770115 711 711 H5471 080 0 2021 Simply Level (HMO C-SNP) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790558 8556790558 711 711 8775770115 8775770115 711 711 H5471 081 0 2021 Simply Comfort (HMO I-SNP) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790557 8556790557 711 711 8775770115 8775770115 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5471 082 0 2021 Simply Complete (HMO D-SNP) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790554 8556790554 711 711 8775770115 8775770115 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5471 083 0 2021 Simply More (HMO) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790556 8556790556 711 711 8775770115 8775770115 711 711 H5471 084 0 2021 Simply Complete (HMO D-SNP) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790554 8556790554 711 711 8775770115 8775770115 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5471 085 0 2021 Simply Level (HMO C-SNP) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790558 8556790558 711 711 8775770115 8775770115 711 711 H5471 090 0 2021 Simply Care (HMO I-SNP) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790557 8556790557 711 711 8775770115 8775770115 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5471 091 0 2021 Simply Comfort (HMO I-SNP) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790557 8556790557 711 711 8775770115 8775770115 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5471 092 0 2021 Simply Care (HMO I-SNP) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790557 8556790557 711 711 8775770115 8775770115 711 711 H5471 093 0 2021 Simply Comfort (HMO I-SNP) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790557 8556790557 711 711 8775770115 8775770115 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5471 094 0 2021 Simply Care (HMO I-SNP) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790557 8556790557 711 711 8775770115 8775770115 711 711 H5471 095 0 2021 Simply Comfort (HMO I-SNP) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790557 8556790557 711 711 8775770115 8775770115 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5471 096 0 2021 Simply Care (HMO I-SNP) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790557 8556790557 711 711 8775770115 8775770115 711 711 H5471 097 0 2021 Simply Comfort (HMO I-SNP) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790557 8556790557 711 711 8775770115 8775770115 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5471 098 0 2021 Simply Select (HMO) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790556 8556790556 711 711 8775770115 8775770115 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5471 099 0 2021 Simply Select (HMO) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790556 8556790556 711 711 8775770115 8775770115 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5471 100 0 2021 Simply Select (HMO) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790556 8556790556 711 711 8775770115 8775770115 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5471 101 0 2021 Simply Select (HMO) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790556 8556790556 711 711 8775770115 8775770115 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5471 103 0 2021 Simply Extra (HMO) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790556 8556790556 711 711 8775770115 8775770115 711 711 H5471 104 0 2021 Simply Extra (HMO) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790556 8556790556 711 711 8775770115 8775770115 711 711 H5471 105 0 2021 Simply Extra (HMO) shop.simplyhealthcareplans.com/medicare Info@simplyhealthcareplans.com 9250 W Flagler Street, Suite 600 Miami FL 33174 8556790556 8556790556 711 711 8775770115 8775770115 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H5475 001 0 2021 WellCare Extra Plus (HMO-POS D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5475 003 0 2021 WellCare Elite (HMO-POS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H5475 004 0 2021 WellCare Extra Plus (HMO-POS D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5475 005 0 2021 WellCare Essential (HMO-POS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H5475 006 0 2021 WellCare Essential (HMO-POS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H5475 010 0 2021 WellCare Extra Plus (HMO-POS D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5475 011 0 2021 WellCare Essential (HMO-POS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H5475 019 0 2021 WellCare Essential (HMO-POS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H5475 021 0 2021 WellCare Extra Plus (HMO-POS D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5475 022 0 2021 WellCare Essential (HMO-POS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H5475 024 0 2021 WellCare Elite Smile (HMO-POS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H5475 026 0 2021 WellCare Explore (HMO-POS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H5475 029 0 2021 WellCare Guardian (HMO-POS C-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H5475 030 0 2021 WellCare Extra Plus (HMO-POS D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5475 031 0 2021 WellCare Dividend (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5475 032 0 2021 WellCare Dividend (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5475 033 0 2021 WellCare Exclusive (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H5475 034 0 2021 WellCare Exclusive (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H5475 035 0 2021 WellCare Extra Plus (HMO-POS D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5475 036 0 2021 WellCare Essential (HMO-POS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H5475 037 0 2021 WellCare Essential (HMO-POS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H5496 005 0 2021 Imperial Senior Value (HMO C-SNP) www.imperialhealthplan.com Members@imperialhealthplan.com 1100 East Green Street Pasadena CA 91106 8008385914 6267080333 711 711 8008388271 6267080333 711 711 H5496 007 0 2021 Imperial Traditional (HMO) www.imperialhealthplan.com Members@imperialhealthplan.com 1100 East Green Street Pasadena CA 91106 8008385914 6267080333 711 711 8008388271 6267080333 711 711 H5496 009 0 2021 Imperial Traditional Plus (HMO) www.imperialhealthplan.com Members@imperialhealthplan.com 1100 East Green Street Pasadena CA 91106 8008385914 6267080333 711 711 8008388271 6267080333 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5496 011 0 2021 Imperial Dual Plan (HMO D-SNP) www.imperialhealthplan.com Members@imperialhealthplan.com 1100 East Green Street Pasadena CA 91106 8008385914 6267080333 711 711 8008388271 6267080333 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5496 012 0 2021 Imperial Dynamic Plan (HMO) www.imperialhealthplan.com Members@imperialhealthplan.com 1100 East Green Street Pasadena CA 91106 8008385914 6267080333 711 711 8008388271 6267080333 711 711 H5521 012 0 2021 Aetna Medicare Premier Plus (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan's deductible only applies to out-of-network services.~ H5521 013 0 2021 Aetna Medicare Explorer Premier Plan (PPO) www.aetnamedicare.com hicksjs@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5521 015 0 2021 Aetna Medicare Premier Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5521 016 0 2021 Aetna Medicare Premier Plus (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 020 0 2021 Aetna Medicare Premier 2 (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan's deductible only applies to out-of-network services.~ H5521 022 0 2021 Aetna Medicare Select Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 027 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan's deductible only applies to out-of-network services.~ H5521 033 0 2021 Aetna Medicare Premier (PPO) www.aetnamedicare.com hicksjs@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5521 037 0 2021 Aetna Medicare Explorer Premier (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5521 040 0 2021 Aetna Medicare Premier Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5521 053 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan's deductible only applies to out-of-network services.~ H5521 055 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan's deductible only applies to out-of-network services.~ H5521 056 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan's deductible only applies to out-of-network services.~ H5521 057 0 2021 Aetna Medicare Prime (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 076 0 2021 Aetna Medicare Premier Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5521 077 0 2021 Aetna Medicare Premier Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5521 081 0 2021 Aetna Medicare Premier Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5521 082 0 2021 Aetna Medicare Essential Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5521 083 0 2021 Aetna Medicare Essential Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5521 084 0 2021 Aetna Medicare Essential Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan's deductible only applies to out-of-network services.~ H5521 085 0 2021 Aetna Medicare Value Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5521 086 0 2021 Aetna Medicare Value (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 087 0 2021 Aetna Medicare Value Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5521 088 0 2021 Aetna Medicare Value Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5521 089 0 2021 Aetna Medicare Value Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5521 090 0 2021 Aetna Medicare Value Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5521 091 0 2021 Aetna Medicare Essential Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H5521 095 0 2021 Aetna Medicare Premier Plus (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan's deductible only applies to out-of-network services.~ H5521 099 0 2021 Aetna Medicare Value (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 100 0 2021 Aetna Medicare Freedom Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan's deductible only applies to out-of-network services.~ H5521 101 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 102 0 2021 Aetna Medicare Essential Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5521 110 0 2021 Aetna Medicare Premier Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5521 116 0 2021 Aetna Medicare Freedom Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H5521 117 0 2021 Aetna Medicare Premier Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5521 118 0 2021 Aetna Medicare Elite Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5521 119 0 2021 Aetna Medicare Elite Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H5521 120 0 2021 Aetna Medicare Elite Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5521 121 0 2021 Aetna Medicare Premier Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5521 122 0 2021 Aetna Medicare Gold Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan's deductible only applies to out-of-network services.~ H5521 123 0 2021 Aetna Medicare SNJ Prime Elite (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H5521 124 0 2021 Aetna Medicare Explorer Premier 2 (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5521 125 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan's deductible only applies to out-of-network services.~ H5521 127 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan's deductible only applies to out-of-network services.~ H5521 128 0 2021 Aetna Medicare Select Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 134 0 2021 Aetna Medicare Premier 1 (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5521 139 0 2021 Aetna Medicare Value Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5521 140 0 2021 Aetna Medicare Premier Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5521 141 0 2021 Aetna Medicare Premier Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 142 0 2021 Aetna Medicare Explorer Plan (PPO) www.aetnamedicare.com hicksjs@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5521 143 0 2021 Aetna Medicare Explorer Plan (PPO) www.aetnamedicare.com hicksjs@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5521 144 0 2021 Aetna Medicare Explorer Plan (PPO) www.aetnamedicare.com hicksjs@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5521 150 0 2021 Aetna Medicare Premier (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5521 154 0 2021 Aetna Medicare Premier Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 156 0 2021 Aetna Medicare Value Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan's deductible only applies to out-of-network services.~ H5521 157 0 2021 Aetna Medicare Elite Plan (PPO) www.aetnamedicare.com hicksjs@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 159 0 2021 Aetna Medicare Explorer Plan (PPO) www.aetnamedicare.com hicksjs@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5521 160 0 2021 Aetna Medicare Explorer Plan (PPO) www.aetnamedicare.com hicksjs@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 168 0 2021 Aetna Medicare Essential Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5521 169 0 2021 Aetna Medicare Value Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5521 170 0 2021 Aetna Medicare Premier Plus Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5521 171 0 2021 Aetna Medicare Freedom Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5521 177 0 2021 Aetna Medicare Freedom Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5521 178 0 2021 Aetna Medicare Freedom Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H5521 184 0 2021 Aetna Medicare Platinum Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 187 0 2021 Aetna Medicare Premier (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 190 0 2021 Aetna Medicare Premier (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 194 0 2021 Aetna Medicare Premier (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 195 0 2021 Aetna Medicare Value (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5521 196 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H5521 197 0 2021 Aetna Medicare Value Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H5521 200 0 2021 Aetna Medicare Platinum Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H5521 205 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan's deductible only applies to out-of-network services.~ H5521 206 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan's deductible only applies to out-of-network services.~ H5521 207 0 2021 Aetna Medicare Prime (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 211 0 2021 Aetna Medicare Value (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 212 0 2021 Aetna Medicare Elite Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 214 0 2021 Aetna Medicare Value (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 215 0 2021 Aetna Medicare Premier Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H5521 216 0 2021 Aetna Medicare Freedom Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 217 0 2021 Aetna Medicare Premier Plus (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 218 0 2021 Aetna Medicare Freedom Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H5521 219 0 2021 Aetna Medicare Value (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 220 0 2021 Aetna Medicare Freedom Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H5521 221 0 2021 Aetna Medicare Explorer Premier Plan (PPO) www.aetnamedicare.com hicksjs@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 222 0 2021 Aetna Medicare Freedom Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5521 223 0 2021 Aetna Medicare Value (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 224 0 2021 Aetna Medicare Freedom Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5521 226 0 2021 Aetna Medicare Premier (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 227 0 2021 Aetna Medicare Freedom Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5521 228 0 2021 Aetna Medicare Explorer Value (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 229 0 2021 Aetna Medicare Eagle Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 230 0 2021 Aetna Medicare Freedom Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5521 231 0 2021 Aetna Medicare Value (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 232 0 2021 Aetna Medicare Freedom Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5521 233 0 2021 Aetna Medicare Freedom Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5521 234 0 2021 Aetna Medicare Freedom Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5521 235 0 2021 Aetna Medicare Eagle Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 236 0 2021 Aetna Medicare Premier Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5521 237 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 239 0 2021 Aetna Medicare Value Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5521 241 0 2021 Aetna Medicare Eagle Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 243 0 2021 Aetna Medicare Value Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5521 244 0 2021 Aetna Medicare Select Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 245 0 2021 Aetna Medicare Premier Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 246 0 2021 Aetna Medicare Elite Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 247 0 2021 Aetna Medicare Premier Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 249 0 2021 Aetna Medicare Premier Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5521 250 0 2021 Aetna Medicare Prime 1 (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 251 0 2021 Aetna Medicare Value Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5521 252 0 2021 Aetna Medicare Value Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H5521 253 0 2021 Aetna Medicare Elite Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 254 0 2021 Aetna Medicare Premier Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 259 0 2021 Aetna Medicare Value Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5521 260 0 2021 Aetna Medicare Value Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5521 261 0 2021 Aetna Medicare Value (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan's deductible only applies to out-of-network services.~ H5521 262 0 2021 Aetna Medicare Value (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5521 263 0 2021 Aetna Medicare Value (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan's deductible only applies to out-of-network services.~ H5521 266 0 2021 Aetna Medicare Value Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan's deductible only applies to out-of-network services.~ H5521 267 0 2021 Aetna Medicare Value Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5521 268 0 2021 Aetna Medicare Premier Plus (PPO) www.aetnamedicare.com hicksjs@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5521 269 0 2021 Aetna Medicare Premier Plus (PPO) www.aetnamedicare.com hicksjs@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5521 270 0 2021 Aetna Medicare Premier Plus (PPO) www.aetnamedicare.com hicksjs@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5521 271 0 2021 Aetna Medicare Premier Plus (PPO) www.aetnamedicare.com hicksjs@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5521 272 0 2021 Aetna Medicare Premier Plus (PPO) www.aetnamedicare.com hicksjs@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5521 273 0 2021 Aetna Medicare Premier Plus (PPO) www.aetnamedicare.com hicksjs@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5521 275 0 2021 Aetna Medicare Prime Premier (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5521 277 0 2021 Aetna Medicare Prime Credit (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5521 278 0 2021 Aetna Medicare Explorer Premier Plus (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5521 279 0 2021 Aetna Medicare Eagle Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 280 0 2021 Aetna Medicare Premier Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 281 0 2021 Aetna Medicare Value Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 282 0 2021 Aetna Medicare Premier (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 283 0 2021 Aetna Medicare Value (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 284 0 2021 Aetna Medicare Premier (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 285 0 2021 Aetna Medicare Value (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 286 0 2021 Aetna Medicare Eagle (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 288 0 2021 Aetna Medicare Value (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 289 0 2021 Aetna Medicare Value (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5521 290 0 2021 Aetna Medicare Elite Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 292 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan's deductible only applies to out-of-network services.~ H5521 293 0 2021 Aetna Medicare Elite Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 294 0 2021 Aetna Medicare St. Luke's Prime Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan's deductible only applies to out-of-network services.~ H5521 295 0 2021 Aetna Medicare Explorer Elite (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5521 296 0 2021 Aetna Medicare Eagle Plan (PPO) www.aetnamedicare.com hicksjs@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 298 0 2021 Aetna Medicare Explorer Premier (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5521 299 0 2021 Aetna Medicare Elite Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 300 0 2021 Aetna Medicare Select Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 301 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan's deductible only applies to out-of-network services.~ H5521 302 0 2021 Aetna Medicare Premier (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 303 0 2021 Aetna Medicare Elite Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 304 0 2021 Aetna Medicare Premier (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 305 0 2021 Aetna Medicare Premier Plus (PPO) www.aetnamedicare.com hicksjs@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5521 306 0 2021 Aetna Medicare Eagle (PPO) www.aetnamedicare.com hicksjs@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 307 0 2021 Aetna Medicare Premier (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 308 0 2021 Aetna Medicare Eagle (PPO) www.aetnamedicare.com hicksjs@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 309 0 2021 Aetna Medicare Elite Plan 2 (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H5521 310 0 2021 Aetna Medicare Elite Plan 3 (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H5521 311 0 2021 Aetna Medicare Value (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 312 0 2021 Aetna Medicare Value Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5521 313 0 2021 Aetna Medicare Credit Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5521 314 0 2021 Aetna Medicare DMG Prime (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 318 0 2021 Aetna Medicare Value Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H5521 319 0 2021 Aetna Medicare Premier Plus Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 320 0 2021 Aetna Medicare Eagle Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 321 0 2021 Aetna Medicare Premier Plus Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 322 0 2021 Aetna Medicare Eagle (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 323 0 2021 Aetna Medicare Eagle Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 324 0 2021 Aetna Medicare Eagle Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 326 0 2021 Aetna Medicare Value Plus Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H5521 328 0 2021 Aetna Medicare Value Plus Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H5521 329 0 2021 Aetna Medicare Eagle Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 330 0 2021 Aetna Medicare Eagle Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 14088 Lexington KY 40512 8338596031 8338596031 711 711 8002825366 8002825366 711 711 H5521 801 0 2021 Aetna Medicare Plan (PPO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H5521 802 0 2021 Aetna Medicare Plan w/Rx (PPO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H5521 809 0 2021 Aetna Medicare $10 Buy-Down Plan (PPO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H5521 810 0 2021 Aetna Medicare $10 Buy-Down Plan w/Rx (PPO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H5521 812 0 2021 Aetna Medicare $75 Buy-Down w/Rx Plan (PPO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H5521 817 0 2021 Aetna Medicare $75 Buy-Down Plan (PPO) www.aetnamedicare.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H5522 001 0 2021 Aetna Medicare Advantra Premier Plus (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan's deductible only applies to out-of-network services.~ H5522 002 0 2021 Aetna Medicare Advantra Premier Plus (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan's deductible only applies to out-of-network services.~ H5522 004 0 2021 Aetna Medicare Advantra Silver (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan's deductible only applies to out-of-network services.~ H5522 005 0 2021 Aetna Medicare Advantra Silver (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan's deductible only applies to out-of-network services.~ H5522 013 0 2021 Aetna Medicare Advantra Silver Plus (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan's deductible only applies to out-of-network services.~ H5522 014 0 2021 Aetna Medicare Advantra Premier Plus (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan's deductible only applies to out-of-network services.~ H5522 017 0 2021 Aetna Medicare Advantra Credit Value (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5522 018 0 2021 Aetna Medicare Advantra Premier (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan's deductible only applies to out-of-network services.~ H5522 802 0 2021 Aetna Medicare Plan (PPO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H5522 803 0 2021 Aetna Medicare Plan w/Rx (PPO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H5525 004 0 2021 HumanaChoice H5525-004 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5525 005 0 2021 HumanaChoice H5525-005 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5525 006 0 2021 HumanaChoice H5525-006 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5525 007 0 2021 HumanaChoice H5525-007 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5525 008 0 2021 HumanaChoice H5525-008 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $220.00 annual deductible only applies to drugs on certain tiers.~ H5525 015 0 2021 HumanaChoice H5525-015 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5525 017 0 2021 HumanaChoice H5525-017 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5525 020 0 2021 HumanaChoice H5525-020 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $360.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5525 022 0 2021 HumanaChoice H5525-022 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5525 023 0 2021 HumanaChoice H5525-023 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5525 024 0 2021 HumanaChoice H5525-024 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5525 026 0 2021 HumanaChoice H5525-026 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $265.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5525 027 0 2021 HumanaChoice H5525-027 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H5525 030 0 2021 HumanaChoice H5525-030 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H5525 031 0 2021 Humana Honor (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5525 034 0 2021 HumanaChoice H5525-034 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $190.00 annual deductible only applies to drugs on certain tiers.~ H5525 035 0 2021 HumanaChoice H5525-035 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $265.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H5525 036 0 2021 HumanaChoice SNP-DE H5525-036 (PPO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5525 037 0 2021 Humana Value Plus H5525-037 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~ H5525 038 0 2021 HumanaChoice H5525-038 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5525 039 0 2021 Humana Value Plus H5525-039 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~ H5525 040 0 2021 Humana Value Plus H5525-040 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $260.00 annual deductible only applies to drugs on certain tiers.~ H5525 041 0 2021 Humana Value Plus H5525-041 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $260.00 annual deductible only applies to drugs on certain tiers.~ H5525 042 0 2021 HumanaChoice H5525-042 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5525 044 0 2021 HumanaChoice H5525-044 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5525 045 0 2021 HumanaChoice SNP-DE H5525-045 (PPO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5525 046 0 2021 HumanaChoice SNP-DE H5525-046 (PPO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5525 047 0 2021 HumanaChoice H5525-047 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5525 048 0 2021 HumanaChoice SNP-DE H5525-048 (PPO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $425.00 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5525 049 0 2021 HumanaChoice H5525-049 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H5525 809 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H5525 810 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H5525 816 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 711 711 8663968810 8663968810 711 711 711 711 H5525 817 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 711 711 8663968810 8663968810 711 711 711 711 H5525 818 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 711 711 8663968810 8663968810 711 711 711 711 H5525 819 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 711 711 8663968810 8663968810 711 711 711 711 H5525 820 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 711 711 8663968810 8663968810 711 711 711 711 H5525 821 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 711 711 8663968810 8663968810 711 711 711 711 H5526 004 0 2021 BlueCross BlueShield Forever Blue 751 (PPO) www.bcbswny.com/medicare customerservice@bcbswny.com PO Box 80 Buffalo NY 14202 8002489296 8002489296 711 711 8003292792 8003292792 711 711 H5526 016 0 2021 BlueCross BlueShield Forever Blue Value (PPO) www.bcbswny.com/medicare customerservice@bcbswny.com PO Box 80 Buffalo NY 14202 8002489296 8002489296 711 711 8003292792 8003292792 711 711 H5526 018 0 2021 BlueShield Forever Blue 770 (PPO) www.bsneny.com/medicare customerservice@bsneny.com PO Box 15013 Albany NY 12214 8772587453 8772587453 711 711 8003292792 8003292792 711 711 H5526 020 0 2021 BlueCross BlueShield Freedom Nation (PPO) www.bcbswny.com/medicare customerservice@bcbswny.com PO Box 80 Buffalo NY 14202 8002489296 8002489296 711 711 8003292792 8003292792 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H5526 021 0 2021 BlueShield Freedom Nation (PPO) www.bsneny.com/medicare customerservice@bsneny.com PO Box 15013 Albany NY 12214 8772587453 8772587453 711 711 8003292792 8003292792 711 711 This plan does not charge an annual deductible for all drugs. The $375.00 annual deductible only applies to drugs on certain tiers.~ H5526 806 0 2021 PPO Group (MA Only) CY (PPO) www.nymedicare.com PO Box 80 Buffalo NY 14202 8552159237 8552159237 711 711 8003292792 8003292792 711 711 H5526 808 0 2021 PPO Group (MA-PD) CY (PPO) www.nymedicare.com PO Box 80 Buffalo NY 14202 8552159237 8552159237 711 711 8003292792 8003292792 711 711 H5528 807 0 2021 EmblemHealth Group Access Rx (PPO) www.emblemhealth.com/our-plans/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8665577300 8665577300 711 711 H5528 815 0 2021 EmblemHealth Group Access Rx Carveout (PPO) www.emblemhealth.com/our-plans/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8665577300 8665577300 711 711 H5533 003 0 2021 UPMC for Life PPO High Deductible with Rx (PPO) http://www.upmchealthplan.com/medicare/ upmchp@msx.upmc.edu 600 Grant Street Pittsburgh PA 15219 8773813765 8773813765 711 711 8775393080 8775393080 711 711 H5533 005 0 2021 UPMC for Life PPO Rx Enhanced (PPO) http://www.upmchealthplan.com/medicare/ upmchp@msx.upmc.edu 600 Grant Street Pittsburgh PA 15219 8773813765 8773813765 711 711 8775393080 8775393080 711 711 This plan's deductible only applies to out-of-network services.~ H5533 007 0 2021 UPMC for Life PPO Rx Enhanced (PPO) http://www.upmchealthplan.com/medicare/ upmchp@msx.upmc.edu 600 Grant Street Pittsburgh PA 15219 8773813765 8773813765 711 711 8448702231 8448702231 711 711 This plan's deductible only applies to out-of-network services.~ H5533 008 0 2021 UPMC for Life PPO Rx Enhanced (PPO) http://www.upmchealthplan.com/medicare/ upmchp@msx.upmc.edu 600 Grant Street Pittsburgh PA 15219 8773813765 8773813765 711 711 8775393080 8775393080 711 711 This plan's deductible only applies to out-of-network services.~ H5533 801 0 2021 UPMC Employer Group (PPO) http://www.upmchealthplan.com/medicare/ upmchp@msx.upmc.edu 600 Grant Street Pittsburgh PA 15219 8773813765 8773813765 711 711 8775393080 8775393080 711 711 H5533 802 0 2021 UPMC Employer Group Rx (PPO) http://www.upmchealthplan.com/medicare/ upmchp@msx.upmc.edu 600 Grant Street Pittsburgh PA 15219 8773813765 8773813765 711 711 8775393080 8775393080 711 711 H5533 803 0 2021 UPMC Employer Group Rx (PPO) http://www.upmchealthplan.com/medicare/ upmchp@msx.upmc.edu 600 Grant Street Pittsburgh PA 15219 8773813765 8773813765 711 711 8775393080 8775393080 711 711 H5549 003 0 2021 VNSNY CHOICE Total (HMO D-SNP) www.vnsnychoice.org 220 East 42nd Street, 3rd Floor New York NY 10017 8667831444 8667831444 711 711 8667831444 8667831444 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5576 008 0 2021 Vantage TRADITIONAL PLUS (HMO-POS) www.VantageMedicare.com 130 DeSiard St, Suite 300 Monroe LA 71201 8667040109 3183610900 1 8665245144 3183612131 8667040109 3183610900 1 8665245144 3183612131 H5576 017 1 2021 Vantage STANDARD (HMO-POS) www.VantageMedicare.com 130 DeSiard St, Suite 300 Monroe LA 71201 8667040109 3183610900 1 8665245144 3183612131 8667040109 3183610900 1 8665245144 3183612131 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H5576 017 2 2021 Vantage STANDARD (HMO-POS) www.VantageMedicare.com 130 DeSiard St, Suite 300 Monroe LA 71201 8667040109 3183610900 1 8665245144 3183612131 8667040109 3183610900 1 8665245144 3183612131 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H5576 018 1 2021 Vantage PREMIUM (HMO-POS) www.VantageMedicare.com 130 DeSiard St, Suite 300 Monroe LA 71201 8667040109 3183610900 1 8665245144 3183612131 8667040109 3183610900 1 8665245144 3183612131 H5576 018 2 2021 Vantage PREMIUM (HMO-POS) www.VantageMedicare.com 130 DeSiard St, Suite 300 Monroe LA 71201 8667040109 3183610900 1 8665245144 3183612131 8667040109 3183610900 1 8665245144 3183612131 H5576 019 0 2021 Vantage DUAL PLUS (HMO-POS D-SNP) www.VantageMedicare.com 130 DeSiard St, Suite 300 Monroe LA 71201 8667040109 3183610900 1 8665245144 3183612131 8667040109 3183610900 1 8665245144 3183612131 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5576 020 1 2021 Vantage BASIC (HMO-POS) www.VantageMedicare.com 130 DeSiard St, Suite 300 Monroe LA 71201 8667040109 3183610900 1 8665245144 3183612131 8667040109 3183610900 1 8665245144 3183612131 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5576 020 2 2021 Vantage BASIC (HMO-POS) www.VantageMedicare.com 130 DeSiard St, Suite 300 Monroe LA 71201 8667040109 3183610900 1 8665245144 3183612131 8667040109 3183610900 1 8665245144 3183612131 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5576 022 0 2021 Vantage 100 (HMO-POS) www.VantageMedicare.com 130 DeSiard St, Suite 300 Monroe LA 71201 8667040109 3183610900 1 8665245144 3183612131 8667040109 3183610900 1 8665245144 3183612131 H5576 801 0 2021 Vantage - MAPD Employer Calendar (HMO-POS) www.VantageMedicare.com 130 DeSiard St, Suite 300 Monroe LA 71201 8667040109 3183610900 1 8665245144 3183612131 8667040109 3183610900 1 8665245144 3183612131 H5576 802 0 2021 Vantage - MAPD Emp Non-Calendar (HMO-POS) www.VantageMedicare.com 130 DeSiard St, Suite 300 Monroe LA 71201 8667040109 3183610900 1 8665245144 3183612131 8667040109 3183610900 1 8665245144 3183612131 H5576 803 0 2021 Vantage - MA Employer Calendar (HMO-POS) www.VantageMedicare.com 130 DeSiard St, Suite 300 Monroe LA 71201 8667040109 3183610900 1 8665245144 3183612131 8667040109 3183610900 1 8665245144 3183612131 H5577 002 0 2021 MCS Classicare Platino Ideal (HMO D-SNP) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5577 005 0 2021 MCS Classicare Efectivo (HMO) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 H5577 008 0 2021 MCS Classicare Essential (HMO-POS) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 H5577 014 0 2021 MCS Classicare MediCa$h (HMO) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 H5577 016 0 2021 MCS Classicare MediOnlyNoRx (HMO) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 H5577 017 0 2021 MCS Classicare Platino Progreso (HMO D-SNP) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5577 028 0 2021 MCS Classicare Platino Clásico (HMO D-SNP) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5577 029 0 2021 MCS Classicare Platino MásCa$h (HMO D-SNP) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5577 031 0 2021 MCS Classicare Activo (HMO) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 H5577 036 0 2021 MCS Classicare Platino Recarga (HMO D-SNP) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5577 037 0 2021 MCS Classicare Platino @Home (HMO D-SNP) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5577 038 0 2021 MCS Classicare Primero (HMO C-SNP) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 H5577 039 0 2021 MCS Classicare SuperRx (HMO) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 H5577 040 0 2021 MCS Classicare AhorraRx (HMO) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 H5577 801 0 2021 MCS Classicare MA Group (HMO) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 H5577 802 0 2021 MCS Classicare MA-PD Group (HMO) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 H5577 809 0 2021 MCS Classicare MA-PD Group 2nd Formulary Opt. (HMO) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 H5577 816 0 2021 MCS Classicare MA-PD Group 2A (HMO) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 H5577 817 0 2021 MCS Classicare MA-PD Group 2B (HMO) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 H5577 818 0 2021 MCS Classicare MA-PD Group 2C (HMO) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 H5577 819 0 2021 MCS Classicare MA-PD Group 2D (HMO) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 H5577 820 0 2021 MCS Classicare MA-PD Group 2E (HMO) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 H5577 821 0 2021 MCS Classicare MA-PD Group 2F (HMO) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 H5577 822 0 2021 MCS Classicare MA-PD Group 2G (HMO) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 H5577 823 0 2021 MCS Classicare MA-PD Group 2H (HMO) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 H5577 824 0 2021 MCS Classicare MA-PD Group 2I (HMO) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 H5577 825 0 2021 MCS Classicare MA-PD Group 2J (HMO) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 H5577 826 0 2021 MCS Classicare MA-PD Group 2K (HMO) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 H5577 827 0 2021 MCS Classicare MA-PD Group 2L (HMO) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 H5577 828 0 2021 MCS Classicare MA-PD Group 2M (HMO) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 H5577 829 0 2021 MCS Classicare MA-PD Group 2N (HMO) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 H5577 830 0 2021 MCS Classicare MA-PD Group 2O (HMO) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 H5577 831 0 2021 MCS Classicare MA-PD Group 2P (HMO) www.mcsclassicare.com supervisorescustomercare@medicalcardsystem.com MCS Advantage, PO Box 191720 San Juan PR 00919 8666278181 7876202528 8666278182 8666278182 8666278183 7876202530 8666278182 8666278182 H5580 001 0 2021 Mercy Care Advantage (HMO D-SNP) www.MercyCareAz.org 4755 S. 44th Place Phoenix AZ 85040 8665715781 6024147630 711 711 8774365288 6025861730 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5580 004 0 2021 Mercy Care Advantage (HMO D-SNP) www.MercyCareAz.org 4755 S. 44th Place Phoenix AZ 85040 8665715781 6024147630 711 711 8774365288 6025861730 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5580 005 0 2021 Mercy Care Advantage (HMO D-SNP) www.MercyCareAz.org 4755 S. 44th Place Phoenix AZ 85040 8665715781 6024147630 711 711 8774365288 6025861730 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5587 002 0 2021 Health Choice Pathway (HMO D-SNP) https://www.healthchoicepathway.com comments@healthchoiceaz.com 410 N 44th Street, Suite 900 Phoenix AZ 85008 8006568991 8006568991 711 711 8006568991 8006568991 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5590 004 0 2021 Allwell Medicare (HMO) allwell.azcompletehealth.com AZ_InternetMemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8009777522 8009777522 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5590 005 0 2021 Allwell Medicare Essentials (HMO) allwell.azcompletehealth.com AZ_InternetMemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8009777522 8009777522 711 711 H5590 007 0 2021 Allwell Medicare Essentials I (HMO) allwell.azcompletehealth.com AZ_InternetMemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8009777522 8009777522 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5590 008 0 2021 Allwell Dual Medicare (HMO D-SNP) allwell.azcompletehealth.com AZ_InternetMemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8009777522 8009777522 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5591 001 0 2021 Martin's Point Generations Advantage Prime (HMO-POS) MartinsPoint.org/Advantage gamemberservices@martinspoint.org P.O. Box 9746, 331 Veranda Street Portland ME 04104 8886404423 8886404423 711 711 8665447504 8665447504 711 711 H5591 003 0 2021 Martin's Point Generations Advantage Alliance (HMO) MartinsPoint.org/Advantage gamemberservices@martinspoint.org P.O. Box 9746, 331 Veranda Street Portland ME 04104 8886404423 8886404423 711 711 8665447504 8665447504 711 711 H5591 005 0 2021 Martin's Point Generations Advantage Prime (HMO-POS) MartinsPoint.org/Advantage gamemberservices@martinspoint.org P.O. Box 9746, 331 Veranda Street Portland ME 04104 8886404423 8886404423 711 711 8665447504 8665447504 711 711 H5591 006 1 2021 Martin's Point Generations Advantage Prime (HMO-POS) MartinsPoint.org/Advantage gamemberservices@martinspoint.org P.O. Box 9746, 331 Veranda Street Portland ME 04104 8886404423 8886404423 711 711 8665447504 8665447504 711 711 H5591 006 2 2021 Martin's Point Generations Advantage Prime (HMO-POS) MartinsPoint.org/Advantage gamemberservices@martinspoint.org P.O. Box 9746, 331 Veranda Street Portland ME 04104 8886404423 8886404423 711 711 8665447504 8665447504 711 711 H5591 006 4 2021 Martin's Point Generations Advantage Prime (HMO-POS) MartinsPoint.org/Advantage gamemberservices@martinspoint.org P.O. Box 9746, 331 Veranda Street Portland ME 04104 8886404423 8886404423 711 711 8665447504 8665447504 711 711 H5591 007 0 2021 Martin's Point Generations Advantage Focus DC (HMO C-SNP) MartinsPoint.org/Advantage gamemberservices@martinspoint.org P.O. Box 9746, 331 Veranda Street Portland ME 04104 8886404423 8886404423 711 711 8665447504 8665447504 711 711 H5591 009 0 2021 Martin's Point Generations Advantage Value Plus (HMO) MartinsPoint.org/Advantage gamemberservices@martinspoint.org P.O. Box 9746, 331 Veranda Street Portland ME 04104 8886404423 8886404423 711 711 8665447504 8665447504 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H5591 013 0 2021 Martin's Point Generations Advantage Value Plus (HMO) MartinsPoint.org/Advantage gamemberservices@martinspoint.org PO Box 9746, 331 Veranda Street Portland ME 04104 8886404423 8886404423 711 711 8665447504 8665447504 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H5591 801 0 2021 Martin's Point Generations Advantage Prime Group (HMO-POS) MartinsPoint.org/Advantage P.O. Box 9746, 331 Veranda Street Portland ME 04104 8886404423 8886404423 711 711 8665447504 8665447504 711 711 H5591 802 0 2021 Martin's Point Generations Advantage Prime Group (HMO-POS) MartinsPoint.org/Advantage P.O. Box 9746, 331 Veranda Street Portland ME 04104 8886404423 8886404423 711 711 8665447504 8665447504 711 711 H5593 001 0 2021 Aetna Medicare Assure Premier (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5593 801 0 2021 Aetna Medicare Plan (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H5593 802 0 2021 Aetna Medicare Plan w/Rx (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H5594 001 0 2021 Optimum Gold Rewards Plan (HMO) www.YourOptimumHealthcare.com member_services@youroptimumhealthcare.com 5403 N. Church Ave. Tampa FL 33614 8883009317 8135066132 711 711 8662455360 8662455360 711 711 H5594 002 0 2021 Optimum Platinum Plan (HMO) www.YourOptimumHealthcare.com member_services@youroptimumhealthcare.com 5403 N. Church Ave. Tampa FL 33614 8883009317 8135066132 711 711 8662455360 8662455360 711 711 H5594 016 0 2021 Optimum Emerald Partial (HMO D-SNP) www.YourOptimumHealthcare.com member_services@youroptimumhealthcare.com 5403 N. Church Ave. Tampa FL 33614 8883009317 8135066132 711 711 8662455360 8662455360 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5594 017 0 2021 Optimum Emerald Full (HMO D-SNP) www.YourOptimumHealthcare.com member_services@youroptimumhealthcare.com 5403 N. Church Ave. Tampa FL 33614 8883009317 8135066132 711 711 8662455360 8662455360 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5594 019 0 2021 Optimum Platinum Plan (HMO) www.YourOptimumHealthcare.com member_services@youroptimumhealthcare.com 5403 N. Church Ave. Tampa FL 33614 8883009317 8135066132 711 711 8662455360 8662455360 711 711 H5594 022 0 2021 Optimum Gold Rewards Plan (HMO) www.YourOptimumHealthcare.com member_services@youroptimumhealthcare.com 5403 N. Church Ave. Tampa FL 33614 8883009317 8135066132 711 711 8662455360 8662455360 711 711 H5594 026 0 2021 Optimum Gold Rewards Plan (HMO) www.YourOptimumHealthcare.com member_services@youroptimumhealthcare.com 5403 N. Church Ave. Tampa FL 33614 8883009317 8135066132 711 711 8662455360 8662455360 711 711 H5594 028 0 2021 Optimum Diamond Rewards (HMO C-SNP) www.YourOptimumHealthcare.com member_services@youroptimumhealthcare.com 5403 N. Church Ave. Tampa FL 33614 8883009317 8135066132 711 711 8662455360 8662455360 711 711 H5594 029 0 2021 Optimum Diamond Rewards COPD (HMO C-SNP) www.YourOptimumHealthcare.com member_services@youroptimumhealthcare.com 5403 N. Church Ave. Tampa FL 33614 8883009317 8135066132 711 711 8662455360 8662455360 711 711 H5594 030 0 2021 Optimum Diamond Rewards (HMO C-SNP) www.YourOptimumHealthcare.com member_services@youroptimumhealthcare.com 5403 N. Church Ave. Tampa FL 33614 8883009317 8135066132 711 711 8662455360 8662455360 711 711 H5594 031 0 2021 Optimum Diamond Rewards COPD (HMO C-SNP) www.YourOptimumHealthcare.com member_services@youroptimumhealthcare.com 5403 N. Church Ave. Tampa FL 33614 8883009317 8135066132 711 711 8662455360 8662455360 711 711 H5594 032 0 2021 Optimum Gold Plus Plan (HMO) www.YourOptimumHealthcare.com member_services@youroptimumhealthcare.com 5403 N. Church Ave. Tampa FL 33614 8883009317 8135066132 711 711 8662455360 8662455360 711 711 H5594 034 0 2021 Optimum Diamond Rewards (HMO C-SNP) www.YourOptimumHealthcare.com member_services@youroptimumhealthcare.com 5403 N. Church Ave. Tampa FL 33614 8883009317 8135066132 711 711 8662455360 8662455360 711 711 H5594 035 0 2021 Optimum Diamond Rewards COPD (HMO C-SNP) www.YourOptimumHealthcare.com member_services@youroptimumhealthcare.com 5403 N. Church Ave. Tampa FL 33614 8883009317 8135066132 711 711 8662455360 8662455360 711 711 H5599 001 0 2021 Fidelis Dual Advantage Flex (HMO D-SNP) fideliscare.org memberservices@fideliscare.org 95-25 Queens Boulevard Rego Park NY 11374 8449420040 8449420040 711 711 8002471447 8002471447 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5599 002 0 2021 Fidelis Medicare Advantage Flex (HMO-POS) fideliscare.org memberservices@fideliscare.org 95-25 Queens Boulevard Rego Park NY 11374 8449420040 8449420040 711 711 8002471447 8002471447 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5599 003 0 2021 Fidelis Medicaid Advantage Plus (HMO D-SNP) fideliscare.org memberservices@fideliscare.org 95-25 Queens Boulevard Rego Park NY 11374 8449420040 8449420040 711 711 8002471447 8002471447 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5599 004 0 2021 Fidelis Medicare $0 Premium (HMO) fideliscare.org memberservices@fideliscare.org 95-25 Queens Boulevard Rego Park NY 11374 8449420040 8449420040 711 711 8002471447 8002471447 711 711 H5599 005 0 2021 Fidelis Medicare Advantage without Rx (HMO-POS) fideliscare.org memberservices@fideliscare.org 95-25 Queens Boulevard Rego Park NY 11374 8449420040 8449420040 711 711 8002471447 8002471447 711 711 H5599 006 0 2021 Fidelis Dual Advantage (HMO D-SNP) fideliscare.org memberservices@fideliscare.org 95-25 Queens Boulevard Rego Park NY 11374 8449420040 8449420040 711 711 8002471447 8002471447 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5599 007 0 2021 Fidelis Medicare Advantage Flex (HMO-POS) fideliscare.org memberservices@fideliscare.org 95-25 Queens Boulevard Rego Park NY 11374 8449420040 8449420040 711 711 8002471447 8002471447 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5599 008 0 2021 Fidelis Medicaid Advantage Plus (HMO D-SNP) fideliscare.org memberservices@fideliscare.org 95-25 Queens Boulevard Rego Park NY 11374 8449420040 8449420040 711 711 8002471447 8002471447 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5599 009 0 2021 Fidelis Medicare $0 Premium (HMO) fideliscare.org memberservices@fideliscare.org 95-25 Queens Boulevard Rego Park NY 11374 8449420040 8449420040 711 711 8002471447 8002471447 711 711 H5599 801 0 2021 Fidelis Medicare Advantage Employer without RX (HMO-POS) fideliscare.org/ memberservices@fideliscare.org 95-25 Queens Boulevard Rego Park NY 11374 8449420040 8449420040 711 711 8002471447 8002471447 711 711 H5599 802 0 2021 Fidelis Medicare Advantage Employer (HMO-POS) fideliscare.org/ memberservices@fideliscare.org 95-25 Queens Boulevard Rego Park NY 11374 8449420040 8449420040 711 711 8002471447 8002471447 711 711 H5599 803 0 2021 Fidelis Medicare Advantage Employer (HMO-POS) fideliscare.org/ memberservices@fideliscare.org 95-25 Queens Boulevard Rego Park NY 11374 8449420040 8449420040 711 711 8002471447 8002471447 711 711 H5608 001 0 2021 Denver Health Medicare Choice (HMO D-SNP) www.denverhealthmedicalplan.org 777 Bannock Street, mail code 6000 Denver CO 80204 8779562111 3036022111 711 711 8779562111 3036022111 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5608 002 0 2021 Denver Health Medicare Select (HMO) www.denverhealthmedicalplan.org 777 Bannock Street, mail code 6000 Denver CO 80204 8779562111 3036022111 711 711 8779562111 3036022111 711 711 H5608 802 0 2021 Denver Health Medical Plan Medicare Advantage (HMO) www.denverhealthmedicalplan.org 777 Bannock Street, mail code 6000 Denver CO 80204 8779562111 3036022111 711 711 8779562111 3036022111 711 711 H5619 001 0 2021 Humana Gold Plus H5619-001 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~ H5619 003 0 2021 Humana Gold Plus SNP-DE H5619-003 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5619 012 0 2021 Humana Gold Plus H5619-012 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 013 0 2021 Humana Gold Plus H5619-013 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 015 0 2021 Humana Gold Plus H5619-015 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 016 0 2021 Humana Gold Plus H5619-016 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 021 0 2021 Humana Gold Plus H5619-021 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 026 0 2021 Humana Gold Plus H5619-026 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5619 029 0 2021 Humana Gold Plus H5619-029 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~ H5619 032 0 2021 Humana Gold Plus H5619-032 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 037 0 2021 Humana Value Plus H5619-037 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5619 038 0 2021 Humana Gold Plus SNP-DE H5619-038 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5619 039 1 2021 Humana Gold Plus H5619-039 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 039 2 2021 Humana Gold Plus H5619-039 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 041 0 2021 Humana Gold Plus H5619-041 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $215.00 annual deductible only applies to drugs on certain tiers.~ H5619 044 0 2021 Humana Gold Plus H5619-044 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $265.00 annual deductible only applies to drugs on certain tiers.~ H5619 045 0 2021 Humana Gold Plus H5619-045 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $160.00 annual deductible only applies to drugs on certain tiers.~ H5619 046 0 2021 Humana Gold Plus - Diabetes and Heart (HMO C-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5619 047 0 2021 Humana Gold Plus H5619-047 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 049 0 2021 Humana Gold Plus H5619-049 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 050 0 2021 Humana Gold Plus H5619-050 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $125.00 annual deductible only applies to drugs on certain tiers.~ H5619 051 0 2021 Humana Gold Plus H5619-051 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 052 0 2021 Humana Gold Plus H5619-052 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 053 0 2021 Humana Gold Plus H5619-053 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H5619 054 0 2021 Humana Gold Plus SNP-DE H5619-054 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5619 055 0 2021 Humana Gold Plus - Diabetes and Heart (HMO C-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5619 056 0 2021 Humana Gold Plus H5619-056 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H5619 057 0 2021 Humana Gold Plus H5619-057 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H5619 059 0 2021 Humana Gold Plus H5619-059 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $50.00 annual deductible only applies to drugs on certain tiers.~ H5619 060 0 2021 Humana Gold Plus H5619-060 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5619 061 0 2021 Humana Gold Plus H5619-061 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $50.00 annual deductible only applies to drugs on certain tiers.~ H5619 062 0 2021 Humana Gold Plus H5619-062 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $160.00 annual deductible only applies to drugs on certain tiers.~ H5619 063 0 2021 Humana Gold Plus H5619-063 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5619 064 0 2021 Humana Gold Plus H5619-064 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5619 065 0 2021 Humana Value Plus H5619-065 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5619 066 0 2021 Humana Gold Plus H5619-066 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $355.00 annual deductible only applies to drugs on certain tiers.~ H5619 069 0 2021 Humana Gold Plus H5619-069 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H5619 071 0 2021 Humana Gold Plus H5619-071 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 073 0 2021 Humana Gold Plus H5619-073 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 075 0 2021 Humana Gold Plus SNP-DE H5619-075 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5619 076 0 2021 Humana Gold Plus SNP-DE H5619-076 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5619 077 0 2021 Humana Gold Plus H5619-077 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5619 078 0 2021 Humana Gold Plus H5619-078 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $320.00 annual deductible only applies to drugs on certain tiers.~ H5619 080 0 2021 Humana Gold Plus H5619-080 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H5619 082 0 2021 Humana Gold Plus SNP-DE H5619-082 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5619 083 0 2021 Humana Gold Plus H5619-083 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8335022012 8335022012 711 711 This plan does not charge an annual deductible for all drugs. The $245.00 annual deductible only applies to drugs on certain tiers.~ H5619 086 0 2021 Humana Gold Plus H5619-086 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 087 0 2021 Humana Gold Plus - Diabetes and Heart (HMO C-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H5619 088 0 2021 Humana Gold Plus H5619-088 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 089 0 2021 Humana Gold Plus H5619-089 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 090 0 2021 Humana Gold Plus H5619-090 (HMO-POS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 091 0 2021 Humana Gold Plus H5619-091 (HMO-POS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 093 0 2021 Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5619 094 0 2021 Humana Gold Plus H5619-094 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 095 0 2021 Humana Gold Plus H5619-095 (HMO-POS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 097 0 2021 Humana Gold Plus H5619-097 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $50.00 annual deductible only applies to drugs on certain tiers.~ H5619 099 0 2021 Humana Gold Plus H5619-099 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5619 100 0 2021 Humana Gold Plus H5619-100 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H5619 101 0 2021 Humana Gold Plus H5619-101 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $50.00 annual deductible only applies to drugs on certain tiers.~ H5619 109 0 2021 Humana Value Plus H5619-109 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5619 111 0 2021 Humana Gold Plus H5619-111 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 112 0 2021 Humana Gold Plus H5619-112 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 113 0 2021 Humana Gold Plus H5619-113 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 114 0 2021 Humana Gold Plus H5619-114 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H5619 115 0 2021 Humana Gold Plus H5619-115 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5619 116 0 2021 Humana Gold Plus H5619-116 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 118 0 2021 Humana Gold Plus H5619-118 (HMO) www.humana.com/medicare 500 West Main St. Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 119 0 2021 Humana Gold Plus H5619-119 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 120 0 2021 Humana Honor (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 121 0 2021 Humana Honor (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 122 0 2021 Humana Gold Plus H5619-122 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 123 0 2021 Humana Gold Plus SNP-DE H5619-123 (HMO D-SNP) www.humana.com/medicare 500 West Main St. Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5619 124 0 2021 Humana Gold Plus H5619-124 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 126 0 2021 Humana Gold Plus SNP-DE H5619-126 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5619 128 0 2021 Humana Gold Plus H5619-128 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 129 0 2021 Humana Gold Plus H5619-129 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H5619 130 1 2021 Humana Gold Plus H5619-130 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 130 2 2021 Humana Gold Plus H5619-130 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 131 0 2021 UC San Diego Health Humana (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 132 1 2021 Humana Gold Plus H5619-132 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 132 2 2021 Humana Gold Plus H5619-132 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 133 0 2021 Humana Gold Plus H5619-133 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5619 134 0 2021 Humana Value Plus H5619-134 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 135 0 2021 Humana Gold Plus H5619-135 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5619 136 1 2021 Humana Gold Plus SNP-DE H5619-136 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5619 136 2 2021 Humana Gold Plus SNP-DE H5619-136 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5619 136 3 2021 Humana Gold Plus SNP-DE H5619-136 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5619 136 4 2021 Humana Gold Plus SNP-DE H5619-136 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5619 137 0 2021 Humana Gold Plus H5619-137 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~ H5619 802 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H5619 803 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H5619 805 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H5619 806 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H5628 001 0 2021 Molina Medicare Complete Care (HMO D-SNP) www.molinahealthcare.com/medicare 200 Oceangate, Suite 100 Long Beach CA 90802 8664038293 8664038293 711 711 8886651328 8886651328 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5628 007 0 2021 Molina Medicare Choice Care (HMO) www.molinahealthcare.com/medicare 200 Oceangate, Suite 100 Long Beach CA 90802 8664038293 8664038293 711 711 8776440344 8776440344 711 711 H5628 008 0 2021 Molina Medicare Complete Care (HMO D-SNP) www.molinahealthcare.com/medicare 200 Oceangate, Suite 100 Long Beach CA 90802 8664038293 8664038293 711 711 8442394913 8442394913 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5628 009 0 2021 Molina Medicare Choice Care (HMO) www.molinahealthcare.com/medicare 200 Oceangate, Suite 100 Long Beach CA 90802 8664038293 8664038293 711 711 8445609811 8445609811 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H5628 010 0 2021 Molina Medicare Choice Care (HMO) www.molinahealthcare.com/medicare 200 Oceangate, Suite 100 Long Beach CA 90802 8664038293 8664038293 711 711 8445609811 8445609811 711 711 This plan does not charge an annual deductible for all drugs. The $125.00 annual deductible only applies to drugs on certain tiers.~ H5644 002 0 2021 Network Health Medicare Explore (HMO) https://networkhealth.com/ 1570 Midway Place, P.O. Box 120 Menasha WI 54952 8009837587 9207201280 8009473529 8009473529 8003785234 9207201345 8009473529 8009473529 This plan does not charge an annual deductible for all drugs. The $260.00 annual deductible only applies to drugs on certain tiers.~ H5649 001 0 2021 Central Health Medicare Plan (HMO) www.centralhealthplan.com memberservices@centralhealthplan.com 1540 Bridgegate Drive Diamond Bar CA 91765 8663142427 6263882390 711 711 8663142427 6263882390 711 711 H5649 002 0 2021 Central Health Medi-Medi Plan (HMO D-SNP) www.centralhealthplan.com memberservices@centralhealthplan.com 1540 Bridgegate Drive Diamond Bar CA 91765 8663142427 6263882390 711 711 8663142427 6263882390 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5649 004 0 2021 Central Health Premier Plan (HMO) www.centralhealthplan.com memberservices@centralhealthplan.com 1540 Bridgegate Drive Diamond Bar CA 91765 8663142427 6263882390 711 711 8663142427 6263882390 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5649 006 0 2021 Central Health Focus Plan (HMO C-SNP) www.centralhealthplan.com memberservices@centralhealthplan.com 1540 Bridgegate Drive Diamond Bar CA 91765 8663142427 6263882390 711 711 8663142427 6263882390 711 711 H5649 008 0 2021 Central Health Ventura Medicare Plan (HMO) www.centralhealthplan.com memberservices@centralhealthplan.com 1540 Bridgegate Drive Diamond Bar CA 91765 8663142427 6263882390 711 711 8663142427 6263882390 711 711 H5649 009 0 2021 Central Health Ventura Medi-Medi Plan (HMO D-SNP) www.centralhealthplan.com memberservices@centralhealthplan.com 1540 Bridgegate Drive Diamond Bar CA 91765 8663142427 6263882390 711 711 8663142427 6263882390 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5652 001 0 2021 Erickson Advantage Signature with Drugs (HMO-POS) www.EricksonAdvantage.com P.O. Box 30770 Salt Lake City UT 84130 8667749671 8667749671 711 711 8663148188 8663148188 711 711 H5652 002 0 2021 Erickson Advantage Liberty without Drugs (HMO-POS) www.EricksonAdvantage.com P.O. Box 30770 Salt Lake City UT 84130 8667749671 8667749671 711 711 8663148188 8663148188 711 711 H5652 003 0 2021 Erickson Advantage Guardian (HMO-POS I-SNP) www.EricksonAdvantage.com P.O. Box 30770 Salt Lake City UT 84130 8667749671 8667749671 711 711 8663148188 8663148188 711 711 H5652 004 0 2021 Erickson Advantage Champion (HMO-POS C-SNP) www.EricksonAdvantage.com P.O. Box 30770 Salt Lake City UT 84130 8667749671 8667749671 711 711 8663148188 8663148188 711 711 H5652 006 0 2021 Erickson Advantage Freedom (HMO-POS) www.EricksonAdvantage.com P.O. Box 30770 Salt Lake City UT 84130 8667749671 8667749671 711 711 8663148188 8663148188 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5652 008 0 2021 Erickson Advantage Liberty with Drugs (HMO-POS) www.EricksonAdvantage.com P.O. Box 30770 Salt Lake City UT 84130 8667749671 8667749671 711 711 8663148188 8663148188 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~ H5656 001 0 2021 WellCare TexanPlus Classic (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H5656 801 0 2021 Retiree - MA-PD CY (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H5656 802 0 2021 Retiree - MA-PD non-CY (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H5656 803 0 2021 Retiree - MA (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H5703 001 0 2021 AbilityCare (HMO D-SNP) www.mnscha.org members@mnscha.org South Country Health Alliance, 2300 Park Drive, Suite 100 Owatonna MN 55060 8665677242 8665677242 711 711 8665677242 8665677242 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5742 001 0 2021 FirstCare Advantage Dual SNP Premier (HMO D-SNP) www.firstcare.com/dualsnp cservice@firstcare.com 7005 Salem Park Drive, Suite 100 Lubbock TX 79424 8662294969 8662294969 711 711 8662294969 8662294969 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5742 002 0 2021 FirstCare Advantage Dual SNP Select (HMO D-SNP) www.firstcare.com/dualsnp cservice@firstcare.com 7005 Salem Park Drive, Suite 100 Lubbock TX 79424 8662294969 8662294969 711 711 8662294969 8662294969 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5746 016 0 2021 Amerivantage Care Access (HMO) https://shop.amerigroup.com/medicare/ Amerigroup New Mexico, 6565 Americas Parkway, NE, Suite 110 Albuquerque NM 87110 8556790559 8556790559 711 711 8668054589 8668054589 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5746 018 0 2021 Amerivantage Plus (HMO) https://shop.amerigroup.com/medicare/ Amerigroup New Mexico, 6565 Americas Parkway, NE, Suite 110 Albuquerque NM 87110 8556790559 8556790559 711 711 8668054589 8668054589 711 711 H5774 003 0 2021 Basic (HMO) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 H5774 005 0 2021 Real (HMO) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 H5774 022 0 2021 Contigo Plus (HMO C-SNP) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 H5774 024 0 2021 Platino Plus (HMO D-SNP) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5774 025 0 2021 Platino Ultra (HMO D-SNP) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5774 026 0 2021 Platino Advance (HMO D-SNP) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5774 027 0 2021 Magno (HMO-POS) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 H5774 028 0 2021 Platino Blindao (HMO D-SNP) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5774 031 0 2021 Brillante (HMO-POS) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 H5774 032 0 2021 Platino Enlace (HMO D-SNP) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5774 033 0 2021 Enlace (HMO) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 H5774 035 0 2021 Platino Alcance (HMO D-SNP) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5774 802 0 2021 Royal A (HMO) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 H5774 806 0 2021 Royal B (HMO) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 H5774 808 0 2021 Royal C (HMO) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 H5774 809 0 2021 Royal D (HMO-POS) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 H5774 810 0 2021 Royal E (HMO) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 H5774 811 0 2021 Royal Plus A (HMO-POS) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 H5774 812 0 2021 Employer BD 1 (HMO-POS) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 H5774 814 0 2021 Employer BD 3 (HMO-POS) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 H5774 816 0 2021 Employer BD 5 (HMO-POS) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 H5774 818 0 2021 Employer BD 7 (HMO-POS) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 H5774 820 0 2021 Employer BD 8 (HMO-POS) www.sssadvantage.com grmartinez@ssspr.com PO Box 11320 San Juan PR 00922 8332212234 8332212234 8666202520 8666202520 8886201919 8886201919 8666202520 8666202520 H5779 002 0 2021 WellCare Essential (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H5779 005 0 2021 WellCare Essential (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H5779 006 0 2021 WellCare Edge (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5779 007 0 2021 WellCare Exclusive (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H5793 001 0 2021 Aetna Medicare Value Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H5793 010 0 2021 Aetna Medicare Elite Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H5793 012 0 2021 Aetna Medicare Prime PCP Elite Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H5793 014 0 2021 Aetna Medicare Value Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5793 015 0 2021 Aetna Medicare Elite Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H5793 016 0 2021 Aetna Medicare Value Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 H5793 017 0 2021 Aetna Medicare Assure Plan (HMO-POS D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5793 018 0 2021 Aetna Medicare Value Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5793 801 0 2021 Aetna Medicare Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H5793 802 0 2021 Aetna Medicare Plan w/Rx (HMO) www.aetnamedicare.com HicksJS@aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H5810 001 0 2021 Molina Medicare Complete Care (HMO D-SNP) www.molinahealthcare.com/medicare 200 Oceangate, Suite 100 Long Beach CA 90802 8664038293 8664038293 711 711 8006650898 8006650898 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5810 013 0 2021 Molina Medicare Complete Care (HMO D-SNP) www.molinahealthcare.com/medicare 200 Oceangate, Suite 100 Long Beach CA 90802 8664038293 8664038293 711 711 8006650898 8006650898 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5823 006 0 2021 Molina Medicare Complete Care (HMO D-SNP) www.molinahealthcare.com/medicare 200 Oceangate, Suite 100 Long Beach CA 90802 8664038293 8664038293 711 711 8006651029 8006651029 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5826 006 0 2021 Community Health Plan of WA MA No Rx Plan (HMO) www.medicare.chpw.org 1111 3rd Avenue, Suite 400 Seattle WA 98101 8009441247 8009441247 711 711 8009420247 8009420247 711 711 H5826 008 0 2021 Community Health Plan of WA MA Plan 3 (HMO) www.medicare.chpw.org 1111 3rd Avenue, Suite 400 Seattle WA 98101 8009441247 8009441247 711 711 8009420247 8009420247 711 711 H5826 009 0 2021 Community Health Plan of WA MA Plan 4 (HMO) www.medicare.chpw.org 1111 3rd Avenue, Suite 400 Seattle WA 98101 8009441247 8009441247 711 711 8009420247 8009420247 711 711 H5826 010 0 2021 Community Health Plan of WA MA Plan 2 (HMO) www.medicare.chpw.org 1111 3rd Avenue, Suite 400 Seattle WA 98101 8009441247 8009441247 711 711 8009420247 8009420247 711 711 H5826 014 0 2021 Community Health Plan of WA Dual Plan (HMO D-SNP) www.medicare.chpw.org 1111 3rd Avenue, Suite 400 Seattle WA 98101 8009441247 8009441247 711 711 8009420247 8009420247 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5826 016 0 2021 Community Health Plan of WA MA Plan 1 (HMO) www.medicare.chpw.org 1111 3rd Avenue, Suite 400 Seattle WA 98101 8009441247 8009441247 711 711 8009420247 8009420247 711 711 This plan does not charge an annual deductible for all drugs. The $230.00 annual deductible only applies to drugs on certain tiers.~ H5828 001 0 2021 Amerivantage Full Dual Coordination (HMO D-SNP) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790560 8556790560 711 711 8337131074 8337131074 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5828 002 0 2021 Amerivantage Dual Premier (HMO D-SNP) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790560 8556790560 711 711 8337131074 8337131074 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5828 005 0 2021 Amerivantage Classic Plus (HMO-POS) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790561 8556790561 711 711 8337131073 8337131073 711 711 H5828 006 0 2021 Amerivantage Classic Plus (HMO-POS) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790561 8556790561 711 711 8337131073 8337131073 711 711 H5828 007 0 2021 Amerivantage Select Plus (HMO) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790562 8556790562 711 711 8337131073 8337131073 711 711 H5828 008 0 2021 Amerivantage Balance Plus (HMO) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8556790562 8556790562 711 711 8337131073 8337131073 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5841 001 0 2021 Bright Advantage Choice (PPO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5841 002 0 2021 Bright Advantage Choice Plus (PPO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H5841 003 0 2021 Bright Advantage Choice (PPO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H5841 004 0 2021 Bright Advantage Choice Plus (PPO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H5841 005 0 2021 Bright Advantage Choice (PPO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5841 010 0 2021 Bright Advantage Choice Plus (PPO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~ H5843 001 0 2021 Banner Medicare Advantage Prime (HMO) www.BannerMA.com 2701 E. Elvira Rd. Tucson AZ 85756 8445491858 6024620831 711 711 8445491857 6024620831 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H5843 002 0 2021 Banner Medicare Advantage Prime (HMO) www.BannerMA.com 2701 E. Elvira Rd. Tucson AZ 85756 8445491858 6024620831 711 711 8445491857 6024620831 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5852 001 0 2021 PHP (HMO C-SNP) www.php-ca.org php@positivehealthcare.org P.O. Box 46160 Los Angeles CA 90046 8002630067 8002630067 711 711 8002630067 8002630067 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5854 007 0 2021 Anthem MediBlue Plus (HMO) www.anthem.com/shop P.O. Box 659403 San Antonio TX 78265 8556790563 8556790563 711 711 8666734157 8666734157 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5854 008 0 2021 Anthem MediBlue Dual Advantage (HMO D-SNP) www.anthem.com/shop P.O. Box 659403 San Antonio TX 78265 8556790564 8556790564 711 711 8445332091 8445332091 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5854 009 0 2021 Anthem MediBlue Plus (HMO) www.anthem.com/shop P.O. Box 659403 San Antonio TX 78265 8556790563 8556790563 711 711 8666734157 8666734157 711 711 This plan does not charge an annual deductible for all drugs. The $380.00 annual deductible only applies to drugs on certain tiers.~ H5854 010 0 2021 Anthem MediBlue Select (HMO) www.anthem.com/shop mediblue@empireblue.com P.O. Box 659403 San Antonio TX 78265 8556790563 8556790563 711 711 8666734157 8666734157 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H5854 011 0 2021 Anthem MediBlue Extra (HMO) www.anthem.com/shop mediblue@empireblue.com P.O. Box 659403 San Antonio TX 78265 8556790563 8556790563 711 711 8444696744 8444696744 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5854 012 0 2021 Anthem MediBlue ESRD Care (HMO-POS C-SNP) www.anthem.com/shop mediblue@empireblue.com P.O. Box 659403 San Antonio TX 78265 8556790565 8556790565 711 711 8444696821 8444696821 711 711 This plan does not charge an annual deductible for all drugs. The $310.00 annual deductible only applies to drugs on certain tiers.~ H5854 013 0 2021 Anthem MediBlue Dual Advantage Select (HMO D-SNP) www.anthem.com/shop P.O. Box 659403 San Antonio TX 78265 8556790564 8556790564 711 711 8445332091 8445332091 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5854 014 0 2021 Anthem MediBlue Care To You (HMO I-SNP) www.anthem.com/shop 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8556790566 8556790566 711 711 8442095421 8442095421 711 711 H5854 015 0 2021 Anthem MediBlue Prime (HMO) www.anthem.com/shop P.O. Box 659403 San Antonio TX 78265 8556790563 8556790563 711 711 8666734157 8666734157 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5854 801 0 2021 Anthem MediBlue (HMO) www.anthem.com/ct/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H5854 803 0 2021 Anthem MediBlue (HMO) www.anthem.com/ct/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H5854 808 0 2021 Anthem MediBlue (HMO) www.anthem.com/ct/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H5854 809 0 2021 Anthem MediBlue (HMO) www.anthem.com/ct/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H5859 001 0 2021 CareOregon Advantage Plus (HMO-POS D-SNP) www.careoregonadvantage.org CareOregon Advantage, 315 SW Fifth Avenue Portland OR 97204 8887123258 5034164279 8007352900 711 8887123258 5034164279 8007352900 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5883 001 1 2021 BCN Advantage HMO-POS Elements (HMO-POS) www.bcbsm.com/medicare 20500 Civic Center Drive Southfield MI 48076 8554257720 8554257720 711 711 8004503680 8004503680 711 711 H5883 001 2 2021 BCN Advantage HMO-POS Elements (HMO-POS) www.bcbsm.com/medicare 20500 Civic Center Drive Southfield MI 48076 8554257720 8554257720 711 711 8004503680 8004503680 711 711 H5883 001 3 2021 BCN Advantage HMO-POS Elements (HMO-POS) www.bcbsm.com/medicare 20500 Civic Center Drive Southfield MI 48076 8554257720 8554257720 711 711 8004503680 8004503680 711 711 H5883 001 4 2021 BCN Advantage HMO-POS Elements (HMO-POS) www.bcbsm.com/medicare 20500 Civic Center Drive Southfield MI 48076 8554257720 8554257720 711 711 8004503680 8004503680 711 711 H5883 001 5 2021 BCN Advantage HMO-POS Elements (HMO-POS) www.bcbsm.com/medicare 20500 Civic Center Drive Southfield MI 48076 8554257720 8554257720 711 711 8004503680 8004503680 711 711 H5883 002 1 2021 BCN Advantage HMO-POS Classic (HMO-POS) www.bcbsm.com/medicare 20500 Civic Center Drive Southfield MI 48076 8554257720 8554257720 711 711 8004503680 8004503680 711 711 H5883 002 2 2021 BCN Advantage HMO-POS Classic (HMO-POS) www.bcbsm.com/medicare 20500 Civic Center Drive Southfield MI 48076 8554257720 8554257720 711 711 8004503680 8004503680 711 711 H5883 002 3 2021 BCN Advantage HMO-POS Classic (HMO-POS) www.bcbsm.com/medicare 20500 Civic Center Drive Southfield MI 48076 8554257720 8554257720 711 711 8004503680 8004503680 711 711 H5883 002 4 2021 BCN Advantage HMO-POS Classic (HMO-POS) www.bcbsm.com/medicare 20500 Civic Center Drive Southfield MI 48076 8554257720 8554257720 711 711 8004503680 8004503680 711 711 H5883 002 7 2021 BCN Advantage HMO-POS Classic (HMO-POS) www.bcbsm.com/medicare 20500 Civic Center Drive Southfield MI 48076 8554257720 8554257720 711 711 8004503680 8004503680 711 711 H5883 003 1 2021 BCN Advantage HMO-POS Prestige (HMO-POS) www.bcbsm.com/medicare 20500 Civic Center Drive Southfield MI 48076 8554257720 8554257720 711 711 8004503680 8004503680 711 711 H5883 003 2 2021 BCN Advantage HMO-POS Prestige (HMO-POS) www.bcbsm.com/medicare 20500 Civic Center Drive Southfield MI 48076 8554257720 8554257720 711 711 8004503680 8004503680 711 711 H5883 003 3 2021 BCN Advantage HMO-POS Prestige (HMO-POS) www.bcbsm.com/medicare 20500 Civic Center Drive Southfield MI 48076 8554257720 8554257720 711 711 8004503680 8004503680 711 711 H5883 003 4 2021 BCN Advantage HMO-POS Prestige (HMO-POS) www.bcbsm.com/medicare 20500 Civic Center Drive Southfield MI 48076 8554257720 8554257720 711 711 8004503680 8004503680 711 711 H5883 003 5 2021 BCN Advantage HMO-POS Prestige (HMO-POS) www.bcbsm.com/medicare 20500 Civic Center Drive Southfield MI 48076 8554257720 8554257720 711 711 8004503680 8004503680 711 711 H5883 007 0 2021 BCN Advantage HMO ConnectedCare (HMO) www.bcbsm.com/medicare 20500 Civic Center Drive Southfield MI 48076 8554257720 8554257720 711 711 8004503680 8004503680 711 711 H5883 012 1 2021 BCN Advantage Community Value (HMO-POS) www.bcbsm.com/medicare 20500 Civic Center Drive Southfield MI 48076 8554257720 8554257720 711 711 8004503680 8004503680 711 711 H5883 012 2 2021 BCN Advantage Community Value (HMO-POS) www.bcbsm.com/medicare 20500 Civic Center Drive Southfield MI 48076 8554257720 8554257720 711 711 8004503680 8004503680 711 711 H5883 014 1 2021 BCN Advantage Prime Value (HMO-POS) www.bcbsm.com/medicare 20500 Civic Center Drive Southfield MI 48076 8554257720 8554257720 711 711 8004503680 8004503680 711 711 This plan does not charge an annual deductible for all drugs. The $50.00 annual deductible only applies to drugs on certain tiers.~ H5883 014 2 2021 BCN Advantage Prime Value (HMO-POS) www.bcbsm.com/medicare 20500 Civic Center Drive Southfield MI 48076 8554257720 8554257720 711 711 8004503680 8004503680 711 711 This plan does not charge an annual deductible for all drugs. The $50.00 annual deductible only applies to drugs on certain tiers.~ H5883 014 3 2021 BCN Advantage Prime Value (HMO-POS) www.bcbsm.com/medicare 20500 Civic Center Drive Southfield MI 48076 8554257720 8554257720 711 711 8004503680 8004503680 711 711 This plan does not charge an annual deductible for all drugs. The $50.00 annual deductible only applies to drugs on certain tiers.~ H5883 014 4 2021 BCN Advantage Prime Value (HMO-POS) www.bcbsm.com/medicare 20500 Civic Center Drive Southfield MI 48076 8554257720 8554257720 711 711 8004503680 8004503680 711 711 This plan does not charge an annual deductible for all drugs. The $50.00 annual deductible only applies to drugs on certain tiers.~ H5883 014 5 2021 BCN Advantage Prime Value (HMO-POS) www.bcbsm.com/medicare 20500 Civic Center Drive Southfield MI 48076 8554257720 8554257720 711 711 8004503680 8004503680 711 711 This plan does not charge an annual deductible for all drugs. The $50.00 annual deductible only applies to drugs on certain tiers.~ H5883 801 0 2021 BCN Advantage (HMO-POS) www.bcbsm.com/medicare 20500 Civic Center Drive Southfield MI 48076 8009706684 8009706684 711 711 8004503680 8004503680 711 711 H5883 805 0 2021 BCN Advantage (HMO-POS) www.bcbsm.com/medicare 20500 Civic Center Drive Southfield MI 48076 8009706684 8009706684 711 711 8004503680 8004503680 711 711 H5926 001 0 2021 Molina Medicare Complete Care (HMO D-SNP) www.molinahealthcare.com/medicare 200 Oceangate, Suite 100 Long Beach CA 90802 8664038293 8664038293 711 711 8006653072 8006653072 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5926 004 0 2021 Molina Medicare Complete Care (HMO D-SNP) www.molinahealthcare.com/medicare 200 Oceangate, Suite 100 Long Beach CA 90802 8664038293 8664038293 711 711 8006653072 8006653072 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5928 004 0 2021 Blue Shield AdvantageOptimum Plan (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland Hills CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 H5928 005 0 2021 Blue Shield TotalDual Plan (HMO D-SNP) blueshieldca.com/medicare 6300 Canoga Avenue Woodland Hills CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5928 010 0 2021 Blue Shield AdvantageOptimum Plan 1 (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland Hills CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 H5928 016 0 2021 Blue Shield AdvantageOptimum Plan (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland Hills CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 H5928 037 0 2021 Blue Shield Coordinated Choice Plan (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland Hills CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5928 044 0 2021 Blue Shield AdvantageOptimum Plan (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland Hills CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 H5928 050 0 2021 Blue Shield AdvantageOptimum Plan (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland Hills CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H5928 051 0 2021 Blue Shield AdvantageOptimum Plan (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland Hills CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 H5928 052 0 2021 Blue Shield AdvantageOptimum Plan (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland Hills CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 H5928 053 0 2021 Blue Shield AdvantageOptimum Plan 2 (HMO) blueshieldca.com/medicare 6300 Canoga Avenue Woodland Hills CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 H5928 054 0 2021 Blue Shield Inspire (HMO D-SNP) blueshieldca.com/medicare 6300 Canoga Avenue Woodland Hills CA 91367 8885344263 8885344263 711 711 8007764466 8007764466 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5932 001 0 2021 Gateway Health Medicare Assured Diamond (HMO D-SNP) www.gatewayhealthplan.com medicareassured@gatewayhealthplan.com Four Gateway Center, 444 Liberty Avenue, Suite 2100 Pittsburgh PA 15222 8779352168 4122551193 711 711 8006855209 4122551323 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5932 009 0 2021 Gateway Health Medicare Assured Ruby (HMO D-SNP) www.gatewayhealthplan.com medicareassured@gatewayhealthplan.com Four Gateway Center, 444 Liberty Avenue, Suite 2100 Pittsburgh PA 15222 8779352168 4122551193 711 711 8006855209 4122551323 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5937 001 0 2021 UCare Connect + Medicare (HMO D-SNP) https://home.ucare.org PO Box 52 Minneapolis MN 55440 8776711065 6126766652 8006882534 6126766810 8552609707 6126763310 8006882534 6126766810 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5938 001 0 2021 Capital Health Plan Advantage Plus (HMO) www.capitalhealth.com/Medicare P.O. Box 15349 Tallahassee FL 32317 8772476512 8505237441 8778708943 8503833534 8772476512 8505237441 8778708943 8503833534 H5938 006 0 2021 Capital Health Plan Preferred Advantage (HMO) www.capitalhealth.com/Medicare P.O. Box 15349 Tallahassee FL 32317 8772476512 8505237441 8778708943 8503833534 8772476512 8505237441 8778708943 8503833534 H5938 008 0 2021 Capital Health Plan Silver Advantage (HMO) www.capitalhealth.com/Medicare P.O. Box 15349 Tallahassee FL 32317 8772476512 8505237441 8778708943 8503833534 8772476512 8505237441 8778708943 8503833534 H5938 802 0 2021 Capital Health Plan Retiree Advantage (HMO) www.capitalhealth.com/Medicare P.O. Box 15349 Tallahassee FL 32317 8772476512 8505237441 8778708943 8503833534 8772476512 8505237441 8778708943 8503833534 H5938 803 0 2021 Capital Health Plan Retiree Advantage (HMO) www.capitalhealth.com/Medicare P.O. Box 15349 Tallahassee FL 32317 8772476512 8505237441 8778708943 8503833534 8772476512 8505237441 8778708943 8503833534 H5938 804 0 2021 Capital Health Plan Retiree Advantage (HMO) www.capitalhealth.com/Medicare P.O. Box 15349 Tallahassee FL 32317 8772476512 8505237441 8778708943 8503833534 8772476512 8505237441 8778708943 8503833534 H5938 805 0 2021 805 Emp-only SOF Capital Health Plan Retiree Advan (HMO) www.capitalhealth.com/Medicare P.O. Box 15349 Tallahassee FL 32317 8772476512 8505237441 8778708943 8503833534 8772476512 8505237441 8778708943 8503833534 H5943 001 0 2021 VillageHealth (HMO-POS C-SNP) www.villagehealthca.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8779161234 8779161234 711 711 8003997226 8003997226 711 711 This plan does not charge an annual deductible for all drugs. The $370.00 annual deductible only applies to drugs on certain tiers.~ H5943 002 0 2021 VillageHealth (HMO-POS C-SNP) www.villagehealthca.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8779161234 8779161234 711 711 8003997226 8003997226 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5945 001 0 2021 Prominence Plus (HMO) www.prominencemedicare.com 1510 Meadow Wood Lane Reno NV 89502 8559695882 8559695882 711 711 8559695882 8559695882 711 711 H5945 002 0 2021 Prominence Plus (HMO) www.prominencemedicare.com 1510 Meadow Wood Lane Reno NV 89502 8559695882 8559695882 711 711 8559695882 8559695882 711 711 H5945 008 0 2021 Prominence Plus (HMO) www.prominencemedicare.com 1510 Meadow Wood Lane Reno NV 89502 8559695882 8559695882 711 711 8559695882 8559695882 711 711 H5945 801 0 2021 Prominence Health Plan (HMO) www.prominencemedicare.com 1510 Meadow Wood Lane Reno NV 89502 8559695882 8559695882 711 711 8559695882 8559695882 711 711 H5945 802 0 2021 Prominence Health Plan (HMO) www.prominencemedicare.com 1510 Meadow Wood Lane Reno NV 89502 8559695882 8559695882 711 711 8559695882 8559695882 711 711 H5959 007 1 2021 Blue Cross Medicare Advantage Choice MA Only (PPO) www.bluecrossmnonline.com 3400 Yankee Dr Eagan MN 55121 8555797658 6516629949 711 711 8007119865 6516625513 711 711 H5959 007 2 2021 Blue Cross Medicare Advantage Choice MA Only (PPO) www.bluecrossmnonline.com 3400 Yankee Dr Eagan MN 55121 8555797658 6516629949 711 711 8007119865 6516625513 711 711 H5959 008 0 2021 Blue Cross Medicare Advantage Choice MA Only (PPO) www.bluecrossmnonline.com 3400 Yankee Dr Eagan MN 55121 8555797658 6516629949 711 711 8007119865 6516625513 711 711 H5959 009 0 2021 Blue Cross Medicare Advantage Choice (PPO) www.bluecrossmnonline.com 3400 Yankee Dr Eagan MN 55121 8555797658 6516629949 711 711 8007119865 6516625513 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H5959 010 1 2021 Blue Cross Medicare Advantage Complete (PPO) www.bluecrossmnonline.com 3400 Yankee Dr Eagan MN 55121 8555797658 6516629949 711 711 8007119865 6516625513 711 711 H5959 010 2 2021 Blue Cross Medicare Advantage Complete (PPO) www.bluecrossmnonline.com 3400 Yankee Dr Eagan MN 55121 8555797658 6516629949 711 711 8007119865 6516625513 711 711 H5959 011 0 2021 Blue Cross Medicare Advantage Complete (PPO) www.bluecrossmnonline.com 3400 Yankee Dr Eagan MN 55121 8555797658 6516629949 711 711 8007119865 6516625513 711 711 H5959 012 0 2021 Blue Cross Medicare Advantage Core (PPO) www.bluecrossmnonline.com 3400 Yankee Dr Eagan MN 55121 8555797658 6516629949 711 711 8007119865 6516625513 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5959 013 1 2021 Blue Cross Medicare Advantage Core (PPO) www.bluecrossmnonline.com 3400 Yankee Dr Eagan MN 55121 8555797658 6516629949 711 711 8007119865 6516625513 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5959 013 2 2021 Blue Cross Medicare Advantage Core (PPO) www.bluecrossmnonline.com 3400 Yankee Dr Eagan MN 55121 8555797658 6516629949 711 711 8007119865 6516625513 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H5959 014 1 2021 Blue Cross Medicare Advantage Choice (PPO) www.bluecrossmnonline.com 3400 Yankee Dr Eagan MN 55121 8555797658 6516629949 711 711 8007119865 6516625513 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H5959 014 2 2021 Blue Cross Medicare Advantage Choice (PPO) www.bluecrossmnonline.com 3400 Yankee Dr Eagan MN 55121 8555797658 6516629949 711 711 8007119865 6516625513 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H5959 801 0 2021 Group EGWP MAPD (PPO) www.bluecrossmnonline.com 3400 Yankee Dr Eagan MN 55121 8555797658 6516629949 711 711 8007119865 6516625513 711 711 H5959 807 0 2021 Group EGWP Medical Only (PPO) www.bluecrossmnonline.com 3499 Yankee Drive Eagan MN 55121 8555797658 6516629949 711 711 8007119865 6516625513 711 711 H5965 001 0 2021 WellCare Prime (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H5965 002 0 2021 WellCare Premier (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5965 003 0 2021 WellCare Patriot (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H5969 002 0 2021 AlohaCare Advantage Plus (HMO D-SNP) AlohaCare.org customerservicedistribution@alohacare.org 1357 Kapiolani Blvd., Suite 1250 Honolulu HI 96814 8669736395 8089736395 8774475990 8774475990 8669736395 8089736395 8774475990 8774475990 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5970 001 0 2021 HumanaChoice H5970-001 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5970 015 0 2021 HumanaChoice H5970-015 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H5970 016 0 2021 Humana Honor (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5970 018 0 2021 HumanaChoice H5970-018 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $310.00 annual deductible only applies to drugs on certain tiers.~ H5970 019 0 2021 HumanaChoice H5970-019 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H5970 020 0 2021 HumanaChoice SNP-DE H5970-020 (PPO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5970 024 1 2021 HumanaChoice H5970-024 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H5970 024 2 2021 HumanaChoice H5970-024 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H5970 801 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H5970 802 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H5970 816 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 711 711 8663968810 8663968810 711 711 711 711 H5970 817 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 711 711 8663968810 8663968810 711 711 711 711 H5970 818 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 711 711 8663968810 8663968810 711 711 711 711 H5970 819 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 711 711 8663968810 8663968810 711 711 711 711 H5970 820 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 711 711 8663968810 8663968810 711 711 711 711 H5970 821 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 711 711 8663968810 8663968810 711 711 711 711 H5989 011 0 2021 Healthfirst Signature (HMO) www.healthfirst.org/medicare Healthfirst Medicare Plan, PO Box 5165 New York NY 10274 8772371303 8772371303 8885423821 8885423821 8557711081 8557711081 8885423821 8885423821 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H5991 001 0 2021 EmblemHealth VIP Dual Select (HMO D-SNP) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5991 002 0 2021 EmblemHealth VIP Solutions (HMO D-SNP) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5991 003 0 2021 EmblemHealth VIP Passport (HMO) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H5991 006 0 2021 EmblemHealth VIP Passport NYC (HMO) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H5991 007 0 2021 EmblemHealth VIP Connect (HMO D-SNP) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5991 008 0 2021 EmblemHealth VIP Assist (HMO D-SNP) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5991 009 0 2021 EmblemHealth VIP Reserve (HMO) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H5991 010 0 2021 EmblemHealth VIP Dual Reserve (HMO D-SNP) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8773447364 8773447364 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5992 007 0 2021 Senior Whole Health of New York NHC (HMO D-SNP) www.molinahealthcare.com/medicare info@seniorwholehealth.com Church St. Station, PO Box 1624 New York NY 10008 8773530188 8773530188 711 711 8773530185 8773530185 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H5995 001 0 2021 ATRIO Special Needs Plan (Willamette) (HMO D-SNP) atriohp.com customerservice@atriohp.com 2965 Ryan Dr SE Salem OR 97301 8776728620 5416728620 711 711 8776728620 5416728620 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H6053 999 0 2021 Santa Fe Employes Hospital Assn. - Coast Lines sfeha.com H6067 001 1 2021 CareFirst BlueCross BlueShield Advantage Core (HMO) carefirst.com/medicare PO Box 3236 Scranton PA 18505 8552905744 8552905744 711 711 8552905744 8552905744 711 711 H6067 001 2 2021 CareFirst BlueCross BlueShield Advantage Core (HMO) carefirst.com/medicare PO Box 3236 Scranton PA 18505 8552905744 8552905744 711 711 8552905744 8552905744 711 711 H6067 002 1 2021 CareFirst BlueCross BlueShield Advantage Enhanced (HMO) carefirst.com/medicare PO Box 3236 Scranton PA 18505 8552905744 8552905744 711 711 8552905744 8552905744 711 711 H6067 002 2 2021 CareFirst BlueCross BlueShield Advantage Enhanced (HMO) carefirst.com/medicare PO Box 3236 Scranton PA 18505 8552905744 8552905744 711 711 8552905744 8552905744 711 711 H6067 801 0 2021 CareFirst BlueCross BlueShield Advantage Group (HMO) carefirst.com/medicare PO Box 3236 Scranton PA 18505 8552905744 8552905744 711 711 8552905744 8552905744 711 711 H6067 802 0 2021 CareFirst BlueCross BlueShield Advantage Group (HMO) carefirst.com/medicare PO Box 3236 Scranton PA 18505 8552905744 8552905744 711 711 8552905744 8552905744 711 711 H6067 803 0 2021 CareFirst BlueCross BlueShield Advantage Group (HMO) carefirst.com/medicare PO Box 3236 Scranton PA 18505 8552905744 8552905744 711 711 8552905744 8552905744 711 711 H6067 804 0 2021 CareFirst BlueCross BlueShield Advantage Group (HMO) carefirst.com/medicare PO Box 3236 Scranton PA 18505 8552905744 8552905744 711 711 8552905744 8552905744 711 711 H6078 801 0 2021 Secure Preferred (PPO) BlueMedicareAdvantage.com/Medicare P.O. Box 110 Fond du Lac WI 54936 8334341252 8334341252 711 711 8334341253 8334341253 711 711 H6078 802 0 2021 Secure Preferred (PPO) BlueMedicareAdvantage.com/Medicare P.O. Box 110 Fond du Lac WI 54936 8334341252 8334341252 711 711 8334341253 8334341253 711 711 H6078 803 0 2021 Secure Preferred (PPO) BlueMedicareAdvantage.com/Medicare P.O. Box 110 Fond du Lac WI 54936 8334341252 8334341252 711 711 8334341253 8334341253 711 711 H6078 804 0 2021 Secure Preferred (PPO) BlueMedicareAdvantage.com/Medicare P.O. Box 110 Fond du Lac WI 54936 8334341252 8334341252 711 711 8334341253 8334341253 711 711 H6080 001 0 2021 MeridianComplete (Medicare-Medicaid Plan) https://corp.mhplan.com/ 1 Campus Martius, Suite 700 Detroit MI 48226 8555801689 8555801689 711 711 8555801689 8555801689 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H6121 003 0 2021 Bright Advantage Assist (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H6121 008 0 2021 Bright Advantage (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H6140 999 0 2021 Wabash Mem. Hospital H6142 999 0 2021 Union Health Service, Inc. www.unionhealth.org H6154 001 0 2021 Medica Advantage Solution H6154-001 (HMO-POS) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8662696804 9529922134 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H6154 002 0 2021 Medica Advantage Solution H6154-002 (HMO-POS) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8662696804 9529922134 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H6154 003 0 2021 Medica Advantage Solution PartnerCare Premier (HMO I-SNP) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8002662157 9529922030 711 711 8883473630 9529922580 711 711 This plan does not charge an annual deductible for all drugs. The $140.00 annual deductible only applies to drugs on certain tiers.~ H6154 004 0 2021 Medica Advantage Solution PartnerCare Focus (HMO I-SNP) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8002662157 9529922030 711 711 8883473630 9529922580 711 711 This plan does not charge an annual deductible for all drugs. The $140.00 annual deductible only applies to drugs on certain tiers.~ H6158 001 0 2021 BlueMedicare Premier (HMO) www.arkansasbluecross.com/medicare P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8444631088 8444631088 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H6158 002 0 2021 BlueMedicare Premier (HMO) www.arkansasbluecross.com/medicare P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8444631088 8444631088 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H6202 001 0 2021 NextBlue Classic PPO (PPO) www.nextblueND.com P.O. Box 261156 Plano TX 75026 8447535678 8447535678 711 711 8447538038 8447538038 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H6202 002 0 2021 NextBlue Premium PPO (PPO) www.nextblueND.com P.O. Box 261156 Plano TX 75026 8447535678 8447535678 711 711 8447538038 8447538038 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H6202 801 0 2021 NextBlue of North Dakota Group PPO (PPO) www.nextblueND.com P.O. Box 261156 Plano TX 75026 8447535678 8447535678 711 711 8005701144 8005701144 711 711 H6202 802 0 2021 NextBlue of North Dakota Group PPO (PPO) www.nextblueND.com P.O. Box 261156 Plano TX 75026 8447535678 8447535678 711 711 8005701144 8005701144 711 711 H6202 803 0 2021 NextBlue of North Dakota Group PPO (PPO) www.nextblueND.com P.O. Box 261156 Plano TX 75026 8447535678 8447535678 711 711 8005701144 8005701144 711 711 H6229 005 0 2021 Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan) duals.anthem.com 12900 Park Plaza Drive, Suite 150 Cerritos CA 90703 8883503447 8883503447 711 711 8883503447 8883503447 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H6229 006 0 2021 Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan) duals.anthem.com 2868 Prospect Park Dr., Suite 100 Rancho Cordova CA 95670 8558175785 8558175785 711 711 8558175785 8558175785 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H6237 006 0 2021 Regence Valiance (HMO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8555228896 8555228896 711 711 H6237 007 1 2021 Regence BlueAdvantage HMO (HMO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8555228896 8555228896 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H6237 007 2 2021 Regence BlueAdvantage HMO (HMO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8555228896 8555228896 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H6237 007 3 2021 Regence BlueAdvantage HMO (HMO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8555228896 8555228896 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H6237 008 1 2021 Regence BlueAdvantage HMO Plus (HMO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8555228896 8555228896 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H6237 008 2 2021 Regence BlueAdvantage HMO Plus (HMO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8555228896 8555228896 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H6237 008 3 2021 Regence BlueAdvantage HMO Plus (HMO) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8555228896 8555228896 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H6306 005 0 2021 FirstMedicare Direct smartHMO (HMO) www.firstmedicare.com 42 Memorial Drive Pinehurst NC 28374 8559035154 8559035154 711 711 8444995630 8444995630 711 711 H6306 011 1 2021 FirstMedicare Direct POS Plus (HMO-POS) www.firstmedicare.com 42 Memorial Drive Pinehurst NC 28374 8883829781 8883829781 711 711 8772109167 8772109167 711 711 H6306 011 3 2021 FirstMedicare Direct POS Plus (HMO-POS) www.firstmedicare.com 42 Memorial Drive Pinehurst NC 28374 8883829781 8883829781 711 711 8772109167 8772109167 711 711 H6306 012 1 2021 FirstMedicare Direct POS Standard (HMO-POS) www.firstmedicare.com 42 Memorial Drive Pinehurst NC 28374 8883829781 8883829781 711 711 8772109167 8772109167 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H6306 012 5 2021 FirstMedicare Direct POS Standard (HMO-POS) www.firstmedicare.com 42 Memorial Drive Pinehurst NC 28374 8883829781 8883829781 711 711 8772109167 8772109167 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H6306 013 0 2021 New Hanover Health FirstMedicare Select (HMO-POS) www.firstmedicare.com 42 Memorial Drive Pinehurst NC 28374 8883844842 8883844842 711 711 8552919336 8552919336 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H6306 014 0 2021 New Hanover Health FirstMedicare Platinum (HMO-POS) www.firstmedicare.com 42 Memorial Drive Pinehurst NC 28374 8883844842 8883844842 711 711 8552919336 8552919336 711 711 H6306 015 0 2021 FirstMedicare Direct POS Choice (HMO-POS) www.firstmedicare.com 42 Memorial Drive Pinehurst NC 28374 8883829781 8883829781 711 711 8772109167 8772109167 711 711 H6316 001 0 2021 Healthy Blue Essential (HMO) https://shop.healthybluemo.com/medicare PO Box 31685 Tampa FL 33631 8556790568 8556790568 711 711 8335570951 8335570951 711 711 H6316 002 0 2021 Healthy Blue Dual (HMO D-SNP) https://shop.healthybluemo.com/medicare PO Box 31685 Tampa FL 33631 8557681039 8557681039 711 711 8335570952 8335570952 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H6328 001 0 2021 Care N' Care Choice Premium (PPO) www.cnchealthplan.com yourteam@cnchealthplan.com 1701 River Run, Suite 402 Fort Worth TX 76107 8776652622 8776652622 711 711 8773747993 8773747993 711 711 H6328 002 0 2021 Care N' Care Choice Plus (PPO) www.cnchealthplan.com concierge@cnchealthplan.com 1701 River Run, Suite 402 Fort Worth TX 76107 8776652622 8776652622 711 711 8773747993 8773747993 711 711 H6328 003 0 2021 Care N' Care Choice (PPO) www.cnchealthplan.com concierge@cnchealthplan.com 1701 River Run, Suite 402 Fort Worth TX 76107 8776652622 8776652622 711 711 8773747993 8773747993 711 711 H6328 005 0 2021 Care N' Care Choice MA-Only (PPO) www.cnchealthplan.com concierge@cnchealthplan.com 1701 River Run, Suite 402 Fort Worth TX 76107 8776652622 8776652622 711 711 8773747993 8773747993 711 711 H6328 801 0 2021 Care N' Care Choice CY - MAPD (PPO) www.cnchealthplan.com concierge@cnchealthplan.com 1701 River Run, Suite 402 Fort Worth TX 76107 8776652622 8776652622 711 711 8773747993 8773747993 711 711 H6328 802 0 2021 Care N' Care Choice NCY - MAPD (PPO) www.cnchealthplan.com concierge@cnchealthplan.com 1701 River Run, Suite 402 Fort Worth TX 76107 8776652622 8776652622 711 711 8773747993 8773747993 711 711 H6328 803 0 2021 Care N' Care Choice CY - MA-Only (PPO) www.cnchealthplan.com concierge@cnchealthplan.com 1701 River Run, Suite 402 Fort Worth TX 76107 8776652622 8776652622 711 711 8773747993 8773747993 711 711 H6328 804 0 2021 Care N' Care Choice NCY - MA-Only (PPO) www.cnchealthplan.com concierge@cnchealthplan.com 1701 River Run, Suite 402 Fort Worth TX 76107 8776652622 8776652622 711 711 8773747993 8773747993 711 711 H6334 999 0 2021 NY Hotel Trades Council and Hotel Assn. of NYC Hotelfunds.org H6345 001 0 2021 PruittHealth Premier (HMO I-SNP) www.pruitthealthpremier.com PO Box 2190 Glen Allen VA 23058 8442243659 8442243659 711 711 8442243659 8442243659 711 711 H6345 002 0 2021 PruittHealth Premier (HMO I-SNP) www.pruitthealthpremier.com PO Box 2190 Glen Allen VA 23058 8442243659 8442243659 711 711 8442243659 8442243659 711 711 H6348 001 0 2021 Allwell Medicare (PPO) allwell.mhsindiana.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661541 8557661541 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H6348 002 0 2021 Allwell Medicare (PPO) allwell.mhsindiana.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661541 8557661541 711 711 H6348 801 0 2021 Allwell Group (PPO) allwell.mhsindiana.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661541 8557661541 711 711 H6348 802 0 2021 Allwell Group (PPO) allwell.mhsindiana.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661541 8557661541 711 711 H6348 803 0 2021 Allwell Group (PPO) allwell.mhsindiana.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8557661541 8557661541 711 711 H6351 001 0 2021 Liberty Advantage (HMO I-SNP) http://www.libertyadvantageplan.com customerservice@libertyadvantageplan.com PO Box 3630 Little Rock AR 72202 8448546884 8448546884 711 711 8448546884 8448546884 711 711 H6351 003 0 2021 Liberty at Home (HMO I-SNP) www.libertyadvantageplan.com customerservice@libertyadvantageplan.com PO Box 3630 Little Rock AR 72202 8448546884 8448546884 711 711 8448546884 8448546884 711 711 H6379 001 0 2021 Clear Spring Health Essential (HMO) www.clearspringhealthcare.com P.O. BOX 278530 Miramar FL 33027 8773644566 8773644566 711 711 8773644566 8773644566 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H6396 001 0 2021 CareSource Advantage (HMO) www.caresource.com/oh/plans/medicare/ P.O. Box 8738 Dayton OH 45401 8446072830 8446072830 711 711 8446072827 8446072827 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H6396 004 0 2021 CareSource Advantage Zero Premium (HMO) www.caresource.com/oh/plans/medicare/ P.O. Box 8738 Dayton OH 45401 8446072830 8446072830 711 711 8446072827 8446072827 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~ H6396 005 0 2021 CareSource Dual Advantage (HMO D-SNP) www.caresource.com/oh/plans/dsnp/ P.O. Box 8738 Dayton OH 45401 8446072830 8446072830 711 711 8332302020 8332302020 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H6396 011 0 2021 CareSource Advantage (HMO) www.caresource.com/oh/plans/medicare/ P.O. Box 8738 Dayton OH 45401 8446072830 8446072830 711 711 8446072827 8446072827 711 711 This plan does not charge an annual deductible for all drugs. The $75.00 annual deductible only applies to drugs on certain tiers.~ H6396 012 0 2021 CareSource Advantage (HMO) www.caresource.com/oh/plans/medicare/ P.O. Box 8738 Dayton OH 45401 8446072830 8446072830 711 711 8446072827 8446072827 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H6396 013 0 2021 CareSource Advantage Zero Premium (HMO) www.caresource.com/oh/plans/medicare/ P.O. Box 8738 Dayton OH 45401 8446072830 8446072830 711 711 8446072827 8446072827 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H6396 014 0 2021 CareSource Dual Advantage (HMO D-SNP) www.caresource.com/oh/plans/dsnp/ P.O. Box 8738 Dayton OH 45401 8446072830 8446072830 711 711 8332302020 8332302020 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H6396 015 0 2021 CareSource Dual Advantage (HMO D-SNP) www.caresource.com/oh/plans/dsnp/ P.O. Box 8738 Dayton OH 45401 8446072830 8446072830 711 711 8332302020 8332302020 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H6399 001 0 2021 Aetna Assure Premier Plus (HMO D-SNP) www.aetnabetterhealth.com/new-jersey-hmosnp NJSNP_MemberServices@aetna.com 7400 W Campus Rd New Albany OH 43054 8338748529 8338748529 711 711 8443620934 8443620934 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H6439 002 0 2021 WellCare Value (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H6439 003 0 2021 WellCare Compass (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H6439 004 0 2021 WellCare Dividend (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H6446 001 0 2021 Allwell Medicare Select P3 (HMO) allwell.silversummithealthplan.com AZ_InternetMemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8338544766 8338544766 711 711 H6446 003 0 2021 Allwell Medicare Boost P3 (HMO) allwell.silversummithealthplan.com AZ_InternetMemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8338544766 8338544766 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H6446 004 0 2021 Allwell Medicare Boost USHS (HMO) allwell.silversummithealthplan.com AZ_InternetMemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8338544766 8338544766 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H6446 005 0 2021 Allwell Medicare Boost (HMO) allwell.silversummithealthplan.com AZ_InternetMemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8338544766 8338544766 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H6446 009 0 2021 Allwell Medicare Select USHS (HMO) allwell.silversummithealthplan.com AZ_InternetMemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8338544766 8338544766 711 711 H6446 010 0 2021 Allwell Medicare (HMO) allwell.silversummithealthplan.com AZ_InternetMemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8338544766 8338544766 711 711 H6446 011 0 2021 Allwell Medicare Complement P3 (HMO) allwell.silversummithealthplan.com AZ_InternetMemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8338544766 8338544766 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H6446 012 0 2021 Allwell Medicare Complement USHS (HMO) allwell.silversummithealthplan.com AZ_InternetMemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8338544766 8338544766 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H6446 013 0 2021 Allwell Medicare Complement (HMO) allwell.silversummithealthplan.com AZ_InternetMemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8338544766 8338544766 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H6446 014 0 2021 Allwell Dual Medicare Harmony P3 (HMO D-SNP) allwell.silversummithealthplan.com AZ_InternetMemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8337170806 8337170806 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H6446 015 0 2021 Allwell Dual Medicare Harmony USHS (HMO D-SNP) allwell.silversummithealthplan.com AZ_InternetMemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8337170806 8337170806 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H6446 016 0 2021 Allwell Dual Medicare Harmony (HMO D-SNP) allwell.silversummithealthplan.com AZ_InternetMemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8337170806 8337170806 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H6453 005 0 2021 Blue Advantage (HMO) www.bcbsla.com/blueadvantage customerservice@blueadvantage.bcbsla.com 5525 Reitz Ave Baton Rouge LA 70809 8003639152 8003639152 711 711 8665087145 8665087145 711 711 H6453 006 0 2021 Blue Advantage (HMO) www.bcbsla.com/blueadvantage customerservice@blueadvantage.bcbsla.com 5525 Reitz Ave Baton Rouge LA 70809 8003639152 8003639152 711 711 8665087145 8665087145 711 711 H6453 007 1 2021 Blue Advantage (HMO) www.bcbsla.com/blueadvantage customerservice@blueadvantage.bcbsla.com 5525 Reitz Ave Baton Rouge LA 70809 8003639152 8003639152 711 711 8665087145 8665087145 711 711 H6453 007 2 2021 Blue Advantage (HMO) www.bcbsla.com/blueadvantage customerservice@blueadvantage.bcbsla.com 5525 Reitz Ave Baton Rouge LA 70809 8003639152 8003639152 711 711 8665087145 8665087145 711 711 H6453 008 1 2021 Blue Advantage (HMO) www.bcbsla.com/blueadvantage customerservice@blueadvantage.bcbsla.com 5525 Reitz Ave Baton Rouge LA 70809 8003639152 8003639152 711 711 8665087145 8665087145 711 711 H6453 008 2 2021 Blue Advantage (HMO) www.bcbsla.com/blueadvantage customerservice@blueadvantage.bcbsla.com 5525 Reitz Ave Baton Rouge LA 70809 8003639152 8003639152 711 711 8665087145 8665087145 711 711 H6453 009 1 2021 Blue Advantage (HMO) www.bcbsla.com/blueadvantage customerservice@blueadvantage.bcbsla.com 5525 Reitz Ave Baton Rouge LA 70809 8003639152 8003639152 711 711 8665087145 8665087145 711 711 H6453 009 2 2021 Blue Advantage (HMO) www.bcbsla.com/blueadvantage customerservice@blueadvantage.bcbsla.com 5525 Reitz Ave Baton Rouge LA 70809 8003639152 8003639152 711 711 8665087145 8665087145 711 711 H6453 010 1 2021 Blue Advantage (HMO) www.bcbsla.com/blueadvantage customerservice@blueadvantage.bcbsla.com 5525 Reitz Ave Baton Rouge LA 70809 8003639152 8003639152 711 711 8665087145 8665087145 711 711 H6453 010 2 2021 Blue Advantage (HMO) www.bcbsla.com/blueadvantage customerservice@blueadvantage.bcbsla.com 5525 Reitz Ave Baton Rouge LA 70809 8003639152 8003639152 711 711 8665087145 8665087145 711 711 H6453 801 0 2021 Blue Advantage (HMO) www.bcbsla.com/blueadvantage customerservice@blueadvantage.bcbsla.com 5525 Reitz Ave Baton Rouge LA 70809 8003639152 8003639152 711 711 8665087145 8665087145 711 711 H6453 802 0 2021 Blue Advantage (HMO) www.bcbsla.com/blueadvantage customerservice@blueadvantage.bcbsla.com 5525 Reitz Ave Baton Rouge LA 70809 8003639152 8003639152 711 711 8665087145 8665087145 711 711 H6453 803 0 2021 Blue Advantage (HMO) www.bcbsla.com/blueadvantage customerservice@blueadvantage.bcbsla.com 5525 Reitz Ave Baton Rouge LA 70809 8003639152 8003639152 711 711 8665087145 8665087145 711 711 H6502 001 0 2021 Blue Medicare Advantage Access (PPO) www.MedicareBlueKC.com Blue Medicare Advantage, 2301 Main Street Kansas City MO 64108 8552088246 8163953152 711 711 8665087140 8665087140 711 711 H6502 002 0 2021 Blue Medicare Advantage Essential (PPO) www.MedicareBlueKC.com Blue Medicare Advantage, 2301 Main Street Kansas City MO 64108 8552088246 8163953152 711 711 8665087140 8665087140 711 711 H6502 003 0 2021 Blue Medicare Advantage Flex (no Part D) (PPO) www.MedicareBlueKC.com Blue Medicare Advantage, 2301 Main Street Kansas City MO 64108 8552088246 8163953152 711 711 8665087140 8665087140 711 711 H6502 801 0 2021 Blue Medicare Advantage Employer Group MA-CY (PPO) www.MedicareBlueKC.com Blue Medicare Advantage, 2301 Main Street Kansas City MO 64108 8552088246 8163953152 711 711 8665087140 8665087140 711 711 H6502 802 0 2021 Blue Medicare Advantage Employer Group MAPD - CY (PPO) www.MedicareBlueKC.com Blue Medicare Advantage, 2301 Main Street Kansas City MO 64108 8552088246 8163953152 711 711 8665087140 8665087140 711 711 H6502 803 0 2021 Blue Medicare Advantage Employer Group MAPD - BY (PPO) www.MedicareBlueKC.com Blue Medicare Advantage, 2301 Main Street Kansas City MO 64108 8552088246 8163953152 711 711 8665087140 8665087140 711 711 H6526 001 0 2021 AARP Medicare Advantage (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H6526 002 0 2021 AARP Medicare Advantage (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H6528 006 0 2021 UnitedHealthcare Medicare Advantage Choice Plan 1 (PPO) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8002041002 8002041002 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H6528 031 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com memberservices@mypreferredcare.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H6528 032 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com memberservices@mypreferredcare.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H6528 033 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com memberservices@mypreferredcare.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H6529 001 1 2021 MyTruAdvantage Select (HMO) www.mytruadvantage.com MyTruAdvantage, PO Box 428 Columbus IN 47202 8332136731 8123142505 711 711 8444254280 8123484576 711 711 H6529 001 2 2021 MyTruAdvantage Select (HMO) www.mytruadvantage.com MyTruAdvantage, PO Box 428 Columbus IN 47202 8332136731 8123142505 711 711 8444254280 8123484576 711 711 H6550 003 0 2021 Allwell Medicare (HMO) allwell.sunflowerhealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8555659519 8555659519 711 711 H6550 004 0 2021 Allwell Dual Medicare (HMO D-SNP) allwell.sunflowerhealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8334026707 8334026707 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H6550 005 0 2021 Allwell Medicare Harmony (HMO D-SNP) allwell.sunflowerhealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8334026707 8334026707 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H6550 006 0 2021 Allwell Medicare Complement (HMO) allwell.sunflowerhealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8555659519 8555659519 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H6550 007 0 2021 Allwell Medicare Boost (HMO) allwell.sunflowerhealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8555659519 8555659519 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H6550 008 0 2021 Allwell Medicare Simple (HMO) allwell.sunflowerhealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8555659519 8555659519 711 711 H6550 801 0 2021 Allwell Group (HMO) allwell.sunflowerhealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8555659519 8555659519 711 711 H6550 802 0 2021 Allwell Group (HMO) allwell.sunflowerhealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8555659519 8555659519 711 711 H6550 803 0 2021 Allwell Group (HMO) allwell.sunflowerhealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8555659519 8555659519 711 711 H6594 001 0 2021 WellCare Premier (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H6594 002 0 2021 WellCare Absolute (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H6594 003 0 2021 WellCare Plus (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H6595 002 1 2021 UnitedHealthcare Dual Complete (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8448559774 8448559774 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H6595 002 2 2021 UnitedHealthcare Dual Complete (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8448559774 8448559774 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H6622 001 0 2021 Humana Gold Plus H6622-001 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H6622 002 0 2021 Humana Gold Plus H6622-002 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H6622 004 0 2021 Humana Gold Plus H6622-004 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H6622 005 0 2021 Humana Gold Plus H6622-005 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H6622 007 0 2021 Humana Gold Plus H6622-007 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $325.00 annual deductible only applies to drugs on certain tiers.~ H6622 008 0 2021 Humana Gold Plus SNP-DE H6622-008 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H6622 010 0 2021 Humana Gold Plus H6622-010 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H6622 011 0 2021 Humana Gold Plus H6622-011 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H6622 013 0 2021 Humana Gold Plus H6622-013 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H6622 014 0 2021 Humana Gold Plus H6622-014 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H6622 015 0 2021 Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H6622 016 0 2021 Humana Gold Plus H6622-016 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~ H6622 017 0 2021 Humana Gold Plus - Diabetes and Heart (HMO C-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H6622 018 0 2021 Humana Gold Plus SNP-DE H6622-018 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H6622 019 0 2021 Humana Gold Plus H6622-019 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $125.00 annual deductible only applies to drugs on certain tiers.~ H6622 021 1 2021 Humana Gold Plus H6622-021 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H6622 021 2 2021 Humana Gold Plus H6622-021 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H6622 022 0 2021 Humana Gold Plus H6622-022 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H6622 023 0 2021 Humana Cleveland Clinic Preferred (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H6622 025 0 2021 Humana Gold Plus H6622-025 (HMO-POS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $215.00 annual deductible only applies to drugs on certain tiers.~ H6622 026 0 2021 Humana Gold Plus H6622-026 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H6622 027 0 2021 Humana Gold Plus SNP-DE H6622-027 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H6622 028 0 2021 Humana Gold Plus H6622-028 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H6622 029 0 2021 Humana Gold Plus - Diabetes and Heart (HMO C-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H6622 030 0 2021 Humana Gold Plus Lung (HMO C-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H6622 032 0 2021 Humana Gold Plus H6622-032 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H6622 033 0 2021 Humana Gold Plus H6622-033 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H6622 034 0 2021 Humana Gold Plus H6622-034 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H6622 035 0 2021 Humana Gold Plus H6622-035 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H6622 036 0 2021 Humana Gold Plus H6622-036 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H6622 037 0 2021 Humana Gold Plus H6622-037 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H6622 038 0 2021 Humana Gold Plus SNP-DE H6622-038 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H6622 040 0 2021 Humana Gold Plus H6622-040 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $315.00 annual deductible only applies to drugs on certain tiers.~ H6622 041 0 2021 Humana Gold Plus H6622-041 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H6622 047 0 2021 Humana Gold Plus H6622-047 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H6622 048 0 2021 Humana Gold Plus SNP-DE H6622-048 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H6622 049 0 2021 Humana Value Plus H6622-049 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H6622 051 0 2021 Humana Gold Plus SNP-DE H6622-051 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H6622 052 0 2021 Humana Gold Plus H6622-052 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H6622 054 0 2021 Humana Gold Plus H6622-054 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H6622 055 0 2021 Humana Gold Plus H6622-055 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H6622 056 0 2021 Humana Gold Plus H6622-056 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H6622 057 0 2021 Humana Gold Plus H6622-057 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $160.00 annual deductible only applies to drugs on certain tiers.~ H6622 059 0 2021 Humana Gold Plus H6622-059 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~ H6622 060 0 2021 Humana Gold Plus H6622-060 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H6622 061 0 2021 Humana Gold Plus H6622-061 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H6622 062 0 2021 Humana Gold Plus H6622-062 (HMO-POS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H6622 063 0 2021 Humana Gold Plus H6622-063 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H6622 064 0 2021 Humana Value Plus H6622-064 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H6622 066 0 2021 Humana Gold Plus H6622-066 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H6622 069 0 2021 Humana Gold Plus H6622-069 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H6622 070 0 2021 Humana Gold Plus H6622-070 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H6622 071 0 2021 Humana Gold Plus - Diabetes and Heart (HMO C-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H6622 072 0 2021 Humana Gold Plus H6622-072 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $415.00 annual deductible only applies to drugs on certain tiers.~ H6622 073 0 2021 Humana Gold Plus H6622-073 (HMO-POS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H6622 801 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H6622 802 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H6622 804 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H6622 805 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H6652 001 0 2021 American Health Advantage of Florida (HMO I-SNP) fl.amhealthplans.com MemberServices@AmHealthPlans.com 201 Jordan Road, Suite 200 Franklin TN 37067 8555210626 8555210626 711 711 8555210626 8555210626 711 711 H6672 001 0 2021 Clear Spring Health Deluxe Plan (HMO D-SNP) www.eonhealthplan.com P.O. Box 278530 Miramar FL 33027 8773644566 8773644566 711 711 8773644566 8773644566 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H6672 003 0 2021 Clear Spring Health Silver Plan (HMO C-SNP) www.eonhealthplan.com P.O. Box 278530 Miramar FL 33027 8773644566 8773644566 711 711 8773644566 8773644566 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H6672 004 0 2021 Clear Spring Health Select (HMO) www.eonhealthplan.com P.O. Box 278530 Miramar FL 33027 8773644566 8773644566 711 711 8773644566 8773644566 711 711 H6672 005 0 2021 Clear Spring Health Select Plus (HMO) www.eonhealthplan.com P.O. BOX 278530 Miramar FL 33027 8773644566 8773644566 711 711 8773644566 8773644566 711 711 H6706 001 0 2021 AARP Medicare Advantage (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H6713 001 0 2021 WellCare Premier (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H6713 002 0 2021 WellCare Absolute (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H6723 001 1 2021 MedMutual Advantage Classic (HMO) medmutual.com/planfinder PO BOX 94563 Cleveland OH 44101 8773680081 8773680081 711 711 8009823117 8009823117 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H6723 001 2 2021 MedMutual Advantage Classic (HMO) medmutual.com/planfinder PO BOX 94563 Cleveland OH 44101 8773680081 8773680081 711 711 8009823117 8009823117 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H6723 001 3 2021 MedMutual Advantage Classic (HMO) medmutual.com/planfinder PO BOX 94563 Cleveland OH 44101 8773680081 8773680081 711 711 8009823117 8009823117 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H6723 002 1 2021 MedMutual Advantage Choice (HMO) medmutual.com/planfinder PO BOX 94563 Cleveland OH 44101 8773680081 8773680081 711 711 8009823117 8009823117 711 711 This plan does not charge an annual deductible for all drugs. The $55.00 annual deductible only applies to drugs on certain tiers.~ H6723 002 2 2021 MedMutual Advantage Choice (HMO) medmutual.com/planfinder PO BOX 94563 Cleveland OH 44101 8773680081 8773680081 711 711 8009823117 8009823117 711 711 This plan does not charge an annual deductible for all drugs. The $55.00 annual deductible only applies to drugs on certain tiers.~ H6723 002 3 2021 MedMutual Advantage Choice (HMO) medmutual.com/planfinder PO BOX 94563 Cleveland OH 44101 8773680081 8773680081 711 711 8009823117 8009823117 711 711 This plan does not charge an annual deductible for all drugs. The $55.00 annual deductible only applies to drugs on certain tiers.~ H6723 003 1 2021 MedMutual Advantage Plus (HMO) medmutual.com/planfinder PO Box 94563 Cleveland OH 44101 8773680081 8773680081 711 711 8009823117 8009823117 711 711 This plan does not charge an annual deductible for all drugs. The $55.00 annual deductible only applies to drugs on certain tiers.~ H6723 003 2 2021 MedMutual Advantage Plus (HMO) medmutual.com/planfinder PO Box 94563 Cleveland OH 44101 8773680081 8773680081 711 711 8009823117 8009823117 711 711 This plan does not charge an annual deductible for all drugs. The $55.00 annual deductible only applies to drugs on certain tiers.~ H6723 003 3 2021 MedMutual Advantage Plus (HMO) medmutual.com/planfinder PO Box 94563 Cleveland OH 44101 8773680081 8773680081 711 711 8009823117 8009823117 711 711 This plan does not charge an annual deductible for all drugs. The $55.00 annual deductible only applies to drugs on certain tiers.~ H6723 005 1 2021 MedMutual Advantage Secure (HMO) medmutual.com/planfinder PO BOX 94563 Cleveland OH 44101 8773680081 8773680081 711 711 8009823117 8009823117 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H6723 005 2 2021 MedMutual Advantage Secure (HMO) medmutual.com/planfinder PO BOX 94563 Cleveland OH 44101 8773680081 8773680081 711 711 8009823117 8009823117 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H6723 006 1 2021 MedMutual Advantage Signature (HMO) medmutual.com/planfinder PO BOX 94563 Cleveland OH 44101 8773680081 8773680081 711 711 8009823117 8009823117 711 711 H6723 006 2 2021 MedMutual Advantage Signature (HMO) medmutual.com/planfinder PO BOX 94563 Cleveland OH 44101 8773680081 8773680081 711 711 8009823117 8009823117 711 711 H6723 801 0 2021 MedMutual Advantage EGWP (Calendar Year) (HMO) medmutual.com/magroup PO BOX 94563 Cleveland OH 44101 8664068777 8664068777 711 711 8008014823 8008014823 711 711 H6723 802 0 2021 MedMutual Advantage EGWP (Non-Calendar Year) (HMO) medmutual.com/magroup PO BOX 94563 Cleveland OH 44101 8664068777 8664068777 711 711 8008014823 8008014823 711 711 H6723 803 0 2021 MedMutual Advantage EGWP (MA-Only) (HMO) medmutual.com/magroup PO BOX 94563 Cleveland OH 44101 8664068777 8664068777 711 711 8008014823 8008014823 711 711 H6743 001 0 2021 ATRIO Bronze Rx (Basin) (PPO) atriohp.com customerservice@atriohp.com 2965 Ryan Dr SE Salem OR 97301 8776728620 5416728620 711 711 8776728620 5416728620 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H6743 007 0 2021 ATRIO Bronze Rx (Umpqua) (PPO) atriohp.com customerservice@atriohp.com 2965 Ryan Dr SE Salem OR 97301 8776728620 5416728620 711 711 8776728620 5416728620 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H6743 018 1 2021 ATRIO Bronze Rx (Rogue) (PPO) atriohp.com customerservice@atriohp.com 2965 Ryan Dr SE Salem OR 97301 8776728620 5416728620 711 711 8776728620 5416728620 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H6743 018 3 2021 ATRIO Bronze Rx (Rogue) (PPO) atriohp.com customerservice@atriohp.com 2965 Ryan Dr SE Salem OR 97301 8776728620 5416728620 711 711 8776728620 5416728620 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H6743 019 2 2021 ATRIO Silver (PPO) atriohp.com customerservice@atriohp.com 2965 Ryan Dr SE Salem OR 97301 8776728620 5416728620 711 711 8776728620 5416728620 711 711 H6743 019 4 2021 ATRIO Silver (PPO) atriohp.com customerservice@atriohp.com 2965 Ryan Dr SE Salem OR 97301 8776728620 5416728620 711 711 8776728620 5416728620 711 711 H6743 020 1 2021 ATRIO Silver Rx (PPO) atriohp.com customerservice@atriohp.com 2965 Ryan Dr SE Salem OR 97301 8776728620 5416728620 711 711 8776728620 5416728620 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H6743 020 2 2021 ATRIO Silver Rx (PPO) atriohp.com customerservice@atriohp.com 2965 Ryan Dr SE Salem OR 97301 8776728620 5416728620 711 711 8776728620 5416728620 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H6743 020 3 2021 ATRIO Silver Rx (PPO) atriohp.com customerservice@atriohp.com 2965 Ryan Dr SE Salem OR 97301 8776728620 5416728620 711 711 8776728620 5416728620 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H6743 020 4 2021 ATRIO Silver Rx (PPO) atriohp.com customerservice@atriohp.com 2965 Ryan Dr SE Salem OR 97301 8776728620 5416728620 711 711 8776728620 5416728620 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H6743 021 2 2021 ATRIO Gold Rx (PPO) atriohp.com customerservice@atriohp.com 2965 Ryan Dr SE Salem OR 97301 8776728620 5416728620 711 711 8776728620 5416728620 711 711 H6743 021 4 2021 ATRIO Gold Rx (PPO) atriohp.com customerservice@atriohp.com 2965 Ryan Dr SE Salem OR 97301 8776728620 5416728620 711 711 8776728620 5416728620 711 711 H6743 022 1 2021 ATRIO Bronze (PPO) atriohp.com customerservice@atriohp.com 2965 Ryan Dr SE Salem OR 97301 8776728620 5416728620 711 711 8776728620 5416728620 711 711 H6743 022 2 2021 ATRIO Bronze (PPO) atriohp.com customerservice@atriohp.com 2965 Ryan Dr SE Salem OR 97301 8776728620 5416728620 711 711 8776728620 5416728620 711 711 H6743 022 4 2021 ATRIO Bronze (PPO) atriohp.com customerservice@atriohp.com 2965 Ryan Dr SE Salem OR 97301 8776728620 5416728620 711 711 8776728620 5416728620 711 711 H6750 005 0 2021 Harvard Pilgrim Stride Basic Rx (HMO) www.hpforlife.org 1600 Crown Colony Drive Quincy MA 02169 8774314742 8774314742 711 711 8886090692 8886090692 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H6750 006 0 2021 Harvard Pilgrim Stride Basic Rx (HMO) www.hpforlife.org 1600 Crown Colony Drive Quincy MA 02169 8774314742 8774314742 711 711 8886090692 8886090692 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H6750 007 0 2021 Harvard Pilgrim Stride Value Rx (HMO) www.hpforlife.org 1600 Crown Colony Drive Quincy MA 02169 8774314742 8774314742 711 711 8886090692 8886090692 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H6750 008 0 2021 Harvard Pilgrim Stride Value Rx Plus (HMO) www.hpforlife.org 1600 Crown Colony Drive Quincy MA 02169 8774314742 8774314742 711 711 8886090692 8886090692 711 711 H6750 009 0 2021 Harvard Pilgrim Stride Gain Rx (HMO) www.hpforlife.org 1600 Crown Colony Drive Quincy MA 02169 8774314742 8774314742 711 711 8886090692 8886090692 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H6750 012 1 2021 Harvard Pilgrim Stride Value Rx Plus (HMO) www.hpforlife.org 1600 Crown Colony Drive Quincy MA 02169 8774314742 8774314742 711 711 8886090692 8886090692 711 711 This plan does not charge an annual deductible for all drugs. The $270.00 annual deductible only applies to drugs on certain tiers.~ H6750 012 2 2021 Harvard Pilgrim Stride Value Rx Plus (HMO) www.hpforlife.org 1600 Crown Colony Drive Quincy MA 02169 8774314742 8774314742 711 711 8886090692 8886090692 711 711 This plan does not charge an annual deductible for all drugs. The $270.00 annual deductible only applies to drugs on certain tiers.~ H6750 013 0 2021 Harvard Pilgrim Stride Value Rx (HMO) www.hpforlife.org 1600 Crown Colony Drive Quincy MA 02169 8774314742 8774314742 711 711 8886090692 8886090692 711 711 This plan does not charge an annual deductible for all drugs. The $270.00 annual deductible only applies to drugs on certain tiers.~ H6750 014 0 2021 Harvard Pilgrim Stride Choice Rx (HMO-POS) www.hpforlife.org 1600 Crown Colony Drive Quincy MA 02169 8774314742 8774314742 711 711 8886090692 8886090692 711 711 This plan does not charge an annual deductible for all drugs. The $270.00 annual deductible only applies to drugs on certain tiers.~ H6750 803 0 2021 Harvard Pilgrim Stride Value Rx (HMO) www.hpforlife.org 1600 Crown Colony Drive Quincy MA 02169 8774314742 8774314742 711 711 8886090692 8886090692 711 711 H6750 804 0 2021 Harvard Pilgrim Stride Value Rx (HMO) www.hpforlife.org 1600 Crown Colony Drive Quincy MA 02169 8774314742 8774314742 711 711 8886090692 8886090692 711 711 H6750 805 0 2021 Harvard Pilgrim Stride Choice Rx (HMO-POS) www.hpforlife.org 1600 Crown Colony Drive Quincy MA 02169 8774314742 8774314742 711 711 8886090692 8886090692 711 711 H6776 001 0 2021 RiverSpring Star (HMO I-SNP) riverspringstar.org 80 West 225th Street Bronx NY 10463 8005807000 8005807000 711 711 8005807000 8005807000 711 711 H6776 002 0 2021 RiverSpring MAP (HMO D-SNP) riverspringMAP.org 80 West 225th Street Bronx NY 10463 8003622266 8003622266 711 711 8003622266 8003622266 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H6815 005 0 2021 Health Net Ruby (HMO) or.healthnetadvantage.com OR_MemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8884458913 8884458913 711 711 This plan does not charge an annual deductible for all drugs. The $125.00 annual deductible only applies to drugs on certain tiers.~ H6815 006 0 2021 Health Net Ruby (HMO) or.healthnetadvantage.com OR_MemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8884458913 8884458913 711 711 This plan does not charge an annual deductible for all drugs. The $125.00 annual deductible only applies to drugs on certain tiers.~ H6815 037 0 2021 Health Net Medicare Complement (HMO) or.healthnetadvantage.com OR_MemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8884458913 8884458913 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H6815 038 0 2021 Health Net Ruby (HMO) or.healthnetadvantage.com OR_MemberInquiries@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8884458913 8884458913 711 711 This plan does not charge an annual deductible for all drugs. The $125.00 annual deductible only applies to drugs on certain tiers.~ H6815 801 0 2021 Health Net Seniority Plus Employer (HMO) or.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8002754737 8002754737 711 711 H6815 802 0 2021 Health Net Seniority Plus Employer (HMO) or.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8002754737 8002754737 711 711 H6815 803 0 2021 Health Net Seniority Plus Employer (HMO) or.healthnetadvantage.com member_services@healthnet.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8002754737 8002754737 711 711 H6830 001 0 2021 Ascension Complete Via Christi Access (PPO) www.ascensioncomplete.com PO Box 10420 Van Nuys CA 91410 8449420038 8449420038 711 711 8338166623 8338166623 711 711 This plan's deductible only applies to out-of-network services.~ H6832 001 0 2021 Align Thrive (HMO I-SNP) www.alignseniorcare.com 10900 Nuckols Road, Suite 110 Glen Allen VA 23060 8442057244 8442057244 711 711 8442057244 8442057244 711 711 H6832 002 0 2021 Align Connect (HMO C-SNP) www.alignseniorcare.com 10900 Nuckols Road, Suite 110 Glen Allen VA 23060 8442057244 8442057244 711 711 8442057244 8442057244 711 711 H6870 001 0 2021 Superior HealthPlan STAR+PLUS Medicare-Medicaid (Medicare-Medicaid Plan) mmp.superiorhealthplan.com Forum II Building, 7990 IH 10 West, Ste. 300 San Antonio TX 78230 8668961844 8668961844 711 711 8668961844 8668961844 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H6874 001 0 2021 Essential Rx (PPO) www.aspirushealthplan.com/medicare PO BOX 51 Minneapolis MN 55440 8559314859 7156317441 8559314852 7156317413 8559314850 7156317411 8559314852 7156317413 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H6874 002 0 2021 Elite Rx (PPO) www.aspirushealthplan.com/medicare PO BOX 51 Minneapolis MN 55440 8559314859 7156317441 8559314852 7156317413 8559314850 7156317411 8559314852 7156317413 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H6874 003 0 2021 Elite (PPO) www.aspirushealthplan.com/medicare medicaresalesMA@aspirushealthplan.com PO BOX 51 Minneapolis MN 55440 8559314859 7156317441 8559314852 7156317413 8559314850 7156317411 8559314852 7156317413 H6891 001 0 2021 American Health Advantage of Texas (HMO I-SNP) tx.amhealthplans.com MemberServices@AmHealthPlans.com 201 Jordan Road, Suite 200 Franklin TN 37067 8555210628 8555210628 711 711 8555210628 8555210628 711 711 H6898 001 0 2021 Vermont Blue Advantage Freedom PPO (PPO) www.vermontblueadvantage.com P.O. Box 260160 Plano TX 75026 8445102583 8445102583 711 711 8448395125 8448395125 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H6898 002 0 2021 Vermont Blue Advantage Freedom Plus PPO (PPO) www.vermontblueadvantage.com P.O. Box 260160 Plano TX 75026 8445102583 8445102583 711 711 8448395125 8448395125 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H6898 801 0 2021 Vermont Blue Advantage Group PPO (PPO) www.vermontblueadvantage.com P.O. Box 260160 Plano TX 75026 8445102583 8445102583 711 711 8005720280 8005720280 711 711 H6898 802 0 2021 Vermont Blue Advantage Group PPO (PPO) www.vermontblueadvantage.com P.O. Box 260160 Plano TX 75026 8005720280 8005720280 711 711 8005720280 8005720280 711 711 H6898 803 0 2021 Vermont Blue Advantage Group PPO (PPO) www.vermontblueadvantage.com P.O. Box 260160 Plano TX 75026 8005720280 8005720280 711 711 8005720280 8005720280 711 711 H6910 001 0 2021 MediGold Essential Care (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H6910 002 0 2021 MediGold True Advantage (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H6910 003 0 2021 MediGold Classic Preferred (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H6910 004 0 2021 MediGold Medical Only (HMO) www.MediGold.com 6150 E. Broad St, EE320 Columbus OH 43213 8009644525 8009644525 711 711 8002403851 8002403851 711 711 H6936 003 0 2021 BluePathway Plan 2 (HMO) azbluemedicare.com ContactAdvantage@azblue.com 13985 W. Grand Ave, Suite 200 Surprise AZ 85374 8004220761 8004220761 711 711 8004468331 8004468331 711 711 H6936 004 0 2021 BluePathway Plan 3 (HMO) azbluemedicare.com ContactAdvantage@azblue.com 13985 W. Grand Ave, Suite 200 Surprise AZ 85374 8004220761 8004220761 711 711 8004468331 8004468331 711 711 H6936 005 0 2021 BluePathway Plan 2 (HMO) azbluemedicare.com ContactAdvantage@azblue.com 13985 W. Grand Ave, Suite 200 Surprise AZ 85374 8004220761 8004220761 711 711 8004468331 8004468331 711 711 H6936 006 0 2021 BluePathway Plan 1 (HMO) azbluemedicare.com ContactAdvantage@azblue.com 13985 W. Grand Ave, Suite 200 Surprise AZ 85374 8004220761 8004220761 711 711 8004468331 8004468331 711 711 H6959 001 0 2021 KeyCare Advantage (HMO I-SNP) www.keycareadvantage.com 8028 Ritchie HIghway, Suite 210 Pasadena MD 21122 8442061205 8442061205 711 711 8442061205 8442061205 711 711 H6975 001 0 2021 WellCare Value (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H6975 002 0 2021 WellCare Liberty (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H6975 003 0 2021 WellCare Compass (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H6975 004 0 2021 WellCare Access (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H6975 005 0 2021 WellCare Essential (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H6988 001 0 2021 Centers Plan for Medicare Advantage Care (HMO) www.centersplan.com memberservices@centersplan.com 75 Vanderbilt Avenue Staten Island NY 10304 8779409330 8779409330 8004211220 711 8779409330 8779409330 8004211220 711 This plan does not charge an annual deductible for all drugs. The $395.00 annual deductible only applies to drugs on certain tiers.~ H6988 002 0 2021 Centers Plan for Dual Coverage Care (HMO D-SNP) www.centersplan.com memberservices@centersplan.com 75 Vanderbilt Avenue Staten Island NY 10304 8779409330 8779409330 8004211220 711 8779409330 8779409330 8004211220 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H6988 003 0 2021 Centers Plan for Nursing Home Care (HMO I-SNP) www.centersplan.com memberservices@centersplan.com 75 Vanderbilt Avenue Staten Island NY 10304 8779409330 8779409330 8004211220 711 8779409330 8779409330 8004211220 711 H6988 004 0 2021 Centers Plan for Medicaid Advantage Plus (HMO D-SNP) www.centersplan.com memberservices@centersplan.com 75 Vanderbilt Avenue Staten Island NY 10304 8332745627 8332745627 8004211220 711 8332745627 8332745627 8004211220 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H6988 005 0 2021 Centers Plan for Medicaid Advantage (HMO D-SNP) www.centersplan.com memberservices@centersplan.com 75 Vanderbilt Avenue Staten Island NY 10304 8779409330 8779409330 8004211220 711 8779409330 8779409330 8004211220 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H6988 801 0 2021 Centers Plan for Employer Groups (HMO) www.centersplan.com memberservices@centersplan.com 75 Vanderbilt Avenue Staten Island NY 10304 8779409330 8779409330 8004211220 711 8779409330 8779409330 8004211220 711 H7006 001 0 2021 ATRIO Gold Rx (Willamette) (PPO) atriohp.com customerservice@atriohp.com 2965 Ryan Dr SE Salem OR 97301 8776728620 5416728620 711 711 8776728620 5416728620 711 711 H7006 003 0 2021 ATRIO Silver Rx (Willamette) (PPO) atriohp.com customerservice@atriohp.com 2965 Ryan Dr SE Salem OR 97301 8776728620 5416728620 711 711 8776728620 5416728620 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H7020 004 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559803049 8559803049 711 711 8006683813 8006683813 711 711 H7020 005 0 2021 Cigna Fundamental Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559803049 8559803049 711 711 8006683813 8006683813 711 711 H7020 006 0 2021 Cigna Preferred Plus Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559803049 8559803049 711 711 8006683813 8006683813 711 711 H7020 007 0 2021 Cigna Preferred Savings Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559803049 8559803049 711 711 8006683813 8006683813 711 711 H7020 008 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559803049 8559803049 711 711 8006683813 8006683813 711 711 H7020 801 0 2021 Cigna Preferred Medicare (HMO) www.cignahealthspring.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8882817867 8882817867 711 711 8882817867 8882817867 711 711 H7063 001 0 2021 Blue Medicare Advantage (PPO) www.bcbsks.com/medicare 1133 SW Topeka Blvd Topeka KS 66629 8003549387 8003549387 8007663777 8007663777 8002227645 8002227645 711 711 H7063 002 0 2021 Blue Medicare Advantage Comprehensive (PPO) www.bcbsks.com/medicare 1133 SW Topeka Blvd Topeka KS 66629 8003549387 8003549387 8007663777 8007663777 8002227645 8002227645 711 711 H7063 006 0 2021 Blue Medicare Advantage (PPO) www.bcbsks.com/medicare 1133 SW Topeka Blvd Topeka KS 66629 8003549387 8003549387 8007663777 8007663777 8002227645 8002227645 711 711 H7063 007 0 2021 Blue Medicare Advantage Comprehensive (PPO) www.bcbsks.com/medicare 1133 SW Topeka Blvd Topeka KS 66629 8003549387 8003549387 8007663777 8007663777 8002227645 8002227645 711 711 H7063 801 0 2021 MAPD Group Plan Calendar Year (PPO) www.bcbsks.com/medicare 1133 SW Topeka Blvd Topeka KS 66629 8003549387 8003549387 8007663777 8007663777 8002227645 8002227645 711 711 H7063 802 0 2021 MAPD Group Plan Calendar Year (PPO) www.bcbsks.com/medicare 1133 SW Topeka Blvd Topeka KS 66629 8003549387 8003549387 8007663777 8007663777 8002227645 8002227645 711 711 H7076 011 0 2021 CareSource Advantage (HMO) www.caresource.com/in/plans/medicare/ P.O. Box 8738 Dayton OH 45401 8446072830 8446072830 711 711 8446072827 8446072827 711 711 This plan does not charge an annual deductible for all drugs. The $30.00 annual deductible only applies to drugs on certain tiers.~ H7076 012 0 2021 CareSource Advantage (HMO) www.caresource.com/in/plans/medicare/ P.O. Box 8738 Dayton OH 45401 8446072830 8446072830 711 711 8446072827 8446072827 711 711 This plan does not charge an annual deductible for all drugs. The $75.00 annual deductible only applies to drugs on certain tiers.~ H7076 013 0 2021 CareSource Advantage Zero Premium (HMO) www.caresource.com/in/plans/medicare/ P.O. Box 8738 Dayton OH 45401 8446072830 8446072830 711 711 8446072827 8446072827 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H7076 014 0 2021 CareSource Advantage Zero Premium (HMO) www.caresource.com/in/plans/medicare/ P.O. Box 8738 Dayton OH 45401 8446072830 8446072830 711 711 8446072827 8446072827 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H7076 015 0 2021 CareSource Dual Advantage (HMO D-SNP) www.caresource.com/in/plans/dsnp/ P.O. Box 8738 Dayton OH 45401 8446072830 8446072830 711 711 8332302020 8332302020 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H7076 016 0 2021 CareSource Dual Advantage (HMO D-SNP) www.caresource.com/in/plans/dsnp/ P.O. Box 8738 Dayton OH 45401 8446072830 8446072830 711 711 8332302020 8332302020 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H7115 001 0 2021 Memorial Hermann Advantage (HMO) healthplan.memorialhermann.org/medicare 929 Gessner #1500 Houston TX 77024 8664341282 8664341282 711 711 8556458448 8556458448 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H7115 003 0 2021 Memorial Hermann Advantage Plus (HMO) healthplan.memorialhermann.org/medicare 929 Gessner #1500 Houston TX 77024 8664341282 8664341282 711 711 8556458448 8556458448 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H7115 805 0 2021 Memorial Hermann Advantage (HMO) healthplan.memorialhermann.org/medicare 929 Gessner #1500 Houston TX 77024 8888014808 8888014808 711 711 8556458448 8556458448 711 711 H7115 806 0 2021 Memorial Hermann Advantage (HMO) healthplan.memorialhermann.org/medicare 929 Gessner #1500 Houston TX 77024 8888014808 8888014808 711 711 8556458448 8556458448 711 711 H7115 807 0 2021 Memorial Hermann Advantage (HMO) healthplan.memorialhermann.org/medicare 929 Gessner #1500 Houston TX 77024 8888014808 8888014808 711 711 8556458448 8556458448 711 711 H7119 001 0 2021 Provider Partners Ohio Advantage Plan (HMO I-SNP) www.pphealthplan.com info@pphealthplan.com 785 Elkridge Landing Rd, Suite 300 Linthicum Heights MD 21090 8004059681 8004059681 711 711 8004059681 8004059681 711 711 H7123 001 0 2021 UPMC for Life Complete Care (HMO D-SNP) www.upmchealthplan.com/snp upmchp@msx.upmc.edu 600 Grant Street Pittsburgh PA 15219 8664058762 8664058762 711 711 8335266264 8335266264 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H7149 001 0 2021 Aetna Medicare Premier (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H7149 004 0 2021 Aetna Medicare Prime (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H7149 006 0 2021 Aetna Medicare Assure Premier (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H7149 801 0 2021 Aetna Medicare Plan (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H7149 802 0 2021 Aetna Medicare Plan w/Rx (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H7163 002 0 2021 Vantage BASIC (HMO-POS) www.VantageMedicare.com 130 DeSiard St, Suite 300 Monroe LA 71201 8667040109 3183610900 1 8665245144 3183612131 8667040109 3183610900 1 8665245144 3183612131 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H7163 003 0 2021 Vantage DUAL PLUS (HMO-POS D-SNP) www.VantageMedicare.com 130 DeSiard St, Suite 300 Monroe LA 71201 8667040109 3183610900 1 8665245144 3183612131 8667040109 3183610900 1 8665245144 3183612131 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H7163 004 0 2021 Vantage STANDARD (HMO-POS) www.VantageMedicare.com 130 DeSiard St, Suite 300 Monroe LA 71201 8667040109 3183610900 1 8665245144 3183612131 8667040109 3183610900 1 8665245144 3183612131 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H7163 801 0 2021 Vantage - MAPD Employer Calendar (HMO-POS) www.VantageMedicare.com 130 DeSiard St, Suite 300 Monroe LA 71201 8667040109 3183610900 1 8665245144 3183612131 8667040109 3183610900 1 8665245144 3183612131 H7165 001 0 2021 BlueCross Secure (HMO) www.scbluesmedadvantage.com/marx21 P.O. Box 100191 Columbia SC 29223 8009302836 8009302836 711 711 8552042744 8552042744 711 711 This plan does not charge an annual deductible for all drugs. The $70.00 annual deductible only applies to drugs on certain tiers.~ H7165 002 0 2021 BlueCross Secure (HMO) www.scbluesmedadvantage.com/marx21 P.O. Box 100191 Columbia SC 29223 8009302836 8009302836 711 711 8552042744 8552042744 711 711 This plan does not charge an annual deductible for all drugs. The $70.00 annual deductible only applies to drugs on certain tiers.~ H7165 805 0 2021 BlueCross MAPD Calendar Year (HMO) www.scbluesmedadvantage.com/marx21 P.O. Box 100191 Columbia SC 29223 8009302836 8009302836 711 711 8552042744 8552042744 711 711 H7165 806 0 2021 BlueCross MAPD Non-Calendar Year (HMO) www.scbluesmedadvantage.com/marx21 P.O. Box 100191 Columbia SC 29223 8009302836 8009302836 711 711 8552042744 8552042744 711 711 H7172 001 0 2021 Aetna Better Health of Ohio, MyCare Ohio (Medicare-Medicaid Plan) www.aetnabetterhealth.com/ohio 7400 West Campus Road New Albany OH 43054 8553640974 8553640974 711 711 8553640974 8553640974 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H7173 001 0 2021 Allwell Dual Medicare (HMO D-SNP) allwell.pshpgeorgia.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8777257748 8777257748 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H7173 002 0 2021 Allwell Medicare (HMO) allwell.pshpgeorgia.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8448902326 8448902326 711 711 This plan does not charge an annual deductible for all drugs. The $280.00 annual deductible only applies to drugs on certain tiers.~ H7173 007 0 2021 Allwell Medicare Premier (HMO) allwell.pshpgeorgia.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8448902326 8448902326 711 711 H7173 801 0 2021 Allwell Group (HMO) allwell.pshpgeorgia.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8448902326 8448902326 711 711 H7173 802 0 2021 Allwell Group (HMO) allwell.pshpgeorgia.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8448902326 8448902326 711 711 H7173 803 0 2021 Allwell Group (HMO) allwell.pshpgeorgia.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8448902326 8448902326 711 711 H7175 001 0 2021 WellCare Premier (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H7175 002 0 2021 WellCare Imperial (PPO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H7175 003 0 2021 WellCare Summit (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H7175 004 0 2021 WellCare Absolute (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H7175 005 0 2021 WellCare Patriot (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H7220 002 0 2021 IU Health Plans Medicare Select (HMO) www.iuhealthplans.org 950 N. Meridian Street, Suite 200 Indianapolis IN 46204 8663277497 8663277497 8007433333 8007433333 8004559776 3179639700 8007433333 8007433333 H7220 004 0 2021 IU Health Plans Medicare Choice (HMO-POS) www.iuhealthplans.org 950 N. Meridian Street, Suite 200 Indianapolis IN 46204 8663277497 8663277497 8007433333 8007433333 8004559776 3179639700 8007433333 8007433333 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H7220 009 1 2021 IU Health Plans Medicare Select Plus (HMO) www.iuhealthplans.org 950 N. Meridian Street, Suite 200 Indianapolis IN 46204 8663277497 8663277497 8007433333 8007433333 8004559776 3179639700 8007433333 8007433333 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H7220 009 2 2021 IU Health Plans Medicare Select Plus (HMO) www.iuhealthplans.org 950 N. Meridian Street, Suite 200 Indianapolis IN 46204 8663277497 8663277497 8007433333 8007433333 8004559776 3179639700 8007433333 8007433333 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H7220 009 3 2021 IU Health Plans Medicare Select Plus (HMO) www.iuhealthplans.org 950 N. Meridian Street, Suite 200 Indianapolis IN 46204 8663277497 8663277497 8007433333 8007433333 8004559776 3179639700 8007433333 8007433333 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H7245 001 0 2021 Premera Blue Cross Medicare Advantage (HMO) premera.com/ma PO Box 262548 Plano TX 75026 8888687767 8888687767 711 711 8888508526 8888508526 711 711 This plan does not charge an annual deductible for all drugs. The $180.00 annual deductible only applies to drugs on certain tiers.~ H7245 002 0 2021 Premera Blue Cross Medicare Advantage Classic (HMO) premera.com/ma PO Box 262548 Plano TX 75026 8888687767 8888687767 711 711 8888508526 8888508526 711 711 This plan does not charge an annual deductible for all drugs. The $180.00 annual deductible only applies to drugs on certain tiers.~ H7245 003 0 2021 Premera Blue Cross Medicare Advantage Classic Plus (HMO) premera.com/ma PO Box 262548 Plano TX 75026 8888687767 8888687767 711 711 8888508526 8888508526 711 711 This plan does not charge an annual deductible for all drugs. The $180.00 annual deductible only applies to drugs on certain tiers.~ H7245 005 0 2021 Premera Blue Cross Medicare Advantage Total Health (HMO) premera.com/ma PO Box 262548 Plano TX 75026 8888687767 8888687767 711 711 8888508526 8888508526 711 711 This plan does not charge an annual deductible for all drugs. The $180.00 annual deductible only applies to drugs on certain tiers.~ H7245 006 0 2021 Premera Blue Cross Medicare Advantage Core (HMO) premera.com/ma PO Box 262548 Plano TX 75026 8888687767 8888687767 711 711 8888508526 8888508526 711 711 This plan does not charge an annual deductible for all drugs. The $180.00 annual deductible only applies to drugs on certain tiers.~ H7245 008 0 2021 Premera Blue Cross Medicare Advantage Core Plus (HMO) premera.com/ma PO Box 262548 Plano TX 75026 8888687767 8888687767 711 711 8888508526 8888508526 711 711 This plan does not charge an annual deductible for all drugs. The $180.00 annual deductible only applies to drugs on certain tiers.~ H7273 001 0 2021 Banner Medicare Advantage Plus (PPO) www.BannerMA.com 2701 E. Elvira Rd. Tucson AZ 85756 8445567685 6024620830 711 711 8445491859 6024620830 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H7273 002 0 2021 Banner Medicare Advantage Plus (PPO) https://www.bannerhealth.com/services/insurance 2701 E. Elvira Rd. Tucson AZ 85756 8445567685 6024620830 711 711 8445491859 6024620830 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H7284 001 0 2021 HumanaChoice Florida H7284-001 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H7284 002 0 2021 HumanaChoice Florida H7284-002 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H7284 003 0 2021 HumanaChoice SNP-DE H7284-003 (PPO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H7284 006 0 2021 HumanaChoice Florida H7284-006 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H7301 002 0 2021 Aetna Medicare Premier Advantra (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H7301 006 0 2021 Aetna Medicare Value Advantra (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H7301 007 0 2021 Aetna Medicare Value Advantra (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H7301 009 0 2021 Aetna Medicare Premier Advantra (PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H7301 801 0 2021 Aetna Medicare Plan w/Rx (PPO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H7301 803 0 2021 Aetna Medicare Plan (PPO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H7322 001 0 2021 Montefiore + Oscar Easy Care (HMO) www.hioscar.com/medicare PO Box 62045 Phoenix AZ 85082 8556722710 8556722710 711 711 8556722720 8556722720 711 711 H7322 002 0 2021 Oscar Easy Care (HMO) www.hioscar.com/medicare PO Box 62045 Phoenix AZ 85082 8556722710 8556722710 711 711 8556722720 8556722720 711 711 H7322 003 0 2021 Montefiore + Oscar Extra Benefits (HMO) www.hioscar.com/medicare PO Box 62045 Phoenix AZ 85082 8556722710 8556722710 711 711 8556722720 8556722720 711 711 H7323 001 0 2021 WellCare Prime (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H7323 002 0 2021 WellCare Premier (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H7323 003 0 2021 WellCare Premier (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H7323 004 0 2021 WellCare Prime (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H7323 005 0 2021 WellCare Imperial (PPO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H7323 006 0 2021 WellCare Rx Plus (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H7326 001 0 2021 WellCare Premier (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H7326 002 0 2021 WellCare Prime (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H7326 003 0 2021 WellCare Absolute (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 This plan does not charge an annual deductible for all drugs. The $90.00 annual deductible only applies to drugs on certain tiers.~ H7326 004 0 2021 WellCare Flex Complete (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8668928340 8668928340 711 711 H7330 001 0 2021 Zing Choice IL (HMO) myzinghealth.com member.services@myzinghealth.com 303 West Madison Street, Suite 800 Chicago IL 60606 8669464458 8669464458 711 711 8669464458 8669464458 711 711 H7330 002 0 2021 Zing Open Access IL (HMO-POS) myzinghealth.com member.services@myzinghealth.com 303 West Madison Street, Suite 800 Chicago IL 60606 8669464458 8669464458 711 711 8669464458 8669464458 711 711 H7330 801 0 2021 Zing EGWP CY (HMO) myzinghealth.com member.services@myzinghealth.com 303 West Madison Street, Suite 800 Chicago IL 60606 8669464458 8669464458 711 711 8669464458 8669464458 711 711 H7330 802 0 2021 Zing EGWP NCY (HMO) myzinghealth.com member.services@myzinghealth.com 303 West Madison Street, Suite 800 Chicago IL 60606 8669464458 8669464458 711 711 8669464458 8669464458 711 711 H7330 803 0 2021 Zing EGWP MA Only CY (HMO) myzinghealth.com member.services@myzinghealth.com 303 West Madison Street, Suite 800 Chicago IL 60606 8669464458 8669464458 711 711 8669464458 8669464458 711 711 H7330 804 0 2021 Zing EGWP MA Only NCY (HMO) myzinghealth.com member.services@myzinghealth.com 303 West Madison Street, Suite 800 Chicago IL 60606 8669464458 8669464458 711 711 8669464458 8669464458 711 711 H7399 001 0 2021 Ascension Complete AMITA Health Reward (HMO) ascensioncomplete.com PO Box 10420 Van Nuys CA 91410 8449420038 8449420038 711 711 8332935966 8332935966 711 711 This plan does not charge an annual deductible for all drugs. The $430.00 annual deductible only applies to drugs on certain tiers.~ H7399 002 0 2021 Ascension Complete AMITA Health Secure (HMO) ascensioncomplete.com PO Box 10420 Van Nuys CA 91410 8449420038 8449420038 711 711 8332935966 8332935966 711 711 H7404 001 0 2021 AARP Medicare Advantage Headwaters (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448673487 8448673487 711 711 This plan does not charge an annual deductible for all drugs. The $395.00 annual deductible only applies to drugs on certain tiers.~ H7404 002 0 2021 AARP Medicare Advantage Lakeshore (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448673487 8448673487 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H7404 004 0 2021 AARP Medicare Advantage Premier (PPO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448766177 8448766177 711 711 H7404 005 0 2021 AARP Medicare Advantage Headwaters (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448673487 8448673487 711 711 This plan does not charge an annual deductible for all drugs. The $395.00 annual deductible only applies to drugs on certain tiers.~ H7404 006 0 2021 AARP Medicare Advantage Lakeshore (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448673487 8448673487 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H7404 011 0 2021 AARP Medicare Advantage Headwaters (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448673487 8448673487 711 711 This plan does not charge an annual deductible for all drugs. The $395.00 annual deductible only applies to drugs on certain tiers.~ H7404 012 0 2021 AARP Medicare Advantage Lakeshore (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448673487 8448673487 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H7404 014 0 2021 AARP Medicare Advantage Riverbank (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448673487 8448673487 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H7404 015 0 2021 AARP Medicare Advantage Patriot (PPO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448673487 8448673487 711 711 H7404 018 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448673487 8448673487 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H7404 019 0 2021 AARP Medicare Advantage Patriot (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448673487 8448673487 711 711 H7404 020 0 2021 AARP Medicare Advantage Walgreens Plan 2 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448673487 8448673487 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H7404 021 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8448673487 8448673487 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H7409 001 0 2021 Bright Advantage (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H7419 001 0 2021 Tufts Health Unify (Medicare-Medicaid Plan) www.ChooseUnify.org 705 Mount Auburn Street Watertown MA 02472 8553933154 8553933154 711 711 8553933154 8553933154 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H7445 004 0 2021 UnitedHealthcare Medicare Advantage (HMO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H7445 005 0 2021 AARP Medicare Advantage (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H7445 006 0 2021 AARP Medicare Advantage Patriot (HMO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H7464 001 0 2021 UnitedHealthcare Dual Complete (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8443687151 8443687151 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H7464 005 0 2021 UnitedHealthcare Dual Complete ONE (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8443687151 8443687151 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H7511 001 0 2021 Great Plains Medicare Advantage (HMO I-SNP) www.greatplainsmedicareadvantage.com PO Box 2190 Glen Allen VA 23058 8446374760 8446374760 711 711 8446374760 8446374760 711 711 H7511 002 0 2021 Great Plains Medicare Advantage Gold (HMO I-SNP) www.greatplainsmedicareadvantage.com PO Box 2190 Glen Allen VA 23058 8446374760 8446374760 711 711 8446374760 8446374760 711 711 H7518 001 0 2021 WellCare Premier (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H7518 002 0 2021 WellCare Patriot (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H7518 003 0 2021 WellCare Imperial (PPO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H7522 801 0 2021 MMM Advantage Group $0 Calendar (PPO) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H7522 802 0 2021 MMM Advantage Group $25 Calendar (PPO) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H7522 804 0 2021 MMM Advantage Group $50 Calendar (PPO) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H7522 805 0 2021 MMM Advantage Group $100 Calendar (PPO) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H7522 806 0 2021 MMM Advantage Group $0 Non-Calendar (PPO) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H7522 807 0 2021 MMM Advantage Group $25 Non-Calendar (PPO) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H7522 808 0 2021 MMM Advantage Group $50 Non-Calendar (PPO) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H7522 809 0 2021 MMM Advantage Group $100 Non-Calendar (PPO) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H7522 810 0 2021 MMM Advantage Group $144.60 Calendar (PPO) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H7522 811 0 2021 MMM Advantage Group $144.60 Non-Calendar (PPO) www.mmmpr.com manuel.sanchez@mmmhc.com 350 Chardon Avenue, Suite 500 Torre Chardon San Juan PR 00918 8663335471 7876202396 8775220655 8775220655 8663335471 7876202396 8775220655 8775220655 H7557 001 0 2021 Longevity Health Plan (HMO I-SNP) www.longevityhealthplan.com PO Box 5850 Glen Allen VA 23058 8883128825 8883128825 711 711 8883128825 8883128825 711 711 H7559 001 0 2021 Magellan Complete Care of Virginia, LLC (HMO D-SNP) mccofva.com 3829 Gaskins Road Richmond VA 23233 8004244497 8004244497 711 711 8004244495 8004244495 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H7594 001 0 2021 Brandman Health Plan (Arise) (HMO C-SNP) www.brandmanhealthplan.com memberservices@brandmanhealthplan.com 7150 Tampa Avenue Reseda CA 91335 8886975662 8886975662 8007352929 711 8886975662 8886975662 8007352929 711 H7594 002 0 2021 Brandman Health Plan (Arise-D) (HMO C-SNP) www.brandmanhealthplan.com memberservices@brandmanhealthplan.com 7150 Tampa Avenue Reseda CA 91335 8886975662 8886975662 8007352929 711 8886975662 8886975662 8007352929 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H7594 003 0 2021 Brandman Health Plan (Aspire) (HMO C-SNP) www.brandmanhealthplan.com memberservices@brandmanhealthplan.com 7150 Tampa Avenue Reseda CA 91335 8886975662 8886975662 8007352929 711 8886975662 8886975662 8007352929 711 H7594 004 0 2021 Brandman Health Plan (Aspire-D) (HMO C-SNP) www.brandmanhealthplan.com memberservices@brandmanhealthplan.com 7150 Tampa Avenue Reseda CA 91335 8886975662 8886975662 8007352929 711 8886975662 8886975662 8007352929 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H7598 001 0 2021 Cooperative Advantage Premium (HMO I-SNP) www.group-health.com 2503 N Hillcrest Parkway Altoona WI 54720 8882037770 7155524300 8009473529 8009473529 8882037770 7155524300 8009473529 8009473529 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H7598 002 0 2021 Cooperative Advantage (HMO I-SNP) www.group-health.com 2503 N Hillcrest Parkway Altoona WI 54720 8882037770 7155524300 8009473529 8009473529 8882037770 7155524300 8009473529 8009473529 H7607 002 1 2021 Clever Care Longevity Medicare Advantage (HMO) www.clevercarehealthplan.com/plans customerservice@clevercarehealthplan.com 8990 Westminster Blvd., 3rd Floor Westminster CA 92683 8333888168 8333888168 711 711 8333888168 8333888168 711 711 H7607 002 2 2021 Clever Care Longevity Medicare Advantage (HMO) www.clevercarehealthplan.com/plans customerservice@clevercarehealthplan.com 8990 Westminster Blvd., 3rd Floor Westminster CA 92683 8333888168 8333888168 711 711 8333888168 8333888168 711 711 H7607 002 3 2021 Clever Care Longevity Medicare Advantage (HMO) www.clevercarehealthplan.com/plans customerservice@clevercarehealthplan.com 8990 Westminster Blvd., 3rd Floor Westminster CA 92683 8333888168 8333888168 711 711 8333888168 8333888168 711 711 H7607 003 1 2021 Clever Care Balance Medicare Advantage (HMO) www.clevercarehealthplan.com/plans customerservice@clevercarehealthplan.com 8990 Westminster Blvd., 3rd Floor Westminster CA 92683 8333888168 8333888168 711 711 8333888168 8333888168 711 711 This plan does not charge an annual deductible for all drugs. The $435.00 annual deductible only applies to drugs on certain tiers.~ H7607 003 2 2021 Clever Care Balance Medicare Advantage (HMO) www.clevercarehealthplan.com/plans customerservice@clevercarehealthplan.com 8990 Westminster Blvd., 3rd Floor Westminster CA 92683 8333888168 8333888168 711 711 8333888168 8333888168 711 711 This plan does not charge an annual deductible for all drugs. The $435.00 annual deductible only applies to drugs on certain tiers.~ H7607 003 3 2021 Clever Care Balance Medicare Advantage (HMO) www.clevercarehealthplan.com/plans customerservice@clevercarehealthplan.com 8990 Westminster Blvd., 3rd Floor Westminster CA 92683 8333888168 8333888168 711 711 8333888168 8333888168 711 711 This plan does not charge an annual deductible for all drugs. The $435.00 annual deductible only applies to drugs on certain tiers.~ H7617 001 0 2021 HumanaChoice H7617-001 (PPO) www.humana.com/medicare 500 West Main St. Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H7621 001 0 2021 Humana Community (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H7621 002 0 2021 Humana Community (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H7621 003 0 2021 Humana Community (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H7646 001 0 2021 Sparrow Advantage (HMO-POS) www.sparrowadvantage.com PO Box 12487 St. Louis MO 63132 8445293826 8445293826 711 711 8445293757 8445293757 711 711 H7646 002 0 2021 Covenant Advantage (HMO-POS) www.covenantadvantage.com PO Box 12487 St. Louis MO 63132 8445279389 8445279389 711 711 8443299247 8443299247 711 711 H7646 003 0 2021 PHP Advantage (HMO-POS) www.phpadvantage.com PO Box 12487 St. Louis MO 63132 8445279395 8445279395 711 711 8552292172 8552292172 711 711 H7646 004 0 2021 Sparrow Advantage Plus (HMO-POS) www.sparrowadvantage.com PO Box 12487 St. Louis MO 63132 8445293826 8445293826 711 711 8445293757 8445293757 711 711 H7646 005 0 2021 Covenant Advantage Plus (HMO-POS) www.covenantadvantage.com PO Box 12487 St. Louis MO 63132 8445279389 8445279389 711 711 8443299247 8443299247 711 711 H7646 006 0 2021 PHP Advantage Plus (HMO-POS) www.phpadvantage.com PO Box 12487 St. Louis MO 63132 8445279395 8445279395 711 711 8552292172 8552292172 711 711 H7646 801 0 2021 EGWP MAPD Calendar year (HMO-POS) www.phpmedicare.com PO Box 12487 St. Louis MO 63132 8445293826 8445293826 711 711 8445293757 8445293757 711 711 H7646 802 0 2021 EGWP MAPD Non-Calendar year (HMO-POS) www.phpmedicare.com PO Box 12487 St. Louis MO 63132 8445293826 8445293826 711 711 8445293757 8445293757 711 711 H7678 001 0 2021 Molina Medicare Complete Care (HMO D-SNP) www.molinahealthcare.com/medicare 200 Oceangate, Suite 100 Long Beach CA 90802 8664038293 8664038293 711 711 8664400012 8664400012 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H7680 001 0 2021 Prominence Plus (HMO) www.prominencemedicare.com 1510 Meadow Wood Lane Reno NV 89502 8559695882 8559695882 711 711 8559695882 8559695882 711 711 H7680 002 0 2021 Prominence Plus (HMO) www.prominencemedicare.com 1510 Meadow Wood Lane Reno NV 89502 8559695882 8559695882 711 711 8559695882 8559695882 711 711 H7680 801 0 2021 Prominence Health Plan (HMO) www.prominencemedicare.com 1510 Meadow Wood Lane Reno NV 89502 8559695882 8559695882 711 711 8559695882 8559695882 711 711 H7680 804 0 2021 Prominence Health Plan (HMO) www.prominencemedicare.com 1510 Meadow Wood Lane Reno NV 89502 8559695882 8559695882 711 711 8559695882 8559695882 711 711 H7728 002 0 2021 Anthem MediBlue Access (PPO) shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8557681041 8557681041 711 711 8553041787 8553041787 711 711 This plan does not charge an annual deductible for all drugs. The $260.00 annual deductible only applies to drugs on certain tiers.~ H7728 004 1 2021 Anthem MediBlue Access (PPO) shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8557681041 8557681041 711 711 8556907795 8556907795 711 711 This plan's deductible only applies to out-of-network services.~ H7728 004 2 2021 Anthem MediBlue Access (PPO) shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8557681041 8557681041 711 711 8556907795 8556907795 711 711 This plan's deductible only applies to out-of-network services.~ H7728 005 0 2021 Anthem MediBlue Access (PPO) shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8557681041 8557681041 711 711 8664389968 8664389968 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H7728 006 0 2021 Anthem MediBlue Access Basic (PPO) shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8557681041 8557681041 711 711 8664389968 8664389968 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H7728 008 0 2021 Anthem MediBlue Access Core (PPO) shop.anthem.com/medicare P.O. Box 659404, CN14B-818 San Antonio TX 78265 8557681041 8557681041 711 711 8556907795 8556907795 711 711 H7728 009 0 2021 Anthem MediBlue Access Plus (PPO) shop.anthem.com/medicare P.O. Box 659404, CN14B-818 San Antonio TX 78265 8557681041 8557681041 711 711 8556907795 8556907795 711 711 This plan does not charge an annual deductible for all drugs. The $125.00 annual deductible only applies to drugs on certain tiers.~ H7728 801 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H7728 802 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H7728 803 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H7728 805 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H7728 806 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H7728 810 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H7728 811 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H7728 812 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H7779 001 0 2021 American Health Advantage of Tennessee (HMO I-SNP) tn.AmHealthPlans.com MemberServices@AmHealthPlans.com 201 Jordan Road, Suite 200 Franklin TN 37067 8443211763 8443211763 711 711 8443211763 8443211763 711 711 H7787 001 0 2021 Cigna Preferred Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826174 8559826174 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $190.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H7787 002 0 2021 Cigna Fundamental Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826174 8559826174 711 711 8006683813 8006683813 711 711 This plan's deductible only applies to out-of-network services.~ H7833 001 0 2021 UnitedHealthcare Connected (Medicare-Medicaid Plan) www.UHCCommunityplan.com PO Box 29675 Hot Springs AR 71903 8002566533 8002566533 711 711 8002566533 8002566533 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H7844 001 0 2021 Molina Dual Options (Medicare-Medicaid Plan) www.molinahealthcare.com/duals 200 Oceangate, Suite 100 Long Beach CA 90802 8557014885 8557014885 711 711 8557355604 8557355604 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H7849 001 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8557211583 8557211583 711 711 8006683813 8006683813 711 711 H7849 002 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8888861993 8888861993 711 711 8006683813 8006683813 711 711 H7849 003 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826101 8559826101 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H7849 006 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8008567657 8008567657 711 711 8006683813 8006683813 711 711 H7849 007 0 2021 Cigna True Choice Plus Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8008567657 8008567657 711 711 8006683813 8006683813 711 711 H7849 008 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8008567657 8008567657 711 711 8006683813 8006683813 711 711 H7849 009 0 2021 Cigna True Choice Plus Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8008567657 8008567657 711 711 8006683813 8006683813 711 711 H7849 010 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H7849 011 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559803049 8559803049 711 711 8006683813 8006683813 711 711 H7849 012 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8557077116 8557077116 711 711 8006683813 8006683813 711 711 H7849 013 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8557077116 8557077116 711 711 8006683813 8006683813 711 711 H7849 014 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8666238445 8666238445 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H7849 015 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8553940157 8553940157 711 711 8006683813 8006683813 711 711 H7849 016 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8557077116 8557077116 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H7849 017 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559803046 8559803046 711 711 8006683813 8006683813 711 711 H7849 018 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559803049 8559803049 711 711 8006683813 8006683813 711 711 H7849 019 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559803049 8559803049 711 711 8006683813 8006683813 711 711 H7849 020 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826101 8559826101 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H7849 021 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826101 8559826101 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H7849 022 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826101 8559826101 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H7849 023 0 2021 Cigna True Choice Plus Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826101 8559826101 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.~ H7849 024 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8666121391 8666121391 711 711 8006683813 8006683813 711 711 H7849 026 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559520786 8559520786 711 711 8006683813 8006683813 711 711 H7849 027 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559520786 8559520786 711 711 8006683813 8006683813 711 711 H7849 028 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8553438992 8553438992 711 711 8006683813 8006683813 711 711 H7849 029 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H7849 030 0 2021 Cigna True Choice Plus Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8008567657 8008567657 711 711 8006683813 8006683813 711 711 H7849 031 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8008567657 8008567657 711 711 8006683813 8006683813 711 711 H7849 032 0 2021 Cigna True Choice Plus Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8008567657 8008567657 711 711 8006683813 8006683813 711 711 H7849 033 0 2021 Cigna True Choice Plus Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8008567657 8008567657 711 711 8006683813 8006683813 711 711 H7849 034 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H7849 035 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H7849 036 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H7849 037 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H7849 038 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826174 8559826174 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $190.00 annual deductible only applies to drugs on certain tiers.~ H7849 039 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826174 8559826174 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $190.00 annual deductible only applies to drugs on certain tiers.~ H7849 040 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826174 8559826174 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $190.00 annual deductible only applies to drugs on certain tiers.~ H7849 041 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826174 8559826174 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $190.00 annual deductible only applies to drugs on certain tiers.~ H7849 042 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 This plan does not charge an annual deductible for all drugs. The $190.00 annual deductible only applies to drugs on certain tiers.~ H7849 043 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H7849 801 0 2021 Cigna True Choice Medicare (PPO) www.cignahealthspring.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826172 8559826172 711 711 8006683813 8006683813 711 711 H7849 802 0 2021 Cigna True Choice Core Medicare (PPO) www.cignahealthspring.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826172 8559826172 711 711 8006683813 8006683813 711 711 H7849 803 0 2021 Cigna True Choice Medicare (PPO) www.cignahealthspring.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826172 8559826172 711 711 8006683813 8006683813 711 711 H7849 804 0 2021 Cigna True Choice Core Medicare (PPO) www.cignahealthspring.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826172 8559826172 711 711 8006683813 8006683813 711 711 H7849 805 0 2021 Cigna True Choice Medicare (PPO) www.cignahealthspring.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826172 8559826172 711 711 8006683813 8006683813 711 711 H7849 806 0 2021 Cigna True Choice Core Medicare (PPO) www.cignahealthspring.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826172 8559826172 711 711 8006683813 8006683813 711 711 H7849 807 0 2021 Cigna True Choice Medicare (PPO) www.cignahealthspring.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826172 8559826172 711 711 8006683813 8006683813 711 711 H7849 808 0 2021 Cigna True Choice Core Medicare (PPO) www.cignahealthspring.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826172 8559826172 711 711 8006683813 8006683813 711 711 H7849 809 0 2021 Cigna True Choice Medicare (PPO) www.cignahealthspring.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826172 8559826172 711 711 8006683813 8006683813 711 711 H7849 810 0 2021 Cigna True Choice Core Medicare (PPO) www.cignahealthspring.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826172 8559826172 711 711 8006683813 8006683813 711 711 H7849 811 0 2021 Cigna True Choice Medicare (PPO) www.cignahealthspring.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826172 8559826172 711 711 8006683813 8006683813 711 711 H7849 812 0 2021 Cigna True Choice Core Medicare (PPO) www.cignahealthspring.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826172 8559826172 711 711 8006683813 8006683813 711 711 H7849 813 0 2021 Cigna True Choice Medicare (PPO) www.cignahealthspring.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826172 8559826172 711 711 8006683813 8006683813 711 711 H7849 814 0 2021 Cigna True Choice Core Medicare (PPO) www.cignahealthspring.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826172 8559826172 711 711 8006683813 8006683813 711 711 H7849 815 0 2021 Cigna True Choice Medicare (PPO) www.cignahealthspring.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826172 8559826172 711 711 8006683813 8006683813 711 711 H7849 816 0 2021 Cigna True Choice Core Medicare (PPO) www.cignahealthspring.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826172 8559826172 711 711 8006683813 8006683813 711 711 H7849 817 0 2021 Cigna True Choice Medicare (PPO) www.cignahealthspring.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826172 8559826172 711 711 8006683813 8006683813 711 711 H7849 818 0 2021 Cigna True Choice Core Medicare (PPO) www.cignahealthspring.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559826172 8559826172 711 711 8006683813 8006683813 711 711 H7849 819 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H7849 820 0 2021 Cigna True Choice Core Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H7849 821 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H7849 822 0 2021 Cigna True Choice Core Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H7849 823 0 2021 Cigna True Choice Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H7849 824 0 2021 Cigna True Choice Core Medicare (PPO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H7853 001 0 2021 Bright Advantage (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H7853 002 0 2021 Bright Advantage Plus (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H7853 005 0 2021 Bright Advantage Assist (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H7853 007 0 2021 Bright Advantage (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H7853 008 0 2021 Bright Advantage Plus (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H7885 001 0 2021 CareAdvantage Cal MediConnect Plan (Medicare-Medicaid Plan) www.hpsm.org CareAdvantageUnit@hpsm.org 801 Gateway Blvd, Ste 100 South San Francisco CA 94080 8882523153 6506161500 8007352929 8007352929 8668800606 6506162174 8007352929 8007352929 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H7890 001 0 2021 Santa Clara Family Health Plan (Medicare-Medicaid Plan) www.scfhp.com CallCenterManagement@scfhp.com P.O. Box 18880 San Jose CA 95158 8777234795 4083762000 711 711 8777234795 4083762000 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H7917 009 0 2021 BlueAdvantage Diamond (PPO) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8002925146 8002925146 711 711 8008312583 8008312583 711 711 H7917 010 0 2021 BlueAdvantage Diamond (PPO) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8002925146 8002925146 711 711 8008312583 8008312583 711 711 H7917 011 0 2021 BlueAdvantage Diamond (PPO) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8002925146 8002925146 711 711 8008312583 8008312583 711 711 H7917 012 0 2021 BlueAdvantage Ruby (PPO) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8002925146 8002925146 711 711 8008312583 8008312583 711 711 H7917 013 0 2021 BlueAdvantage Ruby (PPO) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8002925146 8002925146 711 711 8008312583 8008312583 711 711 H7917 014 0 2021 BlueAdvantage Ruby (PPO) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8002925146 8002925146 711 711 8008312583 8008312583 711 711 H7917 015 0 2021 BlueAdvantage Ruby (PPO) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8002925146 8002925146 711 711 8008312583 8008312583 711 711 H7917 030 0 2021 BlueAdvantage Sapphire (PPO) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8002925146 8002925146 711 711 8008312583 8008312583 711 711 H7917 031 0 2021 BlueAdvantage Sapphire (PPO) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8002925146 8002925146 711 711 8008312583 8008312583 711 711 H7917 032 0 2021 BlueAdvantage Garnet (PPO) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8002925146 8002925146 711 711 8008312583 8008312583 711 711 H7917 033 0 2021 BlueAdvantage Garnet (PPO) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8002925146 8002925146 711 711 8008312583 8008312583 711 711 H7917 034 0 2021 BlueAdvantage Emerald (PPO) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8002925146 8002925146 711 711 8008312583 8008312583 711 711 H7917 035 0 2021 BlueAdvantage Emerald (PPO) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8002925146 8002925146 711 711 8008312583 8008312583 711 711 H7917 036 0 2021 BlueAdvantage Emerald (PPO) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8002925146 8002925146 711 711 8008312583 8008312583 711 711 H7917 037 0 2021 BlueAdvantage Emerald (PPO) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8002925146 8002925146 711 711 8008312583 8008312583 711 711 H7917 801 0 2021 BlueAdvantage Plus (PPO) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8884765072 8884765072 711 711 8008180962 8008180962 711 711 H7917 802 0 2021 BlueAdvantage Plus (PPO) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8884765072 8884765072 711 711 8008180962 8008180962 711 711 H7917 803 0 2021 BlueAdvantage Plus (PPO) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8884765072 8884765072 711 711 8008180962 8008180962 711 711 H7925 001 0 2021 Ascension Complete St Vincent Reward (HMO) ascensioncomplete.com PO Box 10420 Van Nuys CA 91410 8449420038 8449420038 711 711 8335250824 8335250824 711 711 This plan does not charge an annual deductible for all drugs. The $390.00 annual deductible only applies to drugs on certain tiers.~ H7925 002 0 2021 Ascension Complete St Vincent Secure (HMO) ascensioncomplete.com PO Box 10420 Van Nuys CA 91410 8449420038 8449420038 711 711 8335250824 8335250824 711 711 H7971 003 0 2021 Horizon Medicare Blue Access (PPO) www.HorizonBlue.com/Medicare 3 Penn Plaza East, PP-12F Newark NJ 07105 8887657134 8887657134 711 711 8003652223 8003652223 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H7971 801 0 2021 Horizon Medicare Blue Group (PPO) www.HorizonBlue.com 3 Penn Plaza East, PP-12F Newark NJ 07105 8887657134 8887657134 711 711 8003652223 8003652223 711 711 H7971 802 0 2021 Horizon Medicare Blue Group w/Rx (PPO) www.HorizonBlue.com 3 Penn Plaza East, PP-12F Newark NJ 07105 8887657134 8887657134 711 711 8003652223 8003652223 711 711 H7971 807 0 2021 Horizon Medicare Blue Group w/Rx Ideal (PPO) www.HorizonBlue.com 3 Penn Plaza East, PP-12F Newark NJ 07105 8887657134 8887657134 711 711 8003652223 8003652223 711 711 H7971 808 0 2021 Horizon Medicare Blue Group w/Rx Complete (PPO) www.HorizonBlue.com 3 Penn Plaza East, PP-12F Newark NJ 07105 8887657134 8887657134 711 711 8003652223 8003652223 711 711 H7993 001 0 2021 Devoted Health Core Greater Houston (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 H7993 002 0 2021 Devoted Health Prime Greater Houston (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 H7993 003 0 2021 Devoted Health Core San Antonio (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H7993 004 0 2021 Devoted Health Prime San Antonio (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H8003 001 0 2021 BlueCross Total (PPO) www.scbluesmedadvantage.com/marx21 P.O. Box 100191 Columbia SC 29202 8009302836 8009302836 711 711 8552042744 8552042744 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H8003 002 0 2021 BlueCross Total (PPO) www.scbluesmedadvantage.com/marx21 P.O. Box 100191 Columbia SC 29202 8009302836 8009302836 711 711 8552042744 8552042744 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H8003 003 0 2021 BlueCross Total (PPO) www.scbluesmedadvantage.com/marx21 P.O. Box 100191 Columbia SC 29202 8009302836 8009302836 711 711 8552042744 8552042744 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H8003 004 0 2021 BlueCross Total Value (PPO) www.scbluesmedadvantage.com/marx21 P.O. Box 100191 Columbia SC 29202 8009302836 8009302836 711 711 8552042744 8552042744 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H8003 005 0 2021 BlueCross Total Value (PPO) www.scbluesmedadvantage.com/marx21 P.O. Box 100191 Columbia SC 29202 8009302836 8009302836 711 711 8552042744 8552042744 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H8003 801 0 2021 BlueCross MAPD Calendar Year Group (PPO) www.SCBluesMedAdvantage.com/retplan21 P.O. Box 100191 Columbia SC 29202 8552042744 8552042744 711 711 8552042744 8552042744 711 711 H8003 802 0 2021 BlueCross MAPD Non-calendar Year Group (PPO) www.SCBluesMedAdvantage.com/retplan21 P.O. Box 100191 Columbia SC 29202 8552042744 8552042744 711 711 8552042744 8552042744 711 711 H8003 803 0 2021 BlueCross MA Only Calendar Year Group (PPO) www.SCBluesMedAdvantage.com/retplan21 P.O. Box 100191 Columbia SC 29202 8552042744 8552042744 711 711 8552042744 8552042744 711 711 H8003 804 0 2021 BlueCross MA Only Non-calendar Year Group (PPO) www.SCBluesMedAdvantage.com/retplan21 P.O. Box 100191 Columbia SC 29202 8552042744 8552042744 711 711 8552042744 8552042744 711 711 H8010 002 0 2021 Clover Health Classic (HMO) www.cloverhealth.com 30 Montgomery Street, 15th Floor Jersey City NJ 07302 8884665044 2014259257 711 711 8887781478 2014149690 711 711 H8010 003 0 2021 Clover Health Value (HMO) www.cloverhealth.com 30 Montgomery Street, 15th Floor Jersey City NJ 07302 8884665044 2014259257 711 711 8887781478 2014149690 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H8010 005 0 2021 Clover Health Classic (HMO) www.cloverhealth.com 30 Montgomery Street, 15th Floor Jersey City NJ 07302 8884665044 2014259257 711 711 8887781478 2014149690 711 711 H8010 008 0 2021 Clover Health Classic (HMO) www.cloverhealth.com 30 Montgomery Street, 15th Floor Jersey City NJ 07302 8884665044 2014259257 711 711 8887781478 2014149690 711 711 H8016 001 0 2021 OneCare Connect (Medicare-Medicaid Plan) www.caloptima.org/onecareconnect 505 City Parkway West Orange CA 92868 8557058823 8557058823 711 711 8557058823 8557058823 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H8019 001 0 2021 SSM Health Plan Unity (HMO) wellfirsthealth.com PO Box 56099 Madison WI 53705 8335510565 8335510565 711 711 8773013326 8773013326 711 711 H8019 002 0 2021 SSM Health Plan Integrity (HMO-POS) wellfirsthealth.com PO Box 56099 Madison WI 53705 8335510565 8335510565 711 711 8773013326 8773013326 711 711 H8019 003 0 2021 SSM Health Plan Harmony (HMO-POS) wellfirsthealth.com PO Box 56099 Madison WI 53705 8335510565 8335510565 711 711 8773013326 8773013326 711 711 H8019 004 0 2021 SSM Health Plan Companion (HMO) wellfirsthealth.com PO Box 56099 Madison WI 53705 8335510565 8335510565 711 711 8773013326 8773013326 711 711 H8019 801 0 2021 SSM EGWP MAPD CY (HMO) wellfirstbenefits.com 1277 Deming Way Madison WI 53717 8772340126 6088281941 711 711 8773013326 8773013326 711 711 H8019 802 0 2021 SSM EGWP MAPD Non CY (HMO) wellfirstbenefits.com 1277 Deming Way Madison WI 53717 8772340126 6088281941 711 711 8773013326 8773013326 711 711 H8019 803 0 2021 SSM EGWP MA Only (HMO) wellfirstbenefits.com 1277 Deming Way Madison WI 53717 8772340126 6088281941 711 711 8773013326 8773013326 711 711 H8019 804 0 2021 SSM EGWP MAPD CY (HMO-POS) wellfirstbenefits.com 1277 Deming Way Madison WI 53717 8772340126 6088281941 711 711 8773013326 8773013326 711 711 H8019 805 0 2021 SSM EGWP MAPD Non CY (HMO-POS) wellfirstbenefits.com 1277 Deming Way Madison WI 53717 8772340126 6088281941 711 711 8773013326 8773013326 711 711 H8019 806 0 2021 SSM EGWP MA Only (HMO-POS) wellfirstbenefits.com 1277 Deming Way Madison WI 53717 8772340126 6088281941 711 711 8773013326 8773013326 711 711 H8026 001 0 2021 Aetna Better Health Premier Plan (Medicare-Medicaid Plan) www.aetnabetterhealth.com/michigan 7400 W. Campus Road, MC F494 New Albany OH 43054 8556765772 8556765772 711 711 8556765772 8556765772 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H8046 001 0 2021 Molina Dual Options (Medicare-Medicaid Plan) www.molinahealthcare.com/duals 1520 Kensington Road, Suite 212 Oak Brook IL 60523 8558959987 8558959987 711 711 8779018181 8779018181 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H8064 002 0 2021 FirstMedicare Direct PPO Plus (PPO) www.firstmedicare.com 42 Memorial Drive Pinehurst NC 28374 8883829781 8883829781 711 711 8772109167 8772109167 711 711 H8064 004 0 2021 FirstMedicare Direct PPO Premier (PPO) www.firstmedicare.com 42 Memorial Drive Pinehurst NC 28374 8883829781 8883829781 711 711 8772109167 8772109167 711 711 H8067 001 0 2021 Provider Partners Maryland Advantage Plan (HMO I-SNP) www.pphealthplan.com info@pphealthplan.com 785 Elkridge Landing Rd, Suite 300 Linthicum Heights MD 21090 8004059681 8004059681 711 711 8004059681 8004059681 711 711 H8067 003 0 2021 Provider Partners Maryland Community Plan (HMO I-SNP) www.pphealthplan.com info@pphealthplan.com 785 Elkridge Landing Rd, Suite 300 Linthicum Heights MD 21090 8004059681 8004059681 711 711 8004059681 8004059681 711 711 H8087 001 0 2021 HumanaChoice H8087-001 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $75.00 annual deductible only applies to drugs on certain tiers.~ H8087 002 0 2021 Humana Value Plus H8087-002 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $260.00 annual deductible only applies to drugs on certain tiers.~ H8087 003 0 2021 HumanaChoice SNP-DE H8087-003 (PPO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8087 801 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H8087 802 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H8087 805 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H8087 806 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H8087 807 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H8087 808 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H8087 809 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H8087 810 0 2021 Humana Medicare Employer (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H8093 001 0 2021 Georgia Health Advantage (HMO I-SNP) GeorgiaHealthAdvantage.com MemberServices@AmHealthPlans.com 201 Jordan Road, Suite 200 Franklin TN 37067 8449170645 8449170645 711 711 8449170645 8449170645 711 711 H8125 002 0 2021 UnitedHealthcare Dual Complete LP1 (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8669443488 8669443488 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8125 003 0 2021 UnitedHealthcare Dual Complete LP1 (HMO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8443687150 8443687150 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8130 001 0 2021 Molina Medicare Complete Care (HMO D-SNP) www.molinahealthcare.com/medicare 200 Oceangate, Suite 100 Long Beach CA 90802 8664038293 8664038293 711 711 8665539494 8665539494 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8133 001 0 2021 Blue Cross Medicare Advantage Basic (HMO) www.getbluetx.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 H8133 003 0 2021 Blue Cross Medicare Advantage Basic (HMO) www.getbluetx.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 This plan does not charge an annual deductible for all drugs. The $255.00 annual deductible only applies to drugs on certain tiers.~ H8133 005 0 2021 Blue Cross Medicare Advantage Basic (HMO) www.getbluetx.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H8133 801 0 2021 Blue Cross Group Medicare Advantage Plan (HMO) getbluetx.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H8133 803 0 2021 Blue Cross Group Medicare Advantage Plan (HMO) getbluetx.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H8133 805 0 2021 Blue Cross Group Medicare Advantage Plan (HMO) getbluetx.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H8142 001 0 2021 BSW SeniorCare Advantage Select Rx (HMO) advantage.swhp.org 1206 West Campus Drive Temple TX 76502 8663343141 8663343141 711 711 8663343141 8663343141 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H8142 002 0 2021 BSW SeniorCare Advantage Preferred Rx (HMO) advantage.swhp.org 1206 West Campus Drive Temple TX 76502 8663343141 8663343141 711 711 8663343141 8663343141 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H8142 003 0 2021 BSW SeniorCare Advantage Premium Rx (HMO) advantage.swhp.org 1206 West Campus Drive Temple TX 76502 8663343141 8663343141 711 711 8663343141 8663343141 711 711 H8142 004 0 2021 BSW SeniorCare Advantage Select (HMO) advantage.swhp.org 1206 West Campus Drive Temple TX 76502 8663343141 8663343141 711 711 8663343141 8663343141 711 711 H8142 005 0 2021 BSW SeniorCare Advantage Preferred (HMO) advantage.swhp.org 1206 West Campus Drive Temple TX 76502 8663343141 8663343141 711 711 8663343141 8663343141 711 711 H8142 006 0 2021 BSW SeniorCare Advantage Premium (HMO) advantage.swhp.org 1206 West Campus Drive Temple TX 76502 8663343141 8663343141 711 711 8663343141 8663343141 711 711 H8142 007 0 2021 BSW SeniorCare Advantage Select Rx (HMO) advantage.swhp.org 1206 West Campus Drive Temple TX 76502 8663343141 8663343141 711 711 8663343141 8663343141 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H8142 008 0 2021 BSW SeniorCare Advantage Select (HMO) advantage.swhp.org 1206 West Campus Drive Temple TX 76502 8663343141 8663343141 711 711 8663343141 8663343141 711 711 H8142 801 0 2021 BSW SeniorCare Advantage EGWP CY Rx (HMO) advantage.swhp.org 1206 West Campus Drive Temple TX 76502 8663343141 8663343141 711 711 8663343141 8663343141 711 711 H8142 802 0 2021 BSW SeniorCare Advantage EGWP CY (HMO) advantage.swhp.org 1206 West Campus Drive Temple TX 76502 8663343141 8663343141 711 711 8663343141 8663343141 711 711 H8142 803 0 2021 BSW SeniorCare Advantage EGWP FY Rx (HMO) advantage.swhp.org 1206 West Campus Drive Temple TX 76502 8663343141 8663343141 711 711 8663343141 8663343141 711 711 H8142 804 0 2021 BSW SeniorCare Advantage EGWP FY (HMO) advantage.swhp.org 1206 West Campus Drive Temple TX 76502 8663343141 8663343141 711 711 8663343141 8663343141 711 711 H8145 004 0 2021 Humana Gold Choice H8145-004 (PFFS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $160.00 annual deductible only applies to drugs on certain tiers.~ H8145 006 0 2021 Humana Gold Choice H8145-006 (PFFS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H8145 008 0 2021 Humana Gold Choice H8145-008 (PFFS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $380.00 annual deductible only applies to drugs on certain tiers.~ H8145 021 0 2021 Humana Gold Choice H8145-021 (PFFS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $360.00 annual deductible only applies to drugs on certain tiers.~ H8145 032 0 2021 Humana Gold Choice H8145-032 (PFFS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H8145 042 0 2021 Humana Gold Choice H8145-042 (PFFS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H8145 052 0 2021 Humana Gold Choice H8145-052 (PFFS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $360.00 annual deductible only applies to drugs on certain tiers.~ H8145 055 0 2021 Humana Gold Choice H8145-055 (PFFS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H8145 061 0 2021 Humana Gold Choice H8145-061 (PFFS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H8145 069 0 2021 Humana Gold Choice H8145-069 (PFFS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $340.00 annual deductible only applies to drugs on certain tiers.~ H8145 075 0 2021 Humana Gold Choice H8145-075 (PFFS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H8145 084 0 2021 Humana Gold Choice H8145-084 (PFFS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H8145 089 0 2021 Humana Gold Choice H8145-089 (PFFS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H8145 091 0 2021 Humana Gold Choice H8145-091 (PFFS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H8145 120 0 2021 Humana Gold Choice H8145-120 (PFFS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H8145 121 0 2021 Humana Gold Choice H8145-121 (PFFS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H8145 122 0 2021 Humana Gold Choice H8145-122 (PFFS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H8145 123 0 2021 Humana Gold Choice H8145-123 (PFFS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H8145 125 0 2021 Humana Gold Choice H8145-125 (PFFS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H8145 126 0 2021 Humana Gold Choice H8145-126 (PFFS) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H8173 001 0 2021 Devoted Health Core (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 H8173 002 0 2021 Devoted Health Select (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 H8173 003 0 2021 Devoted Health Flex (HMO) www.Devoted.com Devoted Health, PO Box 211037 Eagan MN 55121 8003765889 8003765889 711 711 8003386833 8003386833 711 711 H8176 001 0 2021 Molina Medicare Complete Care (HMO D-SNP) www.molinahealthcare.com/medicare 200 Oceangate, Suite 100 Long Beach CA 90802 8664038293 8664038293 711 711 8445263195 8445263195 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8176 002 0 2021 Molina Medicare Complete Care (HMO D-SNP) www.molinahealthcare.com/medicare 200 Oceangate, Suite 100 Long Beach CA 90802 8664038293 8664038293 711 711 8664724584 8664724584 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8181 001 0 2021 Blue Cross Blue Shield Nebraska MA Access PPO (PPO) https://Medicare.NebraskaBlue.com PO Box 261276 Plano TX 75026 8448996060 8448996060 711 711 8884889850 8884889850 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H8181 801 0 2021 BCBSNE Employer Group PPO Rx CY (PPO) https://Medicare.NebraskaBlue.com PO Box 261276 Plano TX 75026 8448996060 8448996060 711 711 8884889850 8884889850 711 711 H8181 802 0 2021 BCBSNE Employer Group PPO CY (PPO) https://Medicare.NebraskaBlue.com PO Box 261276 Plano TX 75026 8448996060 8448996060 711 711 8884889850 8884889850 711 711 H8181 803 0 2021 BCBSNE Employer Group PPO Rx CY (PPO) https://Medicare.NebraskaBlue.com PO Box 261276 Plano TX 75026 8448996060 8448996060 711 711 8884889850 8884889850 711 711 H8181 804 0 2021 BCBSNE Employer Group PPO Rx CY (PPO) https://Medicare.NebraskaBlue.com PO Box 261276 Plano TX 75026 8448996060 8448996060 711 711 8884889850 8884889850 711 711 H8189 001 0 2021 Allwell Dual Medicare (HMO D-SNP) allwell.mhswi.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8779358024 8779358024 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8197 001 0 2021 Molina Dual Options (Medicare-Medicaid Plan) www.molinahealthcare.com/duals 200 Oceangate, Suite 100 Long Beach CA 90802 8558959992 8558959992 711 711 8668568699 8668568699 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H8211 001 0 2021 AARP Medicare Advantage Choice Plan 1 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H8211 002 0 2021 AARP Medicare Advantage Choice Plan 2 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H8211 005 0 2021 AARP Medicare Advantage Patriot (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H8211 006 0 2021 AARP Medicare Advantage Choice Plan 3 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H8211 007 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H8213 001 0 2021 First Choice VIP Care Plus (Medicare-Medicaid Plan) http://www.firstchoicevipcareplus.com 200 Stevens Drive Philadelphia PA 19113 8777039109 8777039109 711 711 8889780862 8889780862 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H8225 001 0 2021 Ascension Complete St. Vincent's Reward (HMO) ascensioncomplete.com PO Box 10420 Van Nuys CA 91410 8449420038 8449420038 711 711 8336032971 8336032971 711 711 This plan does not charge an annual deductible for all drugs. The $360.00 annual deductible only applies to drugs on certain tiers.~ H8225 002 0 2021 Ascension Complete Sacred Heart Reward (HMO) ascensioncomplete.com PO Box 10420 Van Nuys CA 91410 8449420038 8449420038 711 711 8336032971 8336032971 711 711 This plan does not charge an annual deductible for all drugs. The $390.00 annual deductible only applies to drugs on certain tiers.~ H8225 003 0 2021 Ascension Complete St. Vincent's Secure (HMO) ascensioncomplete.com PO Box 10420 Van Nuys CA 91410 8449420038 8449420038 711 711 8336032971 8336032971 711 711 H8225 004 0 2021 Ascension Complete Sacred Heart Secure (HMO) ascensioncomplete.com PO Box 10420 Van Nuys CA 91410 8449420038 8449420038 711 711 8336032971 8336032971 711 711 H8258 001 0 2021 L.A. Care Cal MediConnect Plan (Medicare-Medicaid Plan) www.calmediconnectla.org 1055 West 7th Street Los Angeles CA 90017 8555228243 8555228243 711 711 8885221298 8885221298 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H8280 001 0 2021 Bright Advantage (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H8280 002 0 2021 Bright Advantage Plus (HMO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H8293 001 0 2021 Clear Spring Health Essential (HMO) www.clearspringhealthcare.com P.O. Box 278530 Miramar FL 33027 8773644566 8773644566 711 711 8773644566 8773644566 711 711 H8298 001 0 2021 Horizon NJ TotalCare (HMO D-SNP) www.Horizonblue.com/Medicare 3 Penn Plaza East, PP-12F Newark NJ 07105 8887657134 8887657134 711 711 8005435656 8005435656 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8332 001 0 2021 Aetna Medicare Value Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H8332 002 0 2021 Aetna Medicare Value Plan (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H8332 801 0 2021 Aetna Medicare Plan (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H8332 802 0 2021 Aetna Medicare Plan w/Rx (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H8343 001 0 2021 Amerivantage Choice (PPO) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557681046 8557681046 711 711 8337131307 8337131307 711 711 H8343 002 0 2021 Amerivantage Choice (PPO) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557681046 8557681046 711 711 8337131307 8337131307 711 711 H8343 003 0 2021 Amerivantage Choice (PPO) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557681046 8557681046 711 711 8337131307 8337131307 711 711 H8364 002 0 2021 Bright Advantage Choice Plus (PPO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 H8379 001 0 2021 PriorityMedicare D-SNP (HMO D-SNP) www.priorityhealth.com/dsnp 1231 East Beltline NE Grand Rapids MI 49525 8777294124 6164648850 711 711 8339390983 6164648820 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8390 011 0 2021 CareSource Advantage (HMO) www.caresource.com/ga/plans/medicare/ P.O. Box 8738 Dayton OH 45401 8446072830 8446072830 711 711 8446072827 8446072827 711 711 This plan does not charge an annual deductible for all drugs. The $30.00 annual deductible only applies to drugs on certain tiers.~ H8390 012 0 2021 CareSource Advantage (HMO) www.caresource.com/ga/plans/medicare/ P.O. Box 8738 Dayton OH 45401 8446072830 8446072830 711 711 8446072827 8446072827 711 711 This plan does not charge an annual deductible for all drugs. The $75.00 annual deductible only applies to drugs on certain tiers.~ H8390 013 0 2021 CareSource Advantage Zero Premium (HMO) www.caresource.com/ga/plans/medicare/ P.O. Box 8738 Dayton OH 45401 8446072830 8446072830 711 711 8446072827 8446072827 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H8390 014 0 2021 CareSource Advantage Zero Premium (HMO) www.caresource.com/ga/plans/medicare/ P.O. Box 8738 Dayton OH 45401 8446072830 8446072830 711 711 8446072827 8446072827 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H8390 015 0 2021 CareSource Dual Advantage (HMO D-SNP) www.caresource.com/ga/plans/dsnp/ P.O. Box 8738 Dayton OH 45401 8446072830 8446072830 711 711 8332302020 8332302020 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8390 016 0 2021 CareSource Dual Advantage (HMO D-SNP) www.caresource.com/ga/plans/dsnp/ P.O. Box 8738 Dayton OH 45401 8446072830 8446072830 711 711 8332302020 8332302020 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8423 001 0 2021 Cigna CarePlan MMP (Medicare-Medicaid Plan) www.CarePlanTX.com LetUsHelpYou@HealthSpring.com 2208 Highway 121, Suite 210 Bedford TX 76021 8776530327 8776530327 711 711 8776530327 8776530327 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H8432 007 0 2021 Empire MediBlue Dual Advantage (HMO D-SNP) www.empireblue.com/shop mediblue@empireblue.com P.O. Box 659404 San Antonio TX 78265 8557681047 8557681047 711 711 8772695706 8772695706 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8432 008 5 2021 Empire MediBlue Plus (HMO) www.empireblue.com/shop mediblue@empireblue.com P.O. Box 659404 San Antonio TX 78265 8557681049 8557681049 711 711 8004999554 8004999554 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H8432 008 6 2021 Empire MediBlue Plus (HMO) www.empireblue.com/shop mediblue@empireblue.com P.O. Box 659404 San Antonio TX 78265 8557681049 8557681049 711 711 8004999554 8004999554 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H8432 008 7 2021 Empire MediBlue Plus (HMO) www.empireblue.com/shop mediblue@empireblue.com P.O. Box 659404 San Antonio TX 78265 8557681049 8557681049 711 711 8004999554 8004999554 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H8432 009 0 2021 Empire MediBlue Plus (HMO) www.empireblue.com/shop mediblue@empireblue.com P.O. Box 659404 San Antonio TX 78265 8557681049 8557681049 711 711 8004999554 8004999554 711 711 This plan does not charge an annual deductible for all drugs. The $325.00 annual deductible only applies to drugs on certain tiers.~ H8432 010 0 2021 Empire MediBlue Plus (HMO) www.empireblue.com/shop mediblue@empireblue.com P.O. Box 659404 San Antonio TX 78265 8557681049 8557681049 711 711 8004999554 8004999554 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H8432 011 0 2021 Empire MediBlue Plus (HMO) www.empireblue.com/shop mediblue@empireblue.com P.O. Box 659404 San Antonio TX 78265 8557681049 8557681049 711 711 8004999554 8004999554 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H8432 015 0 2021 Empire MediBlue Choice (HMO-POS) www.empireblue.com/shop mediblue@empireblue.com P.O. Box 659404 San Antonio TX 78265 8557681052 8557681052 711 711 8004999554 8004999554 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H8432 016 0 2021 Empire MediBlue Select (HMO) www.empireblue.com/shop mediblue@empireblue.com P.O. Box 659404 San Antonio TX 78265 8557681049 8557681049 711 711 8004999554 8004999554 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H8432 027 0 2021 Empire MediBlue Select (HMO) www.empireblue.com/shop mediblue@empireblue.com P.O. Box 659404 San Antonio TX 78265 8557681049 8557681049 711 711 8004999554 8004999554 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H8432 028 0 2021 Empire MediBlue Dual Advantage Select (HMO D-SNP) www.empireblue.com/shop mediblue@empireblue.com P.O. Box 659404 San Antonio TX 78265 8557681047 8557681047 711 711 8444691762 8444691762 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8432 032 0 2021 Empire MediBlue Select (HMO) www.empireblue.com/shop mediblue@empireblue.com P.O. Box 659404 San Antonio TX 78265 8557681049 8557681049 711 711 8004999554 8004999554 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H8432 033 0 2021 Empire MediBlue Select (HMO) www.empireblue.com/shop mediblue@empireblue.com P.O. Box 659404 San Antonio TX 78265 8557681049 8557681049 711 711 8004999554 8004999554 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H8432 034 0 2021 Empire MediBlue Dual Advantage Select (HMO D-SNP) shop.anthem.com/medicare mediblue@empireblue.com P.O. Box 659404 San Antonio TX 78265 8557681047 8557681047 711 711 8772695706 8772695706 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8432 035 0 2021 Empire MediBlue Extra Select (HMO) shop.anthem.com/medicare mediblue@empireblue.com P.O. Box 659404 San Antonio TX 78265 8557681049 8557681049 711 711 8004999554 8004999554 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H8432 036 0 2021 Empire MediBlue Core Select (HMO) shop.anthem.com/medicare mediblue@empireblue.com P.O. Box 659404 San Antonio TX 78265 8557681049 8557681049 711 711 8004999554 8004999554 711 711 H8432 037 1 2021 Empire MediBlue Core (HMO) shop.anthem.com/medicare mediblue@empireblue.com P.O. Box 659404 San Antonio TX 78265 8557681049 8557681049 711 711 8004999554 8004999554 711 711 H8432 037 2 2021 Empire MediBlue Core (HMO) shop.anthem.com/medicare mediblue@empireblue.com P.O. Box 659404 San Antonio TX 78265 8557681049 8557681049 711 711 8004999554 8004999554 711 711 H8432 038 1 2021 Empire MediBlue Plus (HMO) shop.anthem.com/medicare mediblue@empireblue.com P.O. Box 659404 San Antonio TX 78265 8557681049 8557681049 711 711 8004999554 8004999554 711 711 This plan does not charge an annual deductible for all drugs. The $325.00 annual deductible only applies to drugs on certain tiers.~ H8432 038 2 2021 Empire MediBlue Plus (HMO) shop.anthem.com/medicare mediblue@empireblue.com P.O. Box 659404 San Antonio TX 78265 8557681049 8557681049 711 711 8004999554 8004999554 711 711 This plan does not charge an annual deductible for all drugs. The $325.00 annual deductible only applies to drugs on certain tiers.~ H8432 039 1 2021 Empire MediBlue Dual Advantage (HMO D-SNP) shop.anthem.com/medicare mediblue@empireblue.com P.O. Box 659404 San Antonio TX 78265 8557681047 8557681047 711 711 8772695706 8772695706 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8432 039 2 2021 Empire MediBlue Dual Advantage (HMO D-SNP) shop.anthem.com/medicare mediblue@empireblue.com P.O. Box 659404 San Antonio TX 78265 8557681047 8557681047 711 711 8772695706 8772695706 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8432 801 0 2021 Anthem MediBlue (HMO) www.anthem.com/me/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H8432 802 0 2021 Anthem MediBlue (HMO) www.anthem.com/me/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H8432 804 0 2021 Empire MediBlue (HMO) www.empireblue.com/ny/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H8432 805 0 2021 Empire MediBlue (HMO) www.empireblue.com/ny/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H8432 808 0 2021 Anthem MediBlue (HMO) www.anthem.com/me/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H8432 809 0 2021 Anthem MediBlue (HMO) www.anthem.com/me/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H8432 812 0 2021 Empire MediBlue (HMO) www.empireblue.com/ny/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H8432 813 0 2021 Empire MediBlue (HMO) www.empireblue.com/ny/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H8452 001 0 2021 CareSource MyCare Ohio (Medicare-Medicaid Plan) www.caresource.com/MyCare/ memberhelp@caresource.com P.O. Box 8738 Dayton OH 45401 8554753163 8554753163 8007500750 8007500750 8554753163 8554753163 8007500750 8007500750 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H8457 001 0 2021 Longevity Health Plan (HMO I-SNP) www.longevityhealthplan.com PO Box 5850 Glen Allen VA 23058 8888857337 8888857337 711 711 8888857337 8888857337 711 711 H8492 001 0 2021 Dignity Health Plan (HMO I-SNP) www.dignityhealthplan.com info@dignityhmo.com 950 West Causeway Approach Mandeville LA 70471 8662666010 2259648581 711 711 8662666010 2259648581 711 711 H8547 001 0 2021 Blue Medicare Advocate Health (HMO) www.getblueil.com/mapd P.O. Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 H8552 020 0 2021 Anthem MediBlue Access (PPO) https://shop.anthem.com/medicare/ca P.O. Box 659404 San Antonio TX 78265 8557681053 8557681053 711 711 8778113107 8778113107 711 711 This plan does not charge an annual deductible for all drugs. The $370.00 annual deductible only applies to drugs on certain tiers.~ H8552 028 0 2021 Anthem MediBlue ESRD Care (PPO C-SNP) https://shop.anthem.com/medicare/ca P.O. Box 659404, 3800 Buffalo Speedway, Suite 400 San Antonio TX 78265 8557681054 8557681054 711 711 8446489540 8446489540 711 711 This plan does not charge an annual deductible for all drugs. The $130.00 annual deductible only applies to drugs on certain tiers.~ H8552 029 0 2021 Anthem MediBlue Access (PPO) https://shop.anthem.com/medicare/ca P.O. Box 659404 San Antonio TX 78265 8557681053 8557681053 711 711 8778113107 8778113107 711 711 This plan does not charge an annual deductible for all drugs. The $370.00 annual deductible only applies to drugs on certain tiers.~ H8552 030 0 2021 Anthem MediBlue Dual Access (PPO D-SNP) https://shop.anthem.com/medicare/ca P.O. Box 659404 San Antonio TX 78265 8557681059 8557681059 711 711 8442095409 8442095409 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8552 801 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H8552 802 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H8552 803 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H8552 806 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H8552 810 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H8552 811 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H8552 812 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H8552 813 0 2021 Anthem Medicare Preferred (PPO) www.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H8553 001 0 2021 WellCare Premier (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H8553 002 0 2021 WellCare Patriot (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H8553 003 0 2021 WellCare Rx Plus (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H8554 001 0 2021 Blue Cross Medicare Advantage Value (HMO) www.getbluetx.com/mapd P.O. Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H8578 001 0 2021 Health New England Medicare Premium (HMO) www.healthnewengland.org/medicare One Monarch Place, Suite 1500 Springfield MA 01144 8774433314 4137870010 711 711 8774433314 4137870010 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H8578 003 0 2021 Health New England Medicare Premium No Rx (HMO) www.healthnewengland.org/medicare One Monarch Place, Suite 1500 Springfield MA 01144 8774433314 4137870010 711 711 8774433314 4137870010 711 711 H8578 004 0 2021 Health New England Medicare Plus (HMO) www.healthnewengland.org/medicare One Monarch Place, Suite 1500 Springfield MA 01144 8774433314 4137870010 711 711 8774433314 4137870010 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H8578 009 0 2021 Health New England Medicare Basic No Rx (HMO) www.healthnewengland.org/medicare One Monarch Place, Suite 1500 Springfield MA 01144 8774433314 4137870010 711 711 8774433314 4137870010 711 711 H8578 012 0 2021 Health New England Medicare Value (HMO) www.healthnewengland.org/medicare One Monarch Place, Suite 1500 Springfield MA 01144 8774433314 4137870010 711 711 8774433314 4137870010 711 711 This plan does not charge an annual deductible for all drugs. The $380.00 annual deductible only applies to drugs on certain tiers.~ H8578 016 0 2021 Health New England Medicare Select (HMO-POS) www.healthnewengland.org/medicare One Monarch Place, Suite 1500 Springfield MA 01144 8774433314 4137870010 711 711 8774433314 4137870010 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H8578 017 0 2021 Health New England Medicare Choice (HMO) www.healthnewengland.org/medicare One Monarch Place, Suite 1500 Springfield MA 01144 8774433314 4137870010 711 711 8774433314 4137870010 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H8578 801 0 2021 Health New England Medicare Employer Group RX (HMO-POS) www.healthnewengland.org/medicare One Monarch Place, Suite 1500 Springfield MA 01144 8774433314 4137870010 711 711 8774433314 4137870010 711 711 H8578 802 0 2021 HNE Medicare Employer Group Calendar (HMO-POS) www.healthnewengland.org/medicare One Monarch Place, Suite 1500 Springfield MA 01144 8774433314 4137870010 711 711 8774433314 4137870010 711 711 H8578 803 0 2021 HNE Medicare Employer Group Non-Calendar (HMO-POS) www.healthnewengland.org/medicare One Monarch Place, Suite 1500 Springfield MA 01144 8774433314 4137870010 711 711 8774433314 4137870010 711 711 H8597 001 0 2021 Aetna Medicare Dual Complete Plan (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8597 002 0 2021 Aetna Medicare Dual Complete Plan (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8597 003 0 2021 Aetna Medicare Dual Complete Plan (HMO D-SNP) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8664091221 8664091221 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8604 010 0 2021 The Health Plan SecureChoice - Option II (PPO) www.healthplan.org/medicare information@healthplan.org The Health Plan, 1110 Main Street Wheeling WV 26003 8778477915 8778477915 711 711 8778477907 8778477907 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H8604 011 0 2021 The Health Plan SecureChoice - Option II (PPO) www.healthplan.org/medicare information@healthplan.org The Health Plan, 1110 Main Street Wheeling WV 26003 8778477915 8778477915 711 711 8778477907 8778477907 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H8604 013 0 2021 The Health Plan SecureChoice Capitol Plan (PPO) www.healthplan.org/medicare information@healthplan.org The Health Plan, 1110 Main Street Wheeling WV 26003 8778477915 8778477915 711 711 8778477907 8778477907 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H8604 801 0 2021 The Health Plan SecureChoice - Employer (PPO) www.healthplan.org/medicare information@healthplan.org The Health Plan, 1110 Main Street Wheeling WV 26003 8778477915 8778477915 711 711 8778477907 8778477907 711 711 H8634 002 0 2021 Blue Cross Medicare Advantage Choice Plus (PPO) www.getbluenm.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H8634 003 0 2021 Blue Cross Medicare Advantage Choice Plus (PPO) www.getblueil.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H8634 004 0 2021 Blue Cross Medicare Advantage Choice Premier (PPO) www.getblueil.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 H8634 007 0 2021 Blue Cross Medicare Advantage Choice Plus (PPO) www.getblueil.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 H8634 008 0 2021 Blue Cross Medicare Advantage Classic (PPO) www.getblueil.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H8634 801 0 2021 Blue Cross Group Medicare Advantage Plan (PPO) www.mybluemedicarenm.com PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H8634 803 0 2021 Blue Cross Group Medicare Advantage Plan (PPO) www.mybluemedicarenm.com PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H8634 805 0 2021 Blue Cross Group Medicare Advantage Plan (PPO) www.mybluemedicarenm.com PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H8634 807 0 2021 Blue Cross Group Medicare Advantage Plan (PPO) www.mybluemedicareok.com PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H8634 809 0 2021 Blue Cross Group Medicare Advantage Plan (PPO) www.mybluemedicareok.com PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H8634 811 0 2021 Blue Cross Group Medicare Advantage Plan (PPO) www.mybluemedicareok.com PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H8634 813 0 2021 Blue Cross Group Medicare Advantage Plan (PPO) www.hcsc.com PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H8634 815 0 2021 Blue Cross Group Medicare Advantage Plan (PPO) www.hcsc.com PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H8634 817 0 2021 Blue Cross Group Medicare Advantage Plan (PPO) www.hcsc.com PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H8649 003 0 2021 Aetna Advantra (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H8649 008 0 2021 Aetna Advantra Select (HMO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H8649 801 0 2021 Aetna Altius Medicare Plan w/Rx (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H8649 803 0 2021 Aetna Altius Medicare Plan (HMO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H8677 001 0 2021 Molina Dual Options (Medicare-Medicaid Plan) www.molinahealthcare.com/duals 200 Oceangate, Suite 100 Long Beach CA 90802 8664089501 8664089501 711 711 8556654627 8556654627 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H8677 002 0 2021 Molina Dual Options (Medicare-Medicaid Plan) www.molinahealthcare.com/duals 200 Oceangate, Suite 100 Long Beach CA 90802 8664089501 8664089501 711 711 8556654627 8556654627 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H8711 001 0 2021 WellCare Premier (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H8711 002 0 2021 WellCare Absolute (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H8748 002 0 2021 AARP Medicare Advantage Plan 1 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H8748 008 0 2021 AARP Medicare Advantage Plus Plan 1 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H8748 009 0 2021 AARP Medicare Advantage Plus Plan 2 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~ H8748 019 0 2021 AARP Medicare Advantage Patriot (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H8748 025 0 2021 AARP Medicare Advantage Plan 2 (HMO-POS) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H8764 001 0 2021 Aspire Health Advantage (HMO) www.aspirehealthplan.org csrII@aspirehealthplan.org 10 Ragsdale Drive, Suite 101 Monterey CA 93940 8888393991 8313751462 711 711 8555701600 8315744938 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H8764 002 0 2021 Aspire Health Plus (HMO-POS) www.aspirehealthplan.org csrII@aspirehealthplan.org 10 Ragsdale Drive, Suite 101 Monterey CA 93940 8888393991 8313751462 711 711 8555701600 8315744938 711 711 H8764 003 0 2021 Aspire Health Value (HMO) www.aspirehealthplan.org csrII@aspirehealthplan.org 10 Ragsdale Dr., Suite 101 Monterey CA 93940 8888393991 8313751462 711 711 8555701600 8315744938 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H8764 801 0 2021 Aspire Health Group Plus (HMO-POS) www.aspirehealthplan.org csrII@aspirehealthplan.org 10 Ragsdale Drive, Suite 101 Monterey CA 93940 8888393991 8313751462 711 711 8555701600 8315744938 711 711 H8768 003 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H8768 005 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H8768 006 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $170.00 annual deductible only applies to drugs on certain tiers.~ H8768 007 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $170.00 annual deductible only applies to drugs on certain tiers.~ H8768 008 0 2021 AARP Medicare Advantage Choice Plan 1 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H8768 009 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H8768 010 0 2021 AARP Medicare Advantage Walgreens (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H8768 011 0 2021 AARP Medicare Advantage Walgreens (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H8768 012 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H8768 013 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ H8768 014 0 2021 AARP Medicare Advantage Walgreens (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H8768 015 0 2021 AARP Medicare Advantage Walgreens (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H8768 016 0 2021 AARP Medicare Advantage Choice Plan 2 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~ H8768 017 1 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H8768 017 2 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H8768 018 0 2021 AARP Medicare Advantage Patriot (PPO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H8768 019 0 2021 AARP Medicare Advantage Patriot (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H8768 020 0 2021 AARP Medicare Advantage Patriot (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H8768 021 0 2021 AARP Medicare Advantage Patriot (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H8768 022 0 2021 AARP Medicare Advantage Choice (PPO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $240.00 annual deductible only applies to drugs on certain tiers.~ H8768 023 0 2021 AARP Medicare Advantage Choice Plan 2 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H8768 024 0 2021 AARP Medicare Advantage Choice Plan 1 (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H8768 025 0 2021 AARP Medicare Advantage Patriot (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H8768 026 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H8768 027 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H8768 028 0 2021 AARP Medicare Advantage Patriot (PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H8768 029 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com PHN.member@peopleshealth.com P.O. Box 30770, 3838 N Causeway Blvd, Suite 2200 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H8768 030 0 2021 AARP Medicare Advantage Choice (PPO) www.AARPMedicarePlans.com PHN.member@peopleshealth.com P.O. Box 30770, 3838 N Causeway Blvd, Suite 2200 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H8768 031 0 2021 AARP Medicare Advantage Patriot (PPO) www.AARPMedicarePlans.com PHN.member@peopleshealth.com P.O. Box 30770, 3838 N Causeway Blvd, Suite 2200 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 H8783 001 0 2021 EssentiaCare Secure (PPO) https://home.ucare.org PO Box 52 Minneapolis MN 55440 8776711061 6126766640 8006882534 6126766810 8554327025 2187224915 8006882534 6126766810 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~ H8783 002 0 2021 EssentiaCare Grand (PPO) https://home.ucare.org PO Box 52 Minneapolis MN 55440 8776711061 6126766640 8006882534 6126766810 8554327025 2187224915 8006882534 6126766810 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H8783 003 0 2021 EssentiaCare Access (PPO) https://home.ucare.org PO BOX 52 Minneapolis MN 55440 8776711061 6126766640 8006882534 6126766810 8554327025 2187224915 8006882534 6126766810 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H8786 001 0 2021 Amerigroup Medicare-Medicaid Plan (Medicare-Medicaid Plan) www.myamerigroup.com/txmmp Amerigroup Texas, Inc., 5959 Corporate Dr. Suite 1300 Houston TX 77036 8558781784 8558781784 711 711 8558781784 8558781784 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H8797 001 0 2021 Perennial Advantage Strive (HMO I-SNP) www.perennialadvantage.com 1001 Kingsmill Parkway Columbus OH 43229 8447886986 8447886986 711 711 8447886986 8447886986 711 711 H8797 002 0 2021 Perennial Advantage Concierge (HMO C-SNP) www.perennialadvantage.com 1001 Kingsmill Parkway Columbus OH 43229 8447886986 8447886986 711 711 8447886986 8447886986 711 711 H8845 001 0 2021 Magellan Complete Care of Arizona (HMO D-SNP) mccofaz.com 4801 E Washington Street, Suite 225 Phoenix AZ 85034 8004244505 8004244505 711 711 8004244509 8004244509 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8849 001 0 2021 Amerivantage Diabetes Care Plus (HMO C-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557931925 8557931925 711 711 8337131306 8337131306 711 711 H8849 002 0 2021 Amerivantage Care To You Plus (HMO I-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557931926 8557931926 711 711 8337131306 8337131306 711 711 H8849 003 0 2021 Amerivantage Diabetes Care Plus (HMO C-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557931925 8557931925 711 711 8337131306 8337131306 711 711 H8849 004 0 2021 Amerivantage Heart Care Plus (HMO C-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557931925 8557931925 711 711 8337131306 8337131306 711 711 H8849 005 0 2021 Amerivantage Lung Care Plus (HMO C-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557931925 8557931925 711 711 8337131306 8337131306 711 711 H8849 006 0 2021 Amerivantage Select Plus (HMO) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557931927 8557931927 711 711 8337131304 8337131304 711 711 H8849 007 0 2021 Amerivantage Plus (HMO) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557931927 8557931927 711 711 8337131304 8337131304 711 711 H8849 008 1 2021 Amerivantage Classic Plus (HMO) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557931927 8557931927 711 711 8337131304 8337131304 711 711 H8849 008 2 2021 Amerivantage Classic Plus (HMO) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557931927 8557931927 711 711 8337131304 8337131304 711 711 H8849 008 3 2021 Amerivantage Classic Plus (HMO) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557931927 8557931927 711 711 8337131304 8337131304 711 711 H8849 008 4 2021 Amerivantage Classic Plus (HMO) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557931927 8557931927 711 711 8337131304 8337131304 711 711 H8849 008 5 2021 Amerivantage Classic Plus (HMO) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557931927 8557931927 711 711 8337131304 8337131304 711 711 H8849 008 6 2021 Amerivantage Classic Plus (HMO) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557931927 8557931927 711 711 8337131304 8337131304 711 711 H8849 009 0 2021 Amerivantage Select Plus (HMO) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557931927 8557931927 711 711 8337131304 8337131304 711 711 H8849 010 1 2021 Amerivantage Dual Coordination Plus (HMO D-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557931928 8557931928 711 711 8337131305 8337131305 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8849 010 2 2021 Amerivantage Dual Coordination Plus (HMO D-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557931928 8557931928 711 711 8337131305 8337131305 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8849 010 3 2021 Amerivantage Dual Coordination Plus (HMO D-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557931928 8557931928 711 711 8337131305 8337131305 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8849 010 4 2021 Amerivantage Dual Coordination Plus (HMO D-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557931928 8557931928 711 711 8337131305 8337131305 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8849 010 5 2021 Amerivantage Dual Coordination Plus (HMO D-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557931928 8557931928 711 711 8337131305 8337131305 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8849 010 6 2021 Amerivantage Dual Coordination Plus (HMO D-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557931928 8557931928 711 711 8337131305 8337131305 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8849 011 1 2021 Amerivantage Dual Secure Plus (HMO D-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557931928 8557931928 711 711 8337131305 8337131305 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8849 011 2 2021 Amerivantage Dual Secure Plus (HMO D-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557931928 8557931928 711 711 8337131305 8337131305 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8849 011 3 2021 Amerivantage Dual Secure Plus (HMO D-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557931928 8557931928 711 711 8337131305 8337131305 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8849 011 4 2021 Amerivantage Dual Secure Plus (HMO D-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557931928 8557931928 711 711 8337131305 8337131305 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8849 011 5 2021 Amerivantage Dual Secure Plus (HMO D-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557931928 8557931928 711 711 8337131305 8337131305 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8849 011 6 2021 Amerivantage Dual Secure Plus (HMO D-SNP) https://shop.amerigroup.com/medicare Amerigroup Texas, Inc., 3800 Buffalo Speedway, Suite 400 Houston TX 77098 8557931928 8557931928 711 711 8337131305 8337131305 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8854 002 0 2021 Dual Prime (HMO D-SNP) www.ummedicareadvantage.org info@ummedicareadvantage.org 1966 Greenspring Drive, Suite 100 Timonium MD 21093 8442621122 8442621122 711 711 8443866762 4107799932 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8889 001 0 2021 Medica Advantage Solution H8889-001 (PPO) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8662696804 9529922134 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H8889 002 0 2021 Medica Advantage Solution H8889-002 (PPO) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8662696804 9529922134 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H8889 003 0 2021 Medica Advantage Solution H8889-003 (PPO) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8662696804 9529922134 711 711 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~ H8889 004 0 2021 Medica Advantage Solution H8889-004 (PPO) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8662696804 9529922134 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H8889 005 0 2021 Medica Advantage Solution H8889-005 (PPO) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8662696804 9529922134 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H8889 801 0 2021 Medica Group Advantage Solution (PPO) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8009065432 9529922345 711 711 8662696804 9529922134 711 711 H8908 001 0 2021 Humana Gold Plus H8908-001 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H8908 002 0 2021 Humana Gold Plus H8908-002 (HMO) www.humana.com/medicare 500 West Main St Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H8908 004 0 2021 Humana Gold Plus H8908-004 (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H8908 005 0 2021 Humana Gold Plus SNP-DE H8908-005 (HMO D-SNP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H8908 801 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H8908 802 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H8908 804 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H8908 805 0 2021 Humana Medicare Employer (HMO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 H8961 001 0 2021 Oscar + Holy Cross + Memorial Health (HMO) www.hioscar.com/medicare PO Box 62045 Phoenix AZ 85082 8556722710 8556722710 711 711 8556722720 8556722720 711 711 H8967 001 0 2021 Great Plains Medicare Advantage (HMO I-SNP) www.greatplainsmedicareadvantage.com PO Box 2190 Glen Allen VA 23058 8446374760 8446374760 711 711 8446374760 8446374760 711 711 H8967 002 0 2021 Great Plains Medicare Advantage Gold (HMO I-SNP) www.greatplainsmedicareadvantage.com PO Box 2190 Glen Allen VA 23058 8446374760 8446374760 711 711 8446374760 8446374760 711 711 H9001 019 0 2021 NaviCare (HMO D-SNP) fallonhealth.org/navicare navicaresupport@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8772557108 8772557108 711 711 8777006996 8777006996 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H9001 029 14 2021 Fallon Medicare Plus Saver No Rx HMO (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 H9001 029 15 2021 Fallon Medicare Plus Saver No Rx HMO (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 H9001 029 16 2021 Fallon Medicare Plus Saver No Rx HMO (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 H9001 029 17 2021 Fallon Medicare Plus Saver No Rx HMO (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 H9001 030 14 2021 Fallon Medicare Plus Green HMO (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H9001 030 15 2021 Fallon Medicare Plus Green HMO (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H9001 030 16 2021 Fallon Medicare Plus Green HMO (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H9001 030 17 2021 Fallon Medicare Plus Green HMO (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H9001 031 14 2021 Fallon Medicare Plus Blue HMO (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 H9001 031 15 2021 Fallon Medicare Plus Blue HMO (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 H9001 031 16 2021 Fallon Medicare Plus Blue HMO (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 H9001 031 17 2021 Fallon Medicare Plus Blue HMO (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 H9001 032 14 2021 Fallon Medicare Plus Super Saver HMO (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H9001 032 15 2021 Fallon Medicare Plus Super Saver HMO (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H9001 032 16 2021 Fallon Medicare Plus Super Saver HMO (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H9001 032 17 2021 Fallon Medicare Plus Super Saver HMO (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H9001 034 14 2021 Fallon Medicare Plus Orange HMO (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H9001 034 15 2021 Fallon Medicare Plus Orange HMO (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H9001 034 16 2021 Fallon Medicare Plus Orange HMO (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H9001 034 17 2021 Fallon Medicare Plus Orange HMO (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H9001 035 0 2021 Fallon Medicare Plus Central Blue HMO (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 H9001 036 0 2021 Fallon Medicare Plus Central Green HMO (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H9001 037 0 2021 Fallon Medicare Plus Central Orange HMO (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H9001 803 0 2021 MA-PD HMO (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 H9001 804 0 2021 MA-PD HMO PSP (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 H9001 805 0 2021 MA-only HMO (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 H9001 806 0 2021 MA-only non-calendar HMO (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 H9001 807 0 2021 MA-only HMO PSP (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 H9001 808 0 2021 MA-only non-calendar HMO PSP (HMO) fallonhealth.org/medicare contactcustomerservice@fallonhealth.org 10 Chestnut Street Worcester MA 01608 8003255669 8003255669 711 711 8003255669 8003255669 711 711 H9003 001 0 2021 Kaiser Permanente Senior Advantage Enhanced (HMO) kp.org/medicare 500 NE Multnomah Suite 100 Portland OR 97232 8774083496 8774083496 711 711 8772218221 8772218221 711 711 H9003 006 0 2021 Kaiser Permanente Senior Advantage Standard (HMO) kp.org/medicare 500 NE Multnomah Suite 100 Portland OR 97232 8774083496 8774083496 711 711 8772218221 8772218221 711 711 H9003 007 0 2021 Kaiser Permanente Senior Advantage Standard Lane (HMO) kp.org/medicare 500 NE Multnomah Suite 100 Portland OR 97232 8774083496 8774083496 711 711 8772218221 8772218221 711 711 This plan does not charge an annual deductible for all drugs. The $125.00 annual deductible only applies to drugs on certain tiers.~ H9003 008 0 2021 Kaiser Permanente Senior Advantage Value Lane (HMO) kp.org/medicare 500 NE Multnomah Suite 100 Portland OR 97232 8774083496 8774083496 711 711 8772218221 8772218221 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~ H9003 009 0 2021 Kaiser Permanente Senior Advantage Value (HMO) kp.org/medicare 500 NE Multnomah Suite 100 Portland OR 97232 8774083496 8774083496 711 711 8772218221 8772218221 711 711 H9003 801 0 2021 Employer Group Only with Part D (HMO) kp.org/medicare 500 NE Multnomah Suite 100 Portland OR 97232 8774083496 8774083496 711 711 8772218221 8772218221 711 711 H9003 802 0 2021 Employer Group Only without Part D (HMO) kp.org/medicare 500 NE Multnomah Suite 100 Portland OR 97232 8774083496 8774083496 711 711 8772218221 8772218221 711 711 H9003 805 0 2021 FEHB AB with D (HMO) kp.org/medicare 500 NE Multnomah Suite 100 Portland OR 97232 8774083496 8774083496 711 711 8772218221 8772218221 711 711 H9042 001 1 2021 MyTruAdvantage Choice (PPO) www.mytruadvantage.com MyTruAdvantage, PO Box 428 Columbus IN 47202 8332136731 8123142505 711 711 8444254280 8123484576 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H9042 001 2 2021 MyTruAdvantage Choice (PPO) www.mytruadvantage.com MyTruAdvantage, PO Box 428 Columbus IN 47202 8332136731 8123142505 711 711 8444254280 8123484576 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H9047 033 0 2021 Providence Medicare Focus Medical (HMO) www.providencehealthassurance.com phpcustomerservice@providence.org P.O. Box 4327 Portland OR 97208 8004576064 5035745551 711 711 8006032340 5035748000 711 711 H9047 035 0 2021 Providence Medicare Select Medical (HMO-POS) www.providencehealthassurance.com phpcustomerservice@providence.org P.O. Box 4327 Portland OR 97208 8004576064 5035745551 711 711 8006032340 5035748000 711 711 H9047 037 0 2021 Providence Medicare Prime + RX (HMO) www.providencehealthassurance.com phpcustomerservice@providence.org P.O. Box 4327 Portland OR 97208 8004576064 5035745551 711 711 8006032340 5035748000 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H9047 038 0 2021 Providence Medicare Latitude + RX (HMO-POS) www.providencehealthassurance.com phpcustomerservice@providence.org P.O. Box 4327 Portland OR 97208 8004576064 5035745551 711 711 8006032340 5035748000 711 711 This plan does not charge an annual deductible for all drugs. The $120.00 annual deductible only applies to drugs on certain tiers.~ H9047 039 0 2021 Providence Medicare Compass + RX (HMO-POS) www.providencehealthassurance.com phpcustomerservice@providence.org P.O. Box 4327 Portland OR 97208 8004576064 5035745551 711 711 8006032340 5035748000 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~ H9047 043 0 2021 Providence Medicare Dual Plus (HMO D-SNP) www.providencehealthassurance.com phpcustomerservice@providence.org P.O. Box 4327 Portland OR 97208 8004576064 5035745551 711 711 8006032340 5035748000 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H9047 045 0 2021 Providence Medicare Enrich + RX (HMO) www.providencehealthassurance.com phpcustomerservice@providence.org P.O. Box 4327 Portland OR 97208 8004576064 5035745551 711 711 8006032340 5035748000 711 711 This plan does not charge an annual deductible for all drugs. The $325.00 annual deductible only applies to drugs on certain tiers.~ H9047 047 0 2021 Providence Medicare Summit + RX (HMO-POS) www.providencehealthassurance.com phpcustomerservice@providence.org P.O. Box 4327 Portland OR 97208 8004576064 5035745551 711 711 8006032340 5035748000 711 711 This plan does not charge an annual deductible for all drugs. The $240.00 annual deductible only applies to drugs on certain tiers.~ H9047 049 0 2021 Providence Medicare Harbor + RX (HMO) www.providencehealthassurance.com phpcustomerservice@providence.org P.O. Box 4327 Portland OR 97208 8004576064 5035745551 711 711 8006032340 5035748000 711 711 This plan does not charge an annual deductible for all drugs. The $270.00 annual deductible only applies to drugs on certain tiers.~ H9047 054 0 2021 Providence Medicare Timber + RX (HMO) www.providencehealthassurance.com phpcustomerservice@providence.org P.O. Box 4327 Portland OR 97208 8004576064 5035745551 711 711 8006032340 5035748000 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H9047 055 1 2021 Providence Medicare Extra + RX (HMO) www.providencehealthassurance.com phpcustomerservice@providence.org P.O. Box 4327 Portland OR 97208 8004576064 5035745551 711 711 8006032340 5035748000 711 711 H9047 055 2 2021 Providence Medicare Extra + RX (HMO) www.providencehealthassurance.com phpcustomerservice@providence.org P.O. Box 4327 Portland OR 97208 8004576064 5035745551 711 711 8006032340 5035748000 711 711 H9047 056 1 2021 Providence Medicare Choice + RX (HMO-POS) www.providencehealthassurance.com phpcustomerservice@providence.org P.O. Box 4327 Portland OR 97208 8004576064 5035745551 711 711 8006032340 5035748000 711 711 This plan does not charge an annual deductible for all drugs. The $240.00 annual deductible only applies to drugs on certain tiers.~ H9047 056 2 2021 Providence Medicare Choice + RX (HMO-POS) www.providencehealthassurance.com phpcustomerservice@providence.org P.O. Box 4327 Portland OR 97208 8004576064 5035745551 711 711 8006032340 5035748000 711 711 This plan does not charge an annual deductible for all drugs. The $240.00 annual deductible only applies to drugs on certain tiers.~ H9047 059 0 2021 Providence Medicare Bridge 1 + RX (HMO-POS) www.providencehealthassurance.com phpcustomerservice@providence.org P.O. Box 4327 Portland OR 97208 8004576064 5035745551 711 711 8006032340 5035748000 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H9047 060 0 2021 Providence Medicare Bridge 2 + RX (HMO-POS) www.providencehealthassurance.com phpcustomerservice@providence.org P.O. Box 4327 Portland OR 97208 8004576064 5035745551 711 711 8006032340 5035748000 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H9047 062 0 2021 Providence Medicare Cottonwood + RX (HMO-POS) www.providencehealthassurance.com phpcustomerservice@providence.org P.O. Box 4327 Portland OR 97208 8004576064 5035745551 711 711 8006032340 5035748000 711 711 This plan does not charge an annual deductible for all drugs. The $125.00 annual deductible only applies to drugs on certain tiers.~ H9047 063 0 2021 Providence Medicare Pine + RX (HMO) www.providencehealthassurance.com phpcustomerservice@providence.org P.O. Box 4327 Portland OR 97208 8004576064 5035745551 711 711 8006032340 5035748000 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H9047 804 0 2021 Providence Medicare Align Group Plan + RX (HMO) www.providencehealthassurance.com phpcustomerservice@providence.org P.O. Box 4327 Portland OR 97208 8004576064 5035745551 711 711 8006032340 5035748000 711 711 H9047 805 0 2021 Providence Medicare Flex Group Plan + RX (HMO-POS) www.providencehealthassurance.com phpcustomerservice@providence.org P.O. Box 4327 Portland OR 97208 8004576064 5035745551 711 711 8006032340 5035748000 711 711 H9047 808 0 2021 Providence Medicare Align Group Plan + RX (HMO) www.providencehealthassurance.com phpcustomerservice@providence.org P.O. Box 4327 Portland OR 97208 8004576064 5035745551 711 711 8006032340 5035748000 711 711 H9047 809 0 2021 Providence Medicare Flex Group Plan + RX (HMO-POS) www.providencehealthassurance.com phpcustomerservice@providence.org P.O. Box 4327 Portland OR 97208 8004576064 5035745551 711 711 8006032340 5035748000 711 711 H9065 001 0 2021 Anthem l MaineHealth Advantage Dual Plus (HMO D-SNP) https://shop.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8557931929 8557931929 711 711 8442310247 8442310247 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H9065 002 0 2021 Anthem l MaineHealth Advantage Choice (HMO-POS) https://shop.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8557931930 8557931930 711 711 8442096376 8442096376 711 711 H9065 003 0 2021 Anthem l MaineHealth Advantage Choice (HMO-POS) https://shop.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8557931930 8557931930 711 711 8442096376 8442096376 711 711 H9065 004 0 2021 Anthem l MaineHealth Advantage Choice (HMO-POS) https://shop.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8557931930 8557931930 711 711 8442096376 8442096376 711 711 H9065 005 0 2021 Anthem l MaineHealth Advantage Extra (HMO) https://shop.anthem.com/medicare mediblue@empireblue.com P.O. Box 110 Fond du Lac WI 54936 8557931931 8557931931 711 711 8442096376 8442096376 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H9065 006 0 2021 Anthem l MaineHealth Advantage Extra (HMO) https://shop.anthem.com/medicare mediblue@empireblue.com P.O. Box 110 Fond du Lac WI 54936 8557931931 8557931931 711 711 8442096376 8442096376 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H9065 007 0 2021 Anthem l MaineHealth Advantage Extra (HMO) https://shop.anthem.com/medicare mediblue@empireblue.com P.O. Box 110 Fond du Lac WI 54936 8557931931 8557931931 711 711 8442096376 8442096376 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ H9065 008 0 2021 Anthem l MaineHealth Advantage Plus (HMO) https://shop.anthem.com/medicare P.O. Box 110 Fond du Lac WI 54936 8557931931 8557931931 711 711 8442096376 8442096376 711 711 H9066 001 0 2021 Nascentia Medicaid Advantage Plus (HMO D-SNP) www.Nascentiahealthplus.org 1050 West Genesee St Syracuse NY 13204 8884774663 8884774663 711 711 8884774663 8884774663 711 711 Available to current members only.~This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H9066 002 0 2021 Nascentia Skilled Nursing Facility (HMO I-SNP) www.Nascentiahealthplus.org nascentiahealth@477home.org 1050 West Genesee ST Syracuse NY 13204 8884774663 8884774663 711 711 8884774663 8884774663 711 711 H9066 003 0 2021 Nascentia Dual Advantage (HMO D-SNP) www.Nascentiahealthplus.org 1050 West Genesee St Syracuse NY 13204 8884774663 8884774663 711 711 8884774663 8884774663 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H9070 002 0 2021 Humana Value Plus H9070-002 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ H9070 003 0 2021 HumanaChoice H9070-003 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H9070 004 0 2021 HumanaChoice H9070-004 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H9070 005 0 2021 HumanaChoice H9070-005 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan's deductible only applies to out-of-network services.~ H9070 006 1 2021 HumanaChoice H9070-006 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H9070 006 2 2021 HumanaChoice H9070-006 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H9070 006 3 2021 HumanaChoice H9070-006 (PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 H9082 009 0 2021 Molina Medicare Choice Care (HMO) www.molinahealthcare.com/medicare 200 Oceangate, Suite 100 Long Beach CA 90802 8664038293 8664038293 711 711 8664400127 8664400127 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H9095 001 0 2021 Longevity Health Plan (HMO I-SNP) www.longevityhealthplan.com PO Box 5850 Glen Allen VA 23058 8885851611 8885851611 711 711 8885851611 8885851611 711 711 H9096 001 0 2021 Dean Advantage Assurance (HMO-POS) www.deancare.com/medicare 1277 Deming Way Madison WI 53717 8772340126 6088281941 711 711 8772327566 6088281978 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H9096 002 0 2021 Dean Advantage Balance (HMO-POS) www.deancare.com/medicare 1277 Deming Way Madison WI 53717 8772340126 6088281941 711 711 8772327566 6088281978 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H9096 004 0 2021 Dean Advantage Essential (HMO) www.deancare.com/medicare 1277 Deming Way Madison WI 53717 8772340126 6088281941 711 711 8772327566 6088281978 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H9096 005 0 2021 Dean Advantage Complete (HMO) www.deancare.com/medicare 1277 Deming Way Madison WI 53717 8772340126 6088281941 711 711 8772327566 6088281978 711 711 H9096 006 0 2021 Prevea360 Essential (HMO-POS) www.prevea360.com/medicare 1277 Deming Way Madison WI 53717 8772340126 6088281941 711 711 8772327566 6088281978 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H9096 009 0 2021 Prevea360 Complete (HMO-POS) www.prevea360.com/medicare 1277 Deming Way Madison WI 53717 8772340126 6088281941 711 711 8772327566 6088281978 711 711 H9096 010 0 2021 Dean Advantage Harmony (HMO-POS) deancare.com/medicare 1277 Deming Way Madison WI 53717 8772340126 6088281941 711 711 8772327566 6088281978 711 711 H9096 011 0 2021 Prevea360 Harmony (HMO-POS) prevea360.com/medicare 1277 Deming Way Madison WI 53717 8772340126 6088281941 711 711 8772327566 6088281978 711 711 H9096 801 0 2021 Dean Advantage - EGWP MAPD CY (HMO) www.exploreyouradvantage.com 1277 Deming Way Madison WI 53717 8772340126 6088281941 711 711 8772327566 6088281978 711 711 H9096 802 0 2021 Dean Advantage - EGWP MAPD Non CY (HMO) www.exploreyouradvantage.com 1277 Deming Way Madison WI 53717 8772340126 6088281941 711 711 8772327566 6088281978 711 711 H9096 803 0 2021 Dean Advantage - EGWP MA only (HMO) www.exploreyouradvantage.com 1277 Deming Way Madison WI 53717 8772340126 6088281941 711 711 8772327566 6088281978 711 711 H9096 804 0 2021 Dean Advantage EGWP CY HMOPOS (HMO-POS) www.exploreyouradvantage.com 1277 Deming Way Madison WI 53717 8772340126 6088281941 711 711 8772327566 6088281978 711 711 H9096 805 0 2021 Dean Advantage EGWP Non CY HMOPOS (HMO-POS) www.exploreyouradvantage.com 1277 Deming Way Madison WI 53717 8772340126 6088281941 711 711 8772327566 6088281978 711 711 H9096 806 0 2021 Dean Advantage EGWP MA Only HMOPOS (HMO-POS) www.exploreyouradvantage.com 1277 Deming Way Madison WI 53717 8772340126 6088281941 711 711 8772327566 6088281978 711 711 H9096 807 0 2021 Prevea360 Medicare Advantage - EGWP MAPD CY (HMO) www.exploreyouradvantage.com 1277 Deming Way Madison WI 53717 8772340126 6088281941 711 711 8772327566 6088281978 711 711 H9096 808 0 2021 Prevea360 Medicare Advantage - EGWP MAPD Non CY (HMO) www.exploreyouradvantage.com 1277 Deming Way Madison WI 53717 8772340126 6088281941 711 711 8772327566 6088281978 711 711 H9096 809 0 2021 Prevea360 Medicare Advantage - EGWP MA Only (HMO) www.exploreyouradvantage.com 1277 Deming Way Madison WI 53717 8772340126 6088281941 711 711 8772327566 6088281978 711 711 H9096 810 0 2021 Prevea360 Medicare Advantage EGWP CY HMOPOS (HMO-POS) www.exploreyouradvantage.com 1277 Deming Way Madison WI 53717 8772340126 6088281941 711 711 8772327566 6088281978 711 711 H9096 811 0 2021 Prevea360 Medicare Advantage EGWP Non CY HMOPOS (HMO-POS) www.exploreyouradvantage.com 1277 Deming Way Madison WI 53717 8772340126 6088281941 711 711 8772327566 6088281978 711 711 H9096 812 0 2021 Prevea360 Medicare Advantage EGWP MA Only HMOPOS (HMO-POS) www.exploreyouradvantage.com 1277 Deming Way Madison WI 53717 8772340126 6088281941 711 711 8772327566 6088281978 711 711 H9104 006 0 2021 SCAN Healthy at Home (HMO I-SNP) www.scanhealthplan.com memberservices@scanhealthplan.com 3800 Kilroy Airport Way, Suite 100 Long Beach CA 90806 8883157226 8883157226 711 711 8005593500 8005593500 711 711 H9147 001 0 2021 Healthy Blue + Medicare (HMO D-SNP) https://www.bluecrossnc.com/medicare PO Box 17509 Winston Salem NC 27116 8004008745 8004008745 711 711 8337131078 8337131078 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H9153 001 0 2021 WV Senior Advantage (HMO I-SNP) www.wvsenioradvantage.com P.O. Box 94390 Lubbock TX 79493 8448546888 4 8448546888 4 711 711 8448546888 8448546888 711 711 H9191 001 0 2021 Provider Partners Missouri Advantage Plan (HMO I-SNP) www.pphealthplan.com info@pphealthplan.com 785 Elkridge Landing Rd, Suite 300 Linthicum Heights MD 21090 8004059681 8004059681 711 711 8004059681 8004059681 711 711 H9207 002 0 2021 Health Partners Medicare Prime (HMO-POS) HPPMedicare.com MedicareInfo@HPPlans.com 901 Market Street, Suite 500 Philadelphia PA 19107 8334774773 8334774773 8774548477 8774548477 8669018000 8669018000 8774548477 8774548477 H9207 004 0 2021 Health Partners Medicare Special (HMO D-SNP) HPPMedicare.com MedicareInfo@HPPlans.com 901 Market Street, Suite 500 Philadelphia PA 19107 8334774773 8334774773 8774548477 8774548477 8669018000 8669018000 8774548477 8774548477 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H9207 012 0 2021 Health Partners Medicare Complete (HMO-POS) HPPMedicare.com MedicareInfo@HPPlans.com 901 Market Street, Suite 500 Philadelphia PA 19107 8334774773 8334774773 8774548477 8774548477 8669018000 8669018000 8774548477 8774548477 H9219 001 0 2021 Anthem l MaineHealth Advantage Access (PPO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8557931932 8557931932 711 711 8337131077 8337131077 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H9219 002 0 2021 Anthem l MaineHealth Advantage Access (PPO) https://shop.anthem.com/medicare P.O. Box 659404 San Antonio TX 78265 8557931932 8557931932 711 711 8337131077 8337131077 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ H9258 001 0 2021 WellCare Value (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H9276 021 0 2021 Allwell Medicare (HMO) allwell.sunshinehealth.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8779358022 8779358022 711 711 H9302 003 0 2021 Premera Blue Cross Medicare Advantage Charter + Rx (HMO) premera.com/ma PO Box 262548 Plano TX 75026 8888687767 8888687767 711 711 8888508526 8888508526 711 711 This plan does not charge an annual deductible for all drugs. The $160.00 annual deductible only applies to drugs on certain tiers.~ H9302 004 0 2021 Premera Blue Cross Medicare Advantage Alpine (HMO) premera.com/ma PO Box 262548 Plano TX 75026 8888687767 8888687767 711 711 8888508526 8888508526 711 711 H9302 007 0 2021 Premera Blue Cross Medicare Advantage Sound + Rx (HMO) premera.com/ma PO Box 262548 Plano TX 75026 8888687767 8888687767 711 711 8888508526 8888508526 711 711 This plan does not charge an annual deductible for all drugs. The $160.00 annual deductible only applies to drugs on certain tiers.~ H9302 011 0 2021 Premera Blue Cross Medicare Advantage Peak + Rx (HMO) premera.com/ma PO Box 262548 Plano TX 75026 8888687767 8888687767 711 711 8888508526 8888508526 711 711 This plan does not charge an annual deductible for all drugs. The $160.00 annual deductible only applies to drugs on certain tiers.~ H9302 801 0 2021 Premera Blue Cross Medicare Advantage + Rx (HMO) premera.com/ma PO Box 262548 Plano TX 75026 8888687767 8888687767 711 711 8888508526 8888508526 711 711 H9335 001 0 2021 WellCare Value (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H9335 002 0 2021 WellCare Value (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H9335 003 0 2021 WellCare Access (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H9335 005 0 2021 WellCare Dividend (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H9335 006 0 2021 WellCare Compass (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H9364 001 0 2021 WellCare Value (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H9364 002 0 2021 WellCare Access (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H9364 003 0 2021 WellCare Liberty (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H9387 001 0 2021 Allwell Medicare (PPO) allwell.sunflowerhealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8336960634 8336960634 711 711 H9387 002 0 2021 Allwell Medicare Simple (PPO) allwell.sunflowerhealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8336960634 8336960634 711 711 H9403 001 0 2021 Clear Spring Health Deluxe Plan (HMO D-SNP) www.eonhealthplan.com P.O. Box 278530 Miramar FL 33027 8773644566 8773644566 711 711 8773644566 8773644566 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H9403 003 0 2021 Clear Spring Health Silver Plan (HMO C-SNP) www.eonhealthplan.com P.O. Box 278530 Miramar FL 33027 8773644566 8773644566 711 711 8773644566 8773644566 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H9403 004 0 2021 Clear Spring Health Select Plan (HMO) www.eonhealthplan.com P.O. Box 278530 Miramar FL 33027 8773644566 8773644566 711 711 8773644566 8773644566 711 711 H9408 005 0 2021 Vibra Health Plan Enhanced Complete (PPO) www.vibrahealthplan.com PO BOX 60250 Harrisburg PA 17106 8443240691 8443240691 711 711 8443888268 8443888268 711 711 H9408 006 1 2021 Vibra Essential Advocate (PPO) www.vibrahealthplan.com PO BOX 60250 Harrisburg PA 17106 8443240691 8443240691 711 711 8443888268 8443888268 711 711 H9408 006 2 2021 Vibra Essential Advocate (PPO) www.vibrahealthplan.com PO BOX 60250 Harrisburg PA 17106 8443240691 8443240691 711 711 8443888268 8443888268 711 711 H9408 801 0 2021 Vibra Group PPO Silver Rx (PPO) www.vibrahealthplan.com PO BOX 60250 Harrisburg PA 17106 8443240691 8443240691 711 711 8443888268 8443888268 711 711 H9408 802 0 2021 Vibra Group PPO Bronze Rx FY (PPO) www.vibrahealthplan.com PO BOX 60250 Harrisburg PA 17106 8443240691 8443240691 711 711 8443888268 8443888268 711 711 H9408 803 0 2021 Vibra Group PPO Without Rx (PPO) www.vibrahealthplan.com PO BOX 60250 Harrisburg PA 17106 8443240691 8443240691 711 711 8443888268 8443888268 711 711 H9408 804 0 2021 Vibra Group PPO Without Rx FY (PPO) www.vibrahealthplan.com PO BOX 60250 Harrisburg PA 17106 8443240691 8443240691 711 711 8443888268 8443888268 711 711 H9408 805 0 2021 Vibra Group PPO Platinum Rx (PPO) www.vibrahealthplan.com medicareadvantagehmo@capbluecross.com PO BOX 60250 Harrisburg PA 17106 8443240691 8443240691 711 711 8443888268 8443888268 711 711 H9408 806 0 2021 Vibra Group PPO Gold Rx (PPO) www.vibrahealthplan.com medicareadvantagehmo@capbluecross.com PO BOX 60250 Harrisburg PA 17106 8443240691 8443240691 711 711 8443888268 8443888268 711 711 H9408 807 0 2021 Vibra Group PPO Bronze Rx (PPO) www.vibrahealthplan.com medicareadvantagehmo@capbluecross.com PO BOX 60250 Harrisburg PA 17106 8443240691 8443240691 711 711 8443888268 8443888268 711 711 H9408 808 0 2021 Vibra Group PPO Platinum Rx FY (PPO) www.vibrahealthplan.com medicareadvantagehmo@capbluecross.com PO BOX 60250 Harrisburg PA 17106 8443240691 8443240691 711 711 8443888268 8443888268 711 711 H9408 809 0 2021 Vibra Group PPO Gold Rx FY (PPO) www.vibrahealthplan.com medicareadvantagehmo@capbluecross.com PO BOX 60250 Harrisburg PA 17106 8443240691 8443240691 711 711 8443888268 8443888268 711 711 H9408 810 0 2021 Vibra Group PPO Silver Rx FY (PPO) www.vibrahealthplan.com medicareadvantagehmo@capbluecross.com PO BOX 60250 Harrisburg PA 17106 8443240691 8443240691 711 711 8443888268 8443888268 711 711 H9412 803 0 2021 Geisinger Gold Preferred Rx EGWP NJ (PPO) www.GeisingerGold.com 100 North Academy Avenue Danville PA 17822 8005140138 8005140138 711 711 8004989731 5702718771 711 711 H9428 001 0 2021 WellCare Premier (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $75.00 annual deductible only applies to drugs on certain tiers.~ H9428 002 0 2021 WellCare Absolute (PPO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $90.00 annual deductible only applies to drugs on certain tiers.~ H9431 001 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H9431 002 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H9431 003 0 2021 Aetna Medicare Select Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H9431 004 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H9431 005 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H9431 006 0 2021 Aetna Medicare Choice Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H9431 007 0 2021 Aetna Medicare Select Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H9431 008 0 2021 Aetna Medicare Select Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H9431 009 0 2021 Aetna Medicare Explorer Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H9431 011 0 2021 Aetna Medicare Explorer Plan (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H9431 013 0 2021 Aetna Medicare Premier (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H9431 014 0 2021 Aetna Medicare Elite (PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8335706670 8335706670 711 711 H9431 801 0 2021 Aetna First Health Medicare Plan (PPO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H9431 802 0 2021 Aetna First Health Medicare Plan w/Rx (PPO) www.aetnamedicare.com SchulzF@Aetna.com 151 Farmington Avenue Hartford CT 06156 8003074830 8003074830 711 711 8882672637 8882672637 711 711 H9455 001 0 2021 Health Choice Generations Utah (HMO D-SNP) www.healthchoicegenerations.com 6056 S. Fashion Square Drive, Suite 2400 Murray UT 84107 8444578943 8444578943 711 711 8444578943 8444578943 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H9460 001 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8666121391 8666121391 711 711 8006683813 8006683813 711 711 H9460 002 0 2021 Cigna Fundamental Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8666121391 8666121391 711 711 8006683813 8006683813 711 711 H9487 001 0 2021 Michigan Complete Health (Medicare-Medicaid Plan) mmp.michigancompletehealth.com 800 Tower Drive, Suite 200 Troy MI 48098 8442397387 8442397387 711 711 8442397387 8442397387 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H9489 001 0 2021 Vermont Blue Advantage Unity HMO (HMO) www.vermontblueadvantage.com P.O. Box 260160 Plano TX 75026 8445102583 8445102583 711 711 8448395126 8448395126 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H9489 801 0 2021 Vermont Blue Advantage Group HMO (HMO) www.vermontblueadvantage.com P.O. Box 260160 Plano TX 75026 8445102583 8445102583 711 711 8448395126 8448395126 711 711 H9489 802 0 2021 Vermont Blue Advantage Group HMOPOS (HMO-POS) www.vermontblueadvantage.com P.O. Box 260160 Plano TX 75026 8445102583 8445102583 711 711 8448395126 8448395126 711 711 H9489 803 0 2021 Vermont Blue Advantage Group HMO (HMO) www.vermontblueadvantage.com P.O. Box 260160 Plano TX 75026 8445102583 8445102583 711 711 8448395126 8448395126 711 711 H9489 804 0 2021 Vermont Blue Advantage Group HMOPOS (HMO-POS) www.vermontblueadvantage.com P.O. Box 260160 Plano TX 75026 8445102583 8445102583 711 711 8448395126 8448395126 711 711 H9489 805 0 2021 Vermont Blue Advantage Group HMO (HMO) www.vermontblueadvantage.com P.O. Box 260160 Plano TX 75026 8445102583 8445102583 711 711 8448395126 8448395126 711 711 H9489 806 0 2021 Vermont Blue Advantage Group HMOPOS (HMO-POS) www.vermontblueadvantage.com P.O. Box 260160 Plano TX 75026 8445102583 8445102583 711 711 8448395126 8448395126 711 711 H9516 001 0 2021 Bright Advantage Choice (PPO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H9516 002 0 2021 Bright Advantage Choice Plus (PPO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H9525 003 0 2021 Anthem MediBlue Dual Advantage (HMO D-SNP) shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8557931933 8557931933 711 711 8662420251 8662420251 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H9525 004 0 2021 Anthem MediBlue Plus (HMO) shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8557931934 8557931934 711 711 8553041774 8553041774 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~ H9525 006 0 2021 Anthem MediBlue Plus (HMO) shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8557931934 8557931934 711 711 8553041774 8553041774 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ H9525 007 0 2021 Anthem MediBlue Dual Advantage (HMO D-SNP) shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8557931933 8557931933 711 711 8448793601 8448793601 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H9525 008 0 2021 Anthem MediBlue Plus (HMO) shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8557931934 8557931934 711 711 8555581439 8555581439 711 711 H9525 801 0 2021 Anthem MediBlue (HMO) www.anthem.com/wi/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8553206557 8553206557 711 711 H9525 802 0 2021 Anthem MediBlue (HMO) www.anthem.com/wi/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8553206557 8553206557 711 711 H9525 804 0 2021 Anthem Senior Advantage (HMO) www.anthem.com/ky/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H9525 805 0 2021 Anthem Senior Advantage (HMO) www.anthem.com/ky/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H9525 808 0 2021 Anthem MediBlue (HMO) www.anthem.com/wi/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H9525 809 0 2021 Anthem MediBlue (HMO) www.anthem.com/wi/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H9525 812 0 2021 Anthem Senior Advantage (HMO) www.anthem.com/ky/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H9525 813 0 2021 Anthem Senior Advantage (HMO) www.anthem.com/ky/medicare P.O. Box 110 Fond du Lac WI 54396 8338488729 8338488729 711 711 8338488730 8338488730 711 711 H9572 001 1 2021 Medicare Plus Blue PPO Signature (PPO) www.bcbsm.com/medicare 600 East Lafayette Blvd., MC TC1302 Detroit MI 48226 8554257720 8554257720 711 711 8772412583 8772412583 711 711 H9572 001 2 2021 Medicare Plus Blue PPO Signature (PPO) www.bcbsm.com/medicare 600 East Lafayette Blvd., MC TC1302 Detroit MI 48226 8554257720 8554257720 711 711 8772412583 8772412583 711 711 H9572 001 3 2021 Medicare Plus Blue PPO Signature (PPO) www.bcbsm.com/medicare 600 East Lafayette Blvd., MC TC1302 Detroit MI 48226 8554257720 8554257720 711 711 8772412583 8772412583 711 711 H9572 001 4 2021 Medicare Plus Blue PPO Signature (PPO) www.bcbsm.com/medicare 600 East Lafayette Blvd., MC TC1302 Detroit MI 48226 8554257720 8554257720 711 711 8772412583 8772412583 711 711 H9572 001 6 2021 Medicare Plus Blue PPO Signature (PPO) www.bcbsm.com/medicare 600 East Lafayette Blvd., MC TC1302 Detroit MI 48226 8554257720 8554257720 711 711 8772412583 8772412583 711 711 H9572 002 1 2021 Medicare Plus Blue PPO Vitality (PPO) www.bcbsm.com/medicare 600 East Lafayette Blvd., MC TC1302 Detroit MI 48226 8554257720 8554257720 711 711 8772412583 8772412583 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H9572 002 2 2021 Medicare Plus Blue PPO Vitality (PPO) www.bcbsm.com/medicare 600 East Lafayette Blvd., MC TC1302 Detroit MI 48226 8554257720 8554257720 711 711 8772412583 8772412583 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H9572 002 3 2021 Medicare Plus Blue PPO Vitality (PPO) www.bcbsm.com/medicare 600 East Lafayette Blvd., MC TC1302 Detroit MI 48226 8554257720 8554257720 711 711 8772412583 8772412583 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H9572 002 4 2021 Medicare Plus Blue PPO Vitality (PPO) www.bcbsm.com/medicare 600 East Lafayette Blvd., MC TC1302 Detroit MI 48226 8554257720 8554257720 711 711 8772412583 8772412583 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H9572 002 6 2021 Medicare Plus Blue PPO Vitality (PPO) www.bcbsm.com/medicare 600 East Lafayette Blvd., MC TC1302 Detroit MI 48226 8554257720 8554257720 711 711 8772412583 8772412583 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H9572 003 1 2021 Medicare Plus Blue PPO Assure (PPO) www.bcbsm.com/medicare 600 East Lafayette Blvd., MC TC1302 Detroit MI 48226 8554257720 8554257720 711 711 8772412583 8772412583 711 711 H9572 003 2 2021 Medicare Plus Blue PPO Assure (PPO) www.bcbsm.com/medicare 600 East Lafayette Blvd., MC TC1302 Detroit MI 48226 8554257720 8554257720 711 711 8772412583 8772412583 711 711 H9572 003 3 2021 Medicare Plus Blue PPO Assure (PPO) www.bcbsm.com/medicare 600 East Lafayette Blvd., MC TC1302 Detroit MI 48226 8554257720 8554257720 711 711 8772412583 8772412583 711 711 H9572 003 4 2021 Medicare Plus Blue PPO Assure (PPO) www.bcbsm.com/medicare 600 East Lafayette Blvd., MC TC1302 Detroit MI 48226 8554257720 8554257720 711 711 8772412583 8772412583 711 711 H9572 003 6 2021 Medicare Plus Blue PPO Assure (PPO) www.bcbsm.com/medicare 600 East Lafayette Blvd., MC TC1302 Detroit MI 48226 8554257720 8554257720 711 711 8772412583 8772412583 711 711 H9572 004 1 2021 Medicare Plus Blue PPO Essential (PPO) www.bcbsm.com/medicare 600 East Lafayette Blvd., MC TC1302 Detroit MI 48226 8554257720 8554257720 711 711 8772412583 8772412583 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H9572 004 2 2021 Medicare Plus Blue PPO Essential (PPO) www.bcbsm.com/medicare 600 East Lafayette Blvd., MC TC1302 Detroit MI 48226 8554257720 8554257720 711 711 8772412583 8772412583 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H9572 004 3 2021 Medicare Plus Blue PPO Essential (PPO) www.bcbsm.com/medicare 600 East Lafayette Blvd., MC TC1302 Detroit MI 48226 8554257720 8554257720 711 711 8772412583 8772412583 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H9572 004 4 2021 Medicare Plus Blue PPO Essential (PPO) www.bcbsm.com/medicare 600 East Lafayette Blvd., MC TC1302 Detroit MI 48226 8554257720 8554257720 711 711 8772412583 8772412583 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H9572 004 6 2021 Medicare Plus Blue PPO Essential (PPO) www.bcbsm.com/medicare 600 East Lafayette Blvd., MC TC1302 Detroit MI 48226 8554257720 8554257720 711 711 8772412583 8772412583 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~ H9572 801 0 2021 Medicare Plus Blue PPO Employer Rx CY (PPO) www.bcbsm.com/medicare 600 East Lafayette Blvd., MC TC1302 Detroit MI 48226 8666848216 8666848216 711 711 8666848216 8666848216 711 711 H9572 802 0 2021 Medicare Plus Blue PPO Employer CY (PPO) www.bcbsm.com/medicare 600 East Lafayette Blvd., MC TC1302 Detroit MI 48226 8666848216 8666848216 711 711 8666848216 8666848216 711 711 H9572 803 0 2021 Medicare Plus Blue PPO Employer Rx non-CY (PPO) www.bcbsm.com/medicare 600 East Lafayette Blvd., MC TC1302 Detroit MI 48226 8666848216 8666848216 711 711 8666848216 8666848216 711 711 H9572 804 0 2021 Medicare Plus Blue PPO Employer non-CY (PPO) www.bcbsm.com/medicare 600 East Lafayette Blvd, MC TC1302 Detroit MI 48226 8666848216 8666848216 711 711 8666848216 8666848216 711 711 H9572 805 0 2021 Medicare Plus Blue PPO Employer CY ASC (PPO) www.bcbsm.com/medicare 600 East Lafayette Blvd., MC TC1302 Detroit MI 48226 8666848216 8666848216 711 711 8666848216 8666848216 711 711 H9576 001 0 2021 Neighborhood INTEGRITY (Medicare-Medicaid Plan) www.nhpri.org/INTEGRITY 910 Douglas Pike Smithfield RI 02917 8448126896 4014278181 711 711 8448126896 4014278181 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H9585 001 0 2021 BMC HealthNet Plan Senior Care Options (HMO D-SNP) www.SeniorsGetMore.org 529 Main Street, Suite 500 Charlestown MA 02129 8558338124 8558338124 711 711 8558338125 8558338125 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H9589 003 0 2021 Clear Spring Health Choice Plan (PPO) www.eonhealthplan.com P.O. BOX 278530 Miramar FL 33027 8773644566 8773644566 711 711 8773644566 8773644566 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H9590 001 0 2021 Longevity Health Plan (HMO I-SNP) www.longevityhealthplan.com PO Box 5850 Glen Allen VA 23058 8888869770 8888869770 711 711 8888869770 8888869770 711 711 H9615 007 0 2021 MVP Medicare WellSelect Plus with Part D (PPO) www.joinMVPmedicare.com memberservices@mvphealthcare.com 220 Alexander St., Medicare Sales Rochester NY 14607 8003243899 8003243899 8006621220 8006621220 8006657924 8006657924 8006621220 8006621220 H9615 008 0 2021 MVP Medicare WellSelect with Part D (PPO) www.joinMVPmedicare.com memberservices@mvphealthcare.com 220 Alexander St., Medicare Sales Rochester NY 14607 8003243899 8003243899 8006621220 8006621220 8006657924 8006657924 8006621220 8006621220 This plan does not charge an annual deductible for all drugs. The $325.00 annual deductible only applies to drugs on certain tiers.~ H9615 009 0 2021 MVP Medicare WellSelect Plus with Part D (PPO) www.joinMVPmedicare.com memberservices@mvphealthcare.com 220 Alexander St., Medicare Sales Rochester NY 14607 8003243899 8003243899 8006621220 8006621220 8006657924 8006657924 8006621220 8006621220 H9615 010 0 2021 MVP Medicare WellSelect with Part D (PPO) www.joinMVPmedicare.com memberservices@mvphealthcare.com 220 Alexander St., Medicare Sales Rochester NY 14607 8003243899 8003243899 8006621220 8006621220 8006657924 8006657924 8006621220 8006621220 This plan does not charge an annual deductible for all drugs. The $325.00 annual deductible only applies to drugs on certain tiers.~ H9615 012 0 2021 MVP Medicare WellSelect with Part D (PPO) www.joinmvpmedicare.com memberservices@mvphealthcare.com 220 Alexander St., Medicare Sales Rochester NY 14607 8003243899 8003243899 8006621220 8006621220 8006657924 8006657924 8006621220 8006621220 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H9615 014 0 2021 MVP Medicare Patriot Plan with Part D (PPO) www.joinmvpmedicare.com memberservices@mvphealthcare.com 220 Alexander St, Medicare Sales Rochester NY 14607 8003243899 8003243899 8006621220 8006621220 8006657924 8006657924 8006621220 8006621220 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H9615 802 0 2021 MVP GoldAnywhere Rx - Employer Group (PPO) www.mvphealthcare.com memberservices@mvphealthcare.com 220 Alexander St., Medicare Sales Rochester NY 14607 8003243899 8003243899 8006621220 8006621220 8006657924 8006657924 8006621220 8006621220 H9615 807 0 2021 MVP USA Care Rx - Employer Group (PPO) www.mvphealthcare.com memberservices@mvphealthcare.com 220 Alexander St., Medicare Sales Rochester NY 14607 8003243899 8003243899 8006621220 8006621220 8006657924 8006657924 8006621220 8006621220 H9615 810 0 2021 MVP GoldAnywhere - Employer Group (PPO) www.mvphealthcare.com memberservices@mvphealthcare.com 220 Alexander St., Medicare Sales Rochester NY 14607 8003243899 8003243899 8006621220 8006621220 8006657924 8006657924 8006621220 8006621220 H9615 811 0 2021 MVP USA Care without Part D - Employer Group (PPO) www.mvphealthcare.com memberservices@mvphealthcare.com 220 Alexander St., Medicare Sales Rochester NY 14607 8003243899 8003243899 8006621220 8006621220 8006657924 8006657924 8006621220 8006621220 H9630 001 0 2021 Allwell Medicare (HMO) allwell.arhealthwellness.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8555659518 8555659518 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H9630 002 0 2021 Allwell Medicare (HMO) allwell.arhealthwellness.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8555659518 8555659518 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H9630 003 0 2021 Allwell Medicare Select (HMO) allwell.arhealthwellness.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8555659518 8555659518 711 711 H9630 004 0 2021 Allwell Medicare (HMO) allwell.arhealthwellness.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8555659518 8555659518 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H9630 005 0 2021 Allwell Medicare Premier (HMO) allwell.arhealthwellness.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8555659518 8555659518 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H9630 006 0 2021 Allwell Medicare Premier (HMO) allwell.arhealthwellness.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8555659518 8555659518 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H9630 008 0 2021 Allwell Medicare Boost (HMO) allwell.arhealthwellness.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8555659518 8555659518 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H9630 009 0 2021 Allwell Medicare Simple (HMO) allwell.arhealthwellness.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8555659518 8555659518 711 711 H9630 801 0 2021 Allwell Group (HMO) allwell.arhealthwellness.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8555659518 8555659518 711 711 H9630 802 0 2021 Allwell Group (HMO) allwell.arhealthwellness.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8555659518 8555659518 711 711 H9630 803 0 2021 Allwell Group (HMO) allwell.arhealthwellness.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8555659518 8555659518 711 711 H9662 801 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H9662 802 0 2021 Cigna Preferred Medicare FY (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8665934468 8665934468 711 711 8006683813 8006683813 711 711 H9686 001 0 2021 Platinum (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 8889792247 711 711 8666342247 8666342247 711 711 H9686 002 0 2021 NVPlus (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 8889792247 711 711 8666342247 8666342247 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H9686 003 0 2021 AVA (HMO) www.alignmenthealthplan.com lwendt@ahcusa.com 1100 W Town and Country Rd Suite 1300 Orange CA 92868 8889792247 8889792247 711 711 8666342247 8666342247 711 711 H9699 004 1 2021 Health Advantage Blue Classic (HMO) www.arkansasbluecross.com/medicare P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8773499335 8773499335 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H9699 004 2 2021 Health Advantage Blue Classic (HMO) www.arkansasbluecross.com/medicare P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8773499335 8773499335 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H9699 004 3 2021 Health Advantage Blue Classic (HMO) www.arkansasbluecross.com/medicare P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8773499335 8773499335 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H9699 006 0 2021 Health Advantage Blue Premier (HMO) www.arkansasbluecross.com/medicare P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8773499335 8773499335 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~ H9706 001 0 2021 Blue Cross Medicare Advantage Value (HMO) www.getbluetx.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~ H9706 002 0 2021 Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) www.getbluetx.com/dsnp PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8778956437 8778956437 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H9706 003 0 2021 Blue Cross Medicare Advantage Value (HMO) www.getbluetx.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8777748592 8777748592 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H9706 801 0 2021 Blue Cross Group Medicare Advantage (HMO) www.getbluetx.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H9706 802 0 2021 Blue Cross Group Medicare Advantage (HMO) www.getbluetx.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H9706 803 0 2021 Blue Cross Group Medicare Advantage (HMO) www.getbluetx.com/mapd PO Box 4555 Scranton PA 18505 8775838129 8775838129 711 711 8772991008 8772991008 711 711 H9712 001 0 2021 HAP Empowered MI Health Link (Medicare-Medicaid Plan) www.hap.org/mihealthlink mem_svcs@hap.org PO Box 2578 Detroit MI 48202 8339231630 8339231630 711 711 8886540706 2486633800 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H9725 001 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559803049 8559803049 711 711 8006683813 8006683813 711 711 H9725 003 0 2021 Cigna TotalCare (HMO D-SNP) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559803049 8559803049 711 711 8006683813 8006683813 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H9725 005 0 2021 Cigna Fundamental Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559803049 8559803049 711 711 8006683813 8006683813 711 711 H9725 006 0 2021 Cigna Preferred Plus Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8559803049 8559803049 711 711 8006683813 8006683813 711 711 H9725 801 0 2021 Cigna Preferred Medicare (HMO) www.cignamedicare.com LetUsHelpYou@HealthSpring.com Attn: Member Services, 2800 North Loop West Houston TX 77092 8882817867 8882817867 711 711 8882817867 8882817867 711 711 H9730 002 0 2021 WellCare Value (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H9730 003 0 2021 WellCare Access (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H9730 004 0 2021 WellCare Liberty (HMO D-SNP) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449089 8334449089 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H9730 005 0 2021 WellCare Essential (HMO-POS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H9730 006 0 2021 WellCare Patriot (HMO-POS) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H9730 007 0 2021 WellCare Dividend (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H9730 009 0 2021 WellCare Elite (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 H9730 010 0 2021 WellCare Compass (HMO) www.wellcare.com/medicare ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8665270056 8665270056 711 711 8334449088 8334449088 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H9808 004 0 2021 HealthTeam Advantage Plan I (PPO) www.healthteamadvantage.com conciergehta@healthteamadvantage.com 7800 McCloud Road, Suite 100 Greensboro NC 27409 8779059216 8779059216 711 711 8889651965 8889651965 711 711 H9808 005 0 2021 HealthTeam Advantage Plan II (PPO) www.healthteamadvantage.com conciergehta@healthteamadvantage.com 7800 McCloud Road, Suite 100 Greensboro NC 27409 8779059216 8779059216 711 711 8889651965 8889651965 711 711 H9811 001 0 2021 Allwell Medicare (HMO) allwell.magnoliahealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8447867711 8447867711 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H9811 005 0 2021 Allwell Medicare (HMO) allwell.magnoliahealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8447867711 8447867711 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ H9811 006 0 2021 Allwell Dual Medicare (HMO D-SNP) allwell.magnoliahealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8332604124 8332604124 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H9811 007 0 2021 Allwell Dual Medicare Essentials (HMO D-SNP) allwell.magnoliahealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8332604124 8332604124 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H9811 008 0 2021 Allwell Medicare Boost (HMO) allwell.magnoliahealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8447867711 8447867711 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H9811 009 0 2021 Allwell Medicare Complement (HMO) allwell.magnoliahealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8447867711 8447867711 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H9811 801 0 2021 Allwell Group (HMO) allwell.magnoliahealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8447867711 8447867711 711 711 H9811 802 0 2021 Allwell Group (HMO) allwell.magnoliahealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8447867711 8447867711 711 711 H9811 803 0 2021 Allwell Group (HMO) allwell.magnoliahealthplan.com PO Box 10420 Van Nuys CA 91410 8449420039 8449420039 711 711 8447867711 8447867711 711 711 H9826 001 0 2021 Community Health Choice (HMO D-SNP) www.communityhealthchoice.org/medicare memberservices@communityhealthchoice.org 2636 South Loop West, Suite 125 Houston TX 77054 8332768306 7132955007 711 711 8332768306 7132955007 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H9834 001 0 2021 Gundersen MN Quartz Med Advantage Elite D (w/Rx) (HMO) quartzbenefits.com/medicareadvantage customerservice@quartzbenefits.com 840 Carolina Street Sauk City WI 53583 8003945566 6088818275 8008778973 711 8003945566 6088818275 8008778973 711 H9834 003 0 2021 Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) quartzbenefits.com/medicareadvantage customerservice@quartzbenefits.com 840 Carolina Street Sauk City WI 53583 8003945566 6088818275 8008778973 711 8003945566 6088818275 8008778973 711 H9834 004 0 2021 Gundersen MN Quartz Med Advantage Value (HMO) quartzbenefits.com/medicareadvantage customerservice@quartzbenefits.com 840 Carolina Street Sauk City WI 53583 8003945566 6088818275 8008778973 711 8003945566 6088818275 8008778973 711 H9834 005 0 2021 Gundersen MN Quartz Med Advantage Elite (HMO) quartzbenefits.com/medicareadvantage customerservice@quartzbenefits.com 840 Carolina Street Sauk City WI 53583 8003945566 6088818275 8008778973 711 8003945566 6088818275 8008778973 711 H9834 006 0 2021 Gundersen MN Quartz Med Advantage Core D (w/Rx) (HMO) quartzbenefits.com/medicareadvantage customerservice@quartzbenefits.com 840 Carolina Street Sauk City WI 53583 8003945566 6088818275 8008778973 711 8003945566 6088818275 8008778973 711 H9861 001 0 2021 Reliance Principle Plan (HMO) RelianceMedicareAdvantage.org jnysson@relianceaco.org 23900 Orchard Lake Rd., Suite 210 Farmington Hills MI 48336 8336532041 8336532041 711 711 8559595855 8559595855 711 711 This plan does not charge an annual deductible for all drugs. The $125.00 annual deductible only applies to drugs on certain tiers.~ H9861 002 0 2021 Reliance Cardinal Plan (HMO) RelianceMedicareAdvantage.org jnysson@relianceaco.org 23900 Orchard Lake Rd. Farmington Hills MI 48336 8336532041 8336532041 711 711 8559595855 8559595855 711 711 H9861 003 0 2021 Reliance Dual Care Plus (HMO D-SNP) RelianceMedicareAdvantage.org 23900 Orchard Lake Rd., Suite 210 Farmington Hills MI 48336 8336532041 8336532041 711 711 8559595855 8559595855 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H9869 001 0 2021 PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan) www.phpcares.org 655 Third Avenue, 2nd Floor New York NY 10017 8557475483 8557475483 711 711 8557475483 8557475483 711 711 This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.~ H9870 001 0 2021 Passport Advantage (HMO D-SNP) www.passportadvantage.com 5100 Commerce Crossings Drive Louisville KY 40229 8446432780 8446432780 711 711 8448596152 8448596152 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H9877 001 0 2021 Virginia Premier Advantage Elite (HMO D-SNP) www.virginiapremier.com vphpmedicareadvantage@virginiapremier.com PO Box 4309 Richmond VA 23220 8332280051 8332280051 711 711 8777391370 8048195151 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H9878 001 0 2021 Bright Advantage Choice (PPO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 This plan does not charge an annual deductible for all drugs. The $50.00 annual deductible only applies to drugs on certain tiers.~ H9878 002 0 2021 Bright Advantage Choice Plus (PPO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H9878 003 0 2021 Bright Advantage University Hospitals Choice (PPO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H9878 006 0 2021 Bright Advantage Flex Choice (PPO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H9878 008 0 2021 Bright Advantage University Hospitals Choice Plus (PPO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H9878 009 0 2021 Bright Advantage Choice (PPO) https://brighthealthplan.com/medicare-advantage Bright Health Medicare Advantage – Enrollment, PO Box 853958 Richardson TX 75085 8446792028 8446792028 711 711 8442217736 8442217736 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ H9909 001 0 2021 American Health Advantage of Mississippi (HMO I-SNP) ms.AmHealthPlans.com MemberServices@AmHealthPlans.com 201 Jordan Road, Suite 200 Franklin TN 37067 8449170642 8449170642 711 711 8449170642 8449170642 711 711 H9917 001 0 2021 Align Thrive (HMO I-SNP) www.alignseniorcare.com 8270 Woodland Center Blvd Tampa FL 33614 8447888935 8447888935 711 711 8447888935 8447888935 711 711 H9917 002 0 2021 Align Connect (HMO C-SNP) www.alignseniorcare.com 8270 Woodland Center Blvd Tampa FL 33614 8447888935 8447888935 711 711 8447888935 8447888935 711 711 H9942 001 0 2021 Longevity Health Plan (PPO I-SNP) www.longevityhealthplan.com PO Box 5850 Glen Allen VA 23058 8888998490 8888998490 711 711 8888998490 8888998490 711 711 H9952 001 0 2021 Medica AccessAbility Solution Enhanced (HMO D-SNP) medica.com 401 Carlson Parkway, CP 320 Minnetonka MN 55305 8002662157 9529922030 711 711 8883473630 9529922580 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ H9955 001 0 2021 Molina Medicare Complete Care (HMO D-SNP) www.molinahealthcare.com/medicare 200 Oceangate, Suite 100 Long Beach CA 90802 8664038293 8664038293 711 711 8664724584 8664724584 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ R0110 001 0 2021 HumanaChoice R0110-001 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan's deductible only applies to out-of-network services.~ R0110 003 0 2021 HumanaChoice R0110-003 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~ R0110 801 0 2021 Humana Medicare Employer (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 R0110 802 0 2021 Humana Medicare Employer (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 R0759 001 0 2021 AARP Medicare Advantage Choice Plan 2 (Regional PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $395.00 annual deductible only applies to drugs on certain tiers.~ R0759 002 0 2021 AARP Medicare Advantage Patriot (Regional PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 R0759 003 0 2021 UnitedHealthcare Dual Complete RP (Regional PPO D-SNP) www.UHCCommunityPlan.com P.O. Box 30769 Salt Lake City UT 84130 8888343721 8888343721 711 711 8668424968 8668424968 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ R0802 001 0 2021 Martin's Point Generations Advantage Flex (Regional PPO) MartinsPoint.org/Advantage gamemberservices@martinspoint.org P.O. Box 9746, 331 Veranda Street Portland ME 04104 8886404423 8886404423 711 711 8665447504 8665447504 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ R0865 001 0 2021 HumanaChoice R0865-001 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 R0865 003 0 2021 HumanaChoice R0865-003 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $195.00 annual deductible only applies to drugs on certain tiers.~ R0865 801 0 2021 Humana Medicare Employer (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 R0865 802 0 2021 Humana Medicare Employer (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 R0923 001 0 2021 HumanaChoice R0923-001 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan's deductible only applies to out-of-network services.~ R0923 002 0 2021 HumanaChoice R0923-002 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan's deductible only applies to out-of-network services.~ R0923 801 0 2021 Humana Medicare Employer (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 R0923 802 0 2021 Humana Medicare Employer (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 R1390 001 0 2021 HumanaChoice R1390-001 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 R1390 002 0 2021 HumanaChoice R1390-002 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $360.00 annual deductible only applies to drugs on certain tiers.~ R1390 003 0 2021 Humana Honor R1390-003 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan's deductible only applies to out-of-network services.~ R1390 801 0 2021 Humana Medicare Employer (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 R1390 802 0 2021 Humana Medicare Employer (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 R1532 001 0 2021 HumanaChoice R1532-001 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan's deductible only applies to out-of-network services.~ R1532 002 0 2021 HumanaChoice R1532-002 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ R1532 801 0 2021 Humana Medicare Employer (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 R1532 802 0 2021 Humana Medicare Employer (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 R1548 001 0 2021 UnitedHealthcare Dual Complete RP (Regional PPO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8443687151 8443687151 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ R2604 001 0 2021 UnitedHealthcare Medicare Advantage Choice (Regional PPO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ R2604 002 0 2021 UnitedHealthcare Medicare Silver (Regional PPO C-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 R2604 003 0 2021 UnitedHealthcare Medicare Gold (Regional PPO C-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $210.00 annual deductible only applies to drugs on certain tiers.~ R2604 004 0 2021 UnitedHealthcare Dual Complete Choice (Regional PPO D-SNP) www.UHCCommunityPlan.com P.O. Box 30769 Salt Lake City UT 84130 8888343721 8888343721 711 711 8664801086 8664801086 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ R2604 005 0 2021 UnitedHealthcare Medicare Advantage Patriot (Regional PPO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 R3175 003 0 2021 UnitedHealthcare Dual Complete RP (Regional PPO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8666228054 8666228054 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ R3175 801 0 2021 UnitedHealthcare Group Medicare Advantage (Regional PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 R3175 802 0 2021 UnitedHealthcare Group Medicare Advantage (Regional PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 R3332 001 0 2021 BlueMedicare Choice (Regional PPO) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ R3392 001 0 2021 HumanaChoice R3392-001 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan's deductible only applies to out-of-network services.~ R3392 002 0 2021 HumanaChoice R3392-002 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $340.00 annual deductible only applies to drugs on certain tiers.~ R3392 801 0 2021 Humana Medicare Employer (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 R3392 802 0 2021 Humana Medicare Employer (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 R3444 008 0 2021 UnitedHealthcare Medicare Silver (Regional PPO C-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8002041002 8002041002 711 711 R3444 009 0 2021 UnitedHealthcare Medicare Gold (Regional PPO C-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8002041002 8002041002 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ R3444 011 0 2021 UnitedHealthcare Dual Complete Choice (Regional PPO D-SNP) www.UHCCommunityPlan.com P.O. Box 30770 Salt Lake City UT 84130 8888343721 8888343721 711 711 8664801086 8664801086 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ R3444 012 0 2021 UnitedHealthcare Medicare Advantage Choice Plan 2 (Regional PPO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8002041002 8002041002 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ R3444 023 0 2021 UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8002041002 8002041002 711 711 This plan does not charge an annual deductible for all drugs. The $245.00 annual deductible only applies to drugs on certain tiers.~ R3887 001 0 2021 HumanaChoice R3887-001 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 R3887 002 0 2021 HumanaChoice R3887-002 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $380.00 annual deductible only applies to drugs on certain tiers.~ R3887 801 0 2021 Humana Medicare Employer (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 R3887 802 0 2021 Humana Medicare Employer (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 R4182 001 0 2021 HumanaChoice R4182-001 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan's deductible only applies to out-of-network services.~ R4182 003 0 2021 HumanaChoice R4182-003 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ R4182 004 0 2021 HumanaChoice R4182-004 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ R4182 801 0 2021 Humana Medicare Employer (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 R4182 802 0 2021 Humana Medicare Employer (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 R4487 001 0 2021 Anthem MediBlue Access Basic (Regional PPO) shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8557931935 8557931935 711 711 8004671199 8004671199 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ R4845 001 0 2021 HumanaChoice R4845-001 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 R4845 002 0 2021 HumanaChoice R4845-002 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $395.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ R4845 801 0 2021 Humana Medicare Employer (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 R4845 802 0 2021 Humana Medicare Employer (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 R5329 001 0 2021 AARP Medicare Advantage Choice (Regional PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ R5342 001 0 2021 UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8007116088 8007116088 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ R5342 002 0 2021 UnitedHealthcare Medicare Advantage Patriot (Regional PPO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8007116088 8007116088 711 711 R5342 005 0 2021 UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8007116088 8007116088 711 711 This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.~ R5342 006 0 2021 UnitedHealthcare Medicare Advantage Choice Plan 4 (Regional PPO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8007116088 8007116088 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ R5342 801 0 2021 UnitedHealthcare Group Medicare Advantage (Regional PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 R5342 802 0 2021 UnitedHealthcare Group Medicare Advantage (Regional PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 R5342 803 0 2021 UnitedHealthcare Group Medicare Advantage (Regional PPO) www.UHCRetiree.com PO Box 30770 Salt Lake City UT 84130 8777140178 8777140178 711 711 8004578506 8004578506 711 711 R5361 001 0 2021 HumanaChoice R5361-001 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 R5361 002 0 2021 HumanaChoice R5361-002 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $420.00 annual deductible only applies to drugs on certain tiers.~ R5361 801 0 2021 Humana Medicare Employer (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 R5361 802 0 2021 Humana Medicare Employer (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 R5495 001 0 2021 HumanaChoice R5495-001 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan's deductible only applies to out-of-network services.~ R5495 002 0 2021 HumanaChoice R5495-002 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $380.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ R5495 801 0 2021 Humana Medicare Employer (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 R5495 802 0 2021 Humana Medicare Employer (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 R5826 005 0 2021 HumanaChoice R5826-005 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ R5826 018 0 2021 HumanaChoice R5826-018 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan's deductible only applies to out-of-network services.~ R5826 074 0 2021 HumanaChoice R5826-074 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $395.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ R5826 805 0 2021 Humana Medicare Employer (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 R5826 819 0 2021 Humana Medicare Employer (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 R5941 013 0 2021 Anthem MediBlue Access Core (Regional PPO) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8557931936 8557931936 711 711 8004671199 8004671199 711 711 R5941 014 0 2021 Anthem MediBlue Access Basic (Regional PPO) https://shop.anthem.com/medicare 1351 William Howard Taft Road, CN14B-818 Cincinnati OH 45206 8557931936 8557931936 711 711 8004671199 8004671199 711 711 This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ R6694 003 0 2021 Aetna Medicare Premier Plus 1 (Regional PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan's deductible only applies to out-of-network services.~ R6694 005 0 2021 Aetna Medicare Premier Plus 2 (Regional PPO) www.aetnamedicare.com HicksJS@aetna.com P.O. Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $190.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ R6694 006 0 2021 Aetna Medicare Premier (Regional PPO) www.aetnamedicare.com HicksJS@aetna.com PO Box 7405 London KY 40742 8338596031 8338596031 711 711 8882689800 8882689800 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ R6801 008 0 2021 UnitedHealthcare Medicare Silver (Regional PPO C-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8002041002 8002041002 711 711 R6801 009 0 2021 UnitedHealthcare Medicare Gold (Regional PPO C-SNP) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8002041002 8002041002 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ R6801 011 0 2021 UnitedHealthcare Dual Complete Choice (Regional PPO D-SNP) www.UHCCommunityPlan.com P.O. Box 30769 Salt Lake City UT 84130 8888343721 8888343721 711 711 8664801086 8664801086 711 711 This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.~Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.~ R6801 012 0 2021 UnitedHealthcare Medicare Advantage Choice (Regional PPO) www.UHCMedicareSolutions.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8002041002 8002041002 711 711 This plan does not charge an annual deductible for all drugs. The $395.00 annual deductible only applies to drugs on certain tiers.~ R7220 001 0 2021 HumanaChoice R7220-001 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan's deductible only applies to out-of-network services.~ R7220 002 0 2021 HumanaChoice R7220-002 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $420.00 annual deductible only applies to drugs on certain tiers.~ R7220 801 0 2021 Humana Medicare Employer (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 R7220 802 0 2021 Humana Medicare Employer (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 R7315 001 0 2021 HumanaChoice R7315-001 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan's deductible only applies to out-of-network services.~ R7315 002 0 2021 HumanaChoice R7315-002 (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008332364 8008332364 711 711 8004574708 8004574708 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~This plan's deductible only applies to out-of-network services.~ R7315 801 0 2021 Humana Medicare Employer (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 R7315 802 0 2021 Humana Medicare Employer (Regional PPO) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 R7444 001 0 2021 AARP Medicare Advantage Choice (Regional PPO) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8005555757 8005555757 711 711 8006434845 8006434845 711 711 This plan does not charge an annual deductible for all drugs. The $295.00 annual deductible only applies to drugs on certain tiers.~ H0105 001 0 2021 The Methodist Oaks d.b.a. The Oaks PACE (PACE) http://www.theoakspace.com 153 Founders Court Orangeburg SC 29118 8552685300 8032685300 8552685300 8035351561 8552685300 8032685300 8552685300 8032685306 H0105 002 0 2021 The Methodist Oaks d.b.a. The Oaks PACE (PACE) http://www.theoakspace.com 153 Founders Ct Orangeburg SC 29118 8552685300 8032685300 8552685300 8035351561 8552685300 8032685300 8552685300 8032685306 H0112 001 0 2021 Palm Beach PACE (PACE) www.MorseLife.org 4847 David S. Mack Dr. West Palm Beach FL 33417 8555727223 5616875745 8009558771 8009558771 8555727223 5616875745 8009558771 8009558771 H0112 002 0 2021 Palm Beach PACE (PACE) www.MorseLife.org 4847 David S. Mack Dr. West Palm Beach FL 33417 8555727223 5616875745 8009558771 8009558771 8555727223 5616875745 8009558771 8009558771 H0216 001 0 2021 PACE Iowa (PACE) Immanuel.com 1702 North 16th Street Council Bluffs IA 51501 7122567284 7122567284 7122567284 7122567284 H0216 002 0 2021 PACE Iowa (PACE) Immanuel.com 7700 Hickman Road Windsor Heights IA 50324 5152705000 5152705000 5152705000 5152705000 H0235 001 0 2021 PACE of NE IN - Dual Eligible (PACE) www.agingihs.org 8101 N Jefferson Blvd Fort Wayne IN 46804 2607451200 2607451200 2607451200 2607451200 H0235 002 0 2021 PACE of NE IN - Medicare Only (PACE) www.agingihs.org 8101 N Jefferson Blvd Fort Wayne IN 46804 2607451200 2607451200 2607451200 2607451200 H0247 001 0 2021 AllCare PACE - Dual Eligible (PACE) www.allcarehealth.com 2166 NW Vine Street Grants Pass OR 97526 8449507223 5414748000 711 8449507223 5414748000 711 H0247 002 0 2021 AllCare PACE - Medicare Only (PACE) www.allcarehealth.com 2166 NW Vine Street Grants Pass OR 97526 8449507223 5414748000 711 8449507223 5414748000 711 H0390 001 0 2021 PACE of Southwest Michigan - Dual (PACE) http://www.paceswmi.org/ 2900 Lakeview Ave St. Joseph MI 49085 8552438876 2694084322 8552438876 2694084322 8552438876 2694084322 8552438876 2694084322 H0390 002 0 2021 PACE of Southwest Michigan - Medicare Only (PACE) http://www.paceswmi.org/ 2900 Lakeview Ave St. Joseph MI 49085 8552438876 2694084322 8552438876 2694084322 8552438876 2694084322 8552438876 2694084322 H0477 001 0 2021 Serenity PACE Dual (PACE) http://www.serenitypace.org 604 Cottage st Springfield MA 01104 4132416265 4132416265 4132416265 4132416265 4132416265 4132416265 4132416265 4132416265 H0477 002 0 2021 Serenity PACE Medicare only (PACE) http://www.serenitypace.org 604 Cottage st Springfield MA 01104 4133043977 4133043977 4133043977 4133043977 4132416265 4132416265 4132416265 4132416265 H0542 001 0 2021 AltaMed Health Services Corporation (PACE) www.altamed.org 2040 Camfield Ave Los Angeles CA 90040 8774622582 3237280411 8007352922 8007352922 8774622582 3237280411 8007352922 8007352922 H0542 002 0 2021 AltaMed Health Services Corporation (PACE) www.altamed.org 2040 Camfield Ave Los Angeles CA 90040 8774622582 3237280411 8007352922 8007352922 8774622582 3237280411 8007352922 8007352922 H0613 001 0 2021 Total Longterm Care - Dual eligibles (PACE) www.MyInnovAge.com 8950 E. Lowry Blvd. Denver CO 80230 8447049613 8447049613 8447049613 8447049613 8447049613 8447049613 8447049613 8447049613 H0613 003 0 2021 Total Longterm Care - Medicare only (PACE) www.MyInnovAge.com 8950 E. Lowry Blvd. Denver CO 80230 8772776163 3038694664 8772776163 3038694664 8447049613 711 8447049613 8447049613 711 8447049613 711 H0809 001 0 2021 Mercy LIFE, Inc. (PACE) www.mymercylife.com 200 Hillside Circle, Suite 1 West Springfield MA 01089 4137487223 4137487223 8004392370 8004392370 4137487223 4137487223 8004392370 8004392370 H0809 002 0 2021 Mercy LIFE, Inc. (PACE) www.mymercylife.com 200 Hillside Circle, Suite 1 West Springfield MA 01089 4137487223 4137487223 8004392370 8004392370 4137487223 4137487223 8004392370 8004392370 H0819 001 0 2021 Senior LIFE York & Harrisburg Dual Eligibile (PACE) www.seniorlifepa.com 401 Broad Street Johnstown PA 15906 8779985433 8145356000 8779985433 8145356000 8779985433 8145356000 8779985433 8145356000 H0819 002 0 2021 Senior LIFE York & Harrisburg Medicare Only (PACE) http://www.seniorlifeyork.com 401 Broad Street Johnstown PA 15906 8779985433 8145356000 8779985433 8145356000 8779985433 8145356000 8779985433 8145356000 H0839 001 0 2021 Senior CommUnity Care of North Carolina (PACE) www.seniorcommunitycarenc.org 4022 Stirrup Creek Drive, Suite 315 Durham NC 27703 9194253000 9194253000 9194253000 9194253000 9194253000 9194253000 9194253000 9194253000 H0839 002 0 2021 Senior CommUnity Care of North Carolina (PACE) www.seniorcommunitycarenc.org 4022 Stirrup Creek Drive, Suite 315 Durham NC 27703 9194253000 9194253000 9194253000 9194253000 9194253000 9194253000 9194253000 9194253000 H0934 001 0 2021 Pacific PACE (PACE) https://pacificpace.welbehealth.com 50 Alessandro Place, Suite A20 Pasadena CA 91105 8008510966 8007352922 8008510966 8007352922 H0934 002 0 2021 Pacific PACE (PACE) https://pacificpace.welbehealth.com 50 Alessandro Place, Suite A20 Pasadena CA 91105 8008510966 8007352922 8008510966 8007352922 H1043 001 0 2021 Florida PACE Centers, Inc. (PACE) miamijewishhealthsystems.org 5200 NE 2nd Avenue Miami FL 33137 8557377223 3057518626 66725 8557377223 3057518626 66725 8557377223 3057518626 66725 8009558771 8009558771 H1043 002 0 2021 Florida PACE Centers, Inc (PACE) miamijewishhealthsystems.org 5200 NE 2nd Avenue Miami FL 33137 8557377223 3057518626 8465 8557377223 3057518626 8465 8557377223 3057518626 66725 8009558771 8009558771 H1228 001 0 2021 Central Valley PACE - Dual Eligible (PACE) www.cvpace.org 2401 East Orangeburg Ave, Suite 330 Modesto Ca CA 95355 8554617223 2097246000 8444617223 2097267380 8554617223 2097246000 8444617223 2097267380 H1228 002 0 2021 Central Valley PACE - Medicare Only (PACE) www.cvpace.org 2401 East Orangeburg Ave, Suite 330 Modesto Ca CA 95355 8554617223 2097246000 8444617223 2097267380 8554617223 2097246000 8444617223 2097267380 H1234 001 0 2021 SFMC-Dual (PACE) www.stfrancismedical.org/LIFE 7500 K. Johnson Blvd Bordentown NJ 08505 6095995433 6095995433 6095995433 6095995433 6095995433 6095995433 6095995433 6095995433 H1234 002 0 2021 SFMC-Medicare only (PACE) www.stfrancismedical.org/LIFE 7500 K. Johnson Blvd Bordentown NJ 08505 6095995433 6095995433 6095995433 6095995433 6095995433 6095995433 6095995433 6095995433 H1239 001 0 2021 InnovAge Virginia PACE- Roanoke Valley (PACE) www.MyInnovAge.com 8950 E. Lowry Blvd. Denver CO 80230 8447049613 8447049613 8447049613 8447049613 8447049613 711 8447049613 8447049613 711 8447049613 711 H1239 002 0 2021 InnovAge Virginia PACE- Roanoke Valley (PACE) www.MyInnovAge.com 8950 E. Lowry Blvd. Denver CO 80230 8447049613 8447049613 8447049613 8447049613 8447049613 711 8447049613 8447049613 711 8447049613 711 H1310 001 0 2021 Senior Care Partners PACE Dual (PACE) www.SeniorCarePartnersMI.org 200 West Michigan Avenue, Suite 103 Battle Creek MI 49017 8772844071 2694419300 8006493777 2692809584 8772844071 2694419300 8006493777 2692809584 H1310 003 0 2021 Senior Care Partners PACE Medicare-only (PACE) www.SeniorCarePartnersMI.org 200 West Michigan Avenue, Suite 103 Battle Creek MI 49017 8772844071 2694419300 8006493777 2692809584 8772844071 2694419300 8006493777 2692809584 H1357 001 0 2021 Carolina SeniorCare (PACE) http://www.carolinaseniorcare.org/ 802 East Center Street Lexington NC 27292 8332234476 3367463500 8007352962 8007352962 8332234476 3367463500 8007352962 8007352962 H1357 002 0 2021 Carolina SeniorCare (PACE) http://www.carolinaseniorcare.org/ 802 East Center Street Lexington NC 27292 8332234476 3367463500 8007352962 8007352962 8332234476 3367463500 8007352962 8007352962 H1500 001 0 2021 LIFE St. Joseph of the Pines (PACE) www.sjp.org 4900 Raeford Rd Fayetteville NC 28304 9104834911 9104834911 8774522514 8774522514 9104834911 8774522514 8774522514 H1500 002 0 2021 LIFE St. Joseph of the Pines (PACE) www.sjp.org 4900 Raeford Rd Fayetteville NC 28304 9104834911 9104834911 8774522514 8774522514 9104834911 9104834911 8774522514 8774522514 H1518 001 0 2021 CHS Buffalo - Dual (PACE) https://www.chsbuffalo.org/services/pace 55 Melroy Avenue, Ground Floor Lackawanna NY 14218 8556713341 7168195433 7168195227 8556713341 7168195433 7168195227 H1518 002 0 2021 CHS Buffalo - Medicare only (PACE) https://www.chsbuffalo.org/services/pace 55 Melroy Avenue, Ground Floor Lackawanna NY 14218 8556713341 7168195433 7168195227 8556713341 7168195433 7168195227 H1533 001 0 2021 StayWell Senior Care - Dual Eligible (PACE) https://www.randolphhealth.org/services/staywell 809 Curry Dr. Asheboro, NC 27205 3366284200 3366284200 3366284200 3366284200 3366284200 3366284200 3366284200 3366284200 H1533 002 0 2021 StayWell Senior Care - Medicare Only (PACE) https://www.randolphhealth.org/services/staywell 809 Curry Dr. Asheboro, NC 27205 3366284200 3366284200 3366284200 3366284200 3366284200 3366284200 3366284200 3366284200 H1544 001 0 2021 LA Coast PACE (PACE) www.lacoastpace.welbehealth.com 1220 E 4th Street Long Beach CA 90802 8007348041 8007352922 8007348041 8007352922 H1544 002 0 2021 LA Coast PACE (PACE) www.lacoastpace.welbehealth.com 1220 E 4th Street Long Beach CA 90802 8007348041 8007352922 8007348041 8007352922 H1622 001 0 2021 NEMS PACE (PACE) https://www.nems.org/pace/ 728 Pacific Avenue, Suite 200 San Francisco CA 94133 4153525050 4152131973 4153525050 4152131973 H1622 003 0 2021 NEMS PACE – Medicare Only (PACE) https://www.nems.org/pace/ 728 Pacific Avenue, Suite 200 San Francisco CA 94133 4153525050 4152131973 4153525050 4152131973 H1693 002 0 2021 FamilyHealth - Center for Older Adults (PACE) www.fhcsd.org/pace 3420 College Ave San Diego CA 92115 6195152445 8335309622 6195152445 8335309622 H1693 003 0 2021 FamilyHealth-Center for Older Adults-Medicare-only (PACE) www.fhcsd.org/pace 3420 College Avenue San Diego CA 92115 6195152445 8335309622 6195152445 8335309622 H1714 001 0 2021 Ascension Living HOPE (PACE) ascension.org/HOPEKansas 2622 W. Central Ave, Suite 101 Wichita KS 67203 3168581111 8007663777 8007663777 3168581111 8007663777 8007663777 H1714 002 0 2021 Ascension Living HOPE (PACE) ascension.org/HOPEKansas 2622 W. Central Ave, Suite 101 Wichita KS 67203 3168581111 8007663777 8007663777 3168581111 8007663777 8007663777 H1904 001 0 2021 PACE Greater New Orleans (PACE) http://pacegno.org/ 4201 N RAMPART STREET NEW ORLEANS LA 70117 8663958509 5048350006 8008465277 8008465277 8663958509 5048350006 8008465277 8008465277 H1904 002 0 2021 PACE Greater New Orleans (PACE) http://pacegno.org/ 4201 N RAMPART ST NEW ORLEANS LA 70117 8663958509 5048350006 8008465277 8008465277 8663958509 5048350006 8008465277 8008465277 H2064 001 0 2021 LIFE Geisinger (PACE) www.lifegeisinger.org 100 North Academy Avenue, MC 24-12 Danville PA 17822 5702149790 5702149790 5702149790 5702149790 5702149790 5702149790 5702149790 5702149790 H2064 002 0 2021 LIFE Geisinger (PACE) www.lifegeisinger.org 100 North Academy Avenue, MC 24-12 Danville PA 17822 5702149790 5702149790 5702149790 5702149790 5702149790 5702149790 5702149790 5702149790 H2109 001 0 2021 The Johns Hopkins Health System Corporation. (PACE) www.hopkinsbayview.org/hopkinselderplus 4940 Eastern Avenue, Mason F. Lord Building East Tower, 1st Floor Baltimore MD 21224 4105507044 4105500316 4105507044 4105500316 H2109 002 0 2021 The Johns Hopkins Health System Corporation (PACE) www.hopkinsbayview.org/hopkinselderplus 4940 Eastern Avenue, Mason F. Lord Building East Tower, 1st Floor Baltimore MD 21224 4105507044 4105500316 4105507044 4105500316 H2218 001 0 2021 Harbor Health Elder Service Plan, Dual Eligible (PACE) www.elderserviceplan.org 1135 Morton Street Mattapan MA 02126 6175332400 6175332404 6175332426 6175332404 H2218 002 0 2021 Harbor Health Elder Service Plan, Medicare only (PACE) www.elderserviceplan.org 1135 Morton Street Mattapan MA 02126 6175332400 6175332404 6175332426 6175332404 H2219 001 0 2021 Summit ElderCare (PACE) www.fallonhealth.org/summit 10 Chestnut Street Worcester MA 01608 8006987566 5083689690 711 711 8006987566 5083689690 711 711 H2219 002 0 2021 Summit ElderCare (PACE) www.fallonhealth.org/summit 10 Chestnut Street Worcester MA 01608 8006987566 5083689690 711 711 8006987566 5083689690 711 711 H2220 001 0 2021 Upham's Corner Health Committee (PACE) www.uphamselderserviceplan.org 1140 Dorchester Ave Dorchester MA 02125 6172880970 6172880970 6172878000 6172878000 6172880970 6172880970 6172878000 6172878000 H2220 002 0 2021 Uphams Corner Health Committee (PACE) www.uphamselderserviceplan.org 1140 Dorchester Ave Dorchester MA 02125 6172880970 6172880970 6172878000 6172878000 6172880970 6172880970 6172878000 6172878000 H2221 001 0 2021 CHA PACE fka ESP of CHA (PACE) http://www.challiance.org/esp/elder-service-plan 163 Gore St. Cambridge MA 02139 6175755850 6175755850 6175755850 6175755850 6175755850 8004392370 711 H2221 002 0 2021 CHA PACE fka ESP of CHA (PACE) https://www.challiance.org/esp/elder-service-plan 270 Green Street Cambridge MA 02139 6175755850 6175755850 6175755850 6175755850 6175755850 711 H2222 002 0 2021 Element Care (PACE) www.elementcare.org 37 Friend Street Lynn MA 01902 8778035564 7817156608 711 711 8778035564 7817156608 711 711 H2222 003 0 2021 Element Care (PACE) www.elementcare.org 37 Friend Street Lynn MA 01902 8778035564 7817156608 711 711 8778035564 7817156608 711 711 H2223 001 0 2021 East Boston Elder Service Plan (PACE) www.ebnhc.org/elderservice.php 10 Gove Street East Boston MA 02128 6175686377 6175686377 8007203480 8007203480 6175686377 6175686377 8007203480 8007203480 H2223 002 0 2021 East Boston Elder Service Plan (PACE) www.ebnhc.org/elderservice.php 10 Gove Street East Boston MA 02128 6175686377 6175686377 8007203480 8007203480 6175686377 6175686377 8007203480 8007203480 H2318 001 0 2021 PACE Southeast Michigan (PACE) www.pacesemi.org 24463 W 10 Mile Road Southfield MI 48033 8554454554 8554454554 711 711 8554454554 8554454554 711 711 H2318 002 0 2021 PACE Southeast Michigan (PACE) www.pacesemi.org 24463 W 10 Mile Road Southfield MI 48033 8554454554 8554454554 711 711 8554454554 8554454554 711 711 H2368 001 0 2021 InnovAge California PACE Sacramento Dual Eligibles (PACE) www.myinnovage.com 3870 Rosin Ct. Sacramento CA 95834 8447049613 711 8447049613 711 H2368 002 0 2021 InnovAge California PACE Sacramento Medicare Only (PACE) www.myinnovage.com 3870 Rosin Ct. Sacramento CA 95834 8447049613 711 8447049613 711 H2384 001 0 2021 Sequoia PACE (PACE) https://welbehealth.com/sequoia/ 1649 Van Ness Ave Fresno CA 93721 8006373187 8007352922 8006373187 8007352922 H2384 002 0 2021 Sequoia PACE (PACE) https://welbehealth.com/sequoia/ 1649 Van Ness Ave Fresno CA 93721 8006373187 8007352922 8006373187 8007352922 H2386 001 0 2021 AllCARE for Seniors - Duals (PACE) www.allcareforseniors.org P.O. Box 765 Cedar Bluff VA 24609 8668287723 2769647176 8006562272 2769645765 8668287723 2769647176 8006562272 2769645765 H2386 002 0 2021 AllCARE for Seniors - Medicare only (PACE) www.allcareforseniors.org P.O. Box 765 Cedar Bluff VA 24609 8668287723 2769647176 8006562272 2769645765 8668287723 2769647176 8006562272 2769645765 H2537 001 0 2021 SpiriTrust Lutheran LIFE - Dual (PACE) www.spiritrustlutheranlife.org 840 Fifth Avenue Chambersburg PA 17201 8008409081 7172645433 8008409081 7172645433 8008409081 7172645433 8008409081 7172645433 H2537 002 0 2021 SpiriTrust Lutheran LIFE - Medicare Only (PACE) www.spiritrustlutheranlife.org 840 Fifth Avenue Chambersburg PA 17201 8008409081 7172645433 8008409081 7172645433 8008409081 7172645433 8008409081 7172645433 H2815 001 0 2021 Senior CommUnity Care of Colorado (PACE) www.seniorcommunitycare.org 11485 Highway 65 Eckert CO 81418 8669611451 9708352900 9702520522 8669611451 9708352900 9702520522 H2815 002 0 2021 Senior CommUnity Care of Colorado (PACE) www.seniorcommunitycare.org 2377 Robins Way Montrose CO 81401 8669611451 9702520522 9702520522 8669611451 9702520522 9702520522 H2835 001 0 2021 Thome PACE (PACE) www.thomepace.org Susan Decker, Thome PACE, 2282 Springport Rd Jackson MI 49202 8448557223 5177689791 8006493777 8006493777 8448557223 5177689791 8006493777 8006493777 H2835 002 0 2021 Thome PACE Medicare Only (PACE) www.thomepace.org Susan Decker, Thome PACE, 2282 Springport RD Jackson MI 49202 8448557223 5177689791 8006493777 8006493777 8448557223 5177689791 8006493777 8006493777 H2882 003 0 2021 PACE Central Michigan (PACE) www.pacecmi.org 1750 E Bellows Mount Pleasant MI 48858 9899535800 771 9899535800 771 H2882 004 0 2021 PACE Central Michigan (PACE) www.pacecmi.org 1750 E Bellows Mount Pleasant MI 48858 9899535800 771 9899535800 771 H2936 001 0 2021 LifeCircles (PACE) http:www.lifecircles-pace.org 560 Seminole Rd Muskegon MI 49444 8882048626 2317338686 8882048626 2317338686 8882048626 2317338686 8882048626 2317338686 H2936 002 0 2021 002 - Medicare Only (PACE) http:www.lifecircles-pace.org 560 Seminole Rd Muskegon MI 49444 8882048626 2317338686 8882048626 2317338686 8882048626 2317338686 8882048626 2317338686 H2937 001 0 2021 Senior LIFE Greensburg Dual Eligible (PACE) www.seniorlifepa.com 401 Broad Street Johnstown PA 15906 8779985433 8145356000 8779985433 8145356000 8779985433 8145356000 8779985433 8145356000 H2937 002 0 2021 Senior LIFE Greensburg Medicare Only (PACE) www.Seniorlifegreensburg.com 401 Broad Street Johnstown PA 15906 8779985433 8145356000 8779985433 8145356000 8779985433 8145356000 8779985433 8145356000 H2941 001 0 2021 Sentara Senior Community Care Dual (PACE) www.sentara.com/pace 863 Glenrock Rd, Suite 200 Norfolk VA 23502 8007368272 7572523650 8443590862 7573904049 8007368272 7572523650 8443590862 7573904049 H2941 002 0 2021 Sentara Senior Community Care Private (PACE) www.sentara.com/pace 863 Glenrock Rd, Suite 200 Norfolk VA 23502 8007368272 7572523650 8002257784 7575527120 8007368272 7572523650 8002257784 7575527120 H2992 001 0 2021 Senior LIFE Washington Dual Eligible (PACE) www.seniorlifepa.com 401 Broad Street Johnstown PA 15906 8779985433 8145356000 8779985433 8145356000 8779985433 8145356000 8779985433 8145356000 H2992 002 0 2021 Senior LIFE Washington Medicare Only (PACE) www.seniorlifewashington.com 401 Broad Street Johnstown PA 15906 8779985433 8145356000 8779985433 8145356000 8779985433 8145356000 8779985433 8145356000 H2992 003 0 2021 Senior LIFE Uniontown Dual Eligible (PACE) www.seniorlifeuniontown.com 401 Broad Street Johnstown PA 15906 8779985433 8145356000 8779985433 8145356000 8779985433 8145356000 8779985433 8145356000 H2992 004 0 2021 Senior LIFE Uniontown Medicare Only (PACE) www.seniorlifeuniontown.com 401 Broad Street Johnstown PA 15906 8779985433 8145356000 8779985433 8145356000 8779985433 8145356000 8779985433 8145356000 H3060 001 0 2021 VieCare Butler, LLC dba LIFE Butler County (PACE) www.lutheranseniorlife.org 231 West Diamond Street Butler PA 16001 7242875433 711 7242875433 711 H3060 002 0 2021 VieCare Butler, LLC dba LIFE Butler County (PACE) www.lutheranseniorlife.org 231 West Diamond Street Butler PA 16001 7242875433 711 7242875433 711 H3084 001 0 2021 ICHS PACE - Dual Eligible (PACE) www.ichsPACE.org PO Box 3007 Seattle WA 98114 2064627100 2067883774 2064627100 2067883774 H3084 002 0 2021 ICHS PACE - Medicare Only (PACE) www.ichsPACE.org PO Box 3007 Seattle WA 98114 2064627100 2067883774 2064627100 2067883774 H3321 001 0 2021 PACE CNY (PACE) www.pacecny.org 100 Malta Lane North Syracuse NY 13212 8887287223 3154525800 8006621220 3154525800 8887287223 3154525800 8006621220 3154525800 H3321 003 0 2021 PACE CNY (PACE) www.pacecny.org 100 Malta Lane North Syracuse NY 13212 8887287223 3154525800 8006621220 3154525800 8887287223 3154525800 8006621220 3154525800 H3322 001 0 2021 Senior Care Connection dba Eddy SeniorCare (PACE) eddyseniorcare.com 1930 Curry Road Schenectady NY 12303 8553767888 5183823290 8553767888 5183823290 8553767888 5183823290 8553767888 711 5183823290 711 H3322 002 0 2021 Senior Care Connection dba: Eddy SeniorCare (PACE) eddyseniorcare.com 1930 Curry Road Schenectady NY 12303 8553767888 5183823290 8553767888 5183823290 8553767888 5182137526 8553767888 711 5182137526 711 H3329 001 0 2021 CenterLight Healthcare PACE Dual Eligible (PACE) http://www.centerlighthealthcare.org/ 1733 Eastchester Road, 2nd Floor Bronx NY 10461 8772268500 3476406039 711 711 8772268500 3476406039 711 711 H3329 002 0 2021 CenterLight Healthcare - PACE - Medicare only (PACE) http://www.centerlighthealthcare.org/ 1733 Eastchester Road, 2nd Floor Bronx NY 10461 8772268500 3476406039 711 711 8772268500 3476406039 711 711 H3331 001 0 2021 ElderONE an Affiliate of Rochester Regional Health (PACE) www.ElderONE.org 2066 Hudson Avenue. Rochester NY 14617 8554574636 5859222831 8006621220 5859222831 8554574636 5859222831 8006621220 5859222831 H3331 002 0 2021 ElderONE an Affiliate of Rochester Regional Health (PACE) www.ElderONE.org 2066 Hudson Avenue. Rochester NY 14617 8554574636 5859222831 8006621220 5859222831 8554574636 5859222831 8006621220 5859222831 H3430 001 0 2021 Suncoast PACE, Inc. (PACE) www.suncoastpace.org 5771 Roosevelt Blvd Clearwater FL 33760 8664582933 7272890062 8664582933 7272890062 8664582933 7272890062 8664582933 7272890062 H3430 002 0 2021 Suncoast PACE, Inc. (PACE) www.suncoastpace.org 5771 Roosevelt Blvd Clearwater FL 33760 8664582933 7272890062 8664582933 7272890062 8664582933 7272890062 8664582933 7272890062 H3473 001 0 2021 Blue Ridge PACE Dual (PACE) www.MyInnovAge.com 8950 E. Lowry Blvd. Denver CO 80230 8447049613 8447049613 8447049613 8447049613 8447049613 711 8447049613 8447049613 711 8447049613 711 H3473 002 0 2021 Blue Ridge PACE Medicare Only (PACE) www.MyInnovAge.com 8950 E. Lowry Blvd. Denver CO 80230 8447049613 8447049613 8447049613 8447049613 8447049613 711 8447049613 8447049613 711 8447049613 711 H3493 001 0 2021 LIFE at Lourdes, Inc (PACE) http://www.trinityhealthLIFE-nj.org 2475 McClellan Ave., Bldg C Pennsauken NJ 08109 8566753355 8566753355 8566753355 8566753355 8566753355 8566753355 8566753355 8566753355 H3493 002 0 2021 LIFE at Lourdes, Inc (PACE) http://www.trinityhealthLIFE-nj.org 2475 McClellan Ave., Bldg C Pennsauken NJ 08109 8566753355 8566753355 8566753355 8566753355 8566753355 8566753355 8566753355 8566753355 H3517 001 0 2021 Redwood Coast PACE-Dual (PACE) www.humsenior.org 1910 California Street Eureka CA 95501 7074439747 7074439747 711 711 7074439747 7074439747 711 711 H3517 002 0 2021 Redwood Coast PACE-Medicare Only (PACE) www.humsenior.org 1910 California Street Eureka CA 95501 7074439747 7074439747 711 711 7074439747 7074439747 711 711 H3522 001 0 2021 Reid Health PACE Center (PACE) www.reidhealth.org 2300 National Road West Richmond IN 47374 7659358959 8006432255 8006432255 7659358959 8006432255 8006432255 H3522 002 0 2021 Reid Health PACE Center (PACE) www.reidhealth.org 2300 National Road West Richmond IN 47374 7659358959 8006432255 8006432255 7659358959 8006432255 8006432255 H3563 001 0 2021 Gary and Mary West Senior Services, Inc (PACE) westpace.org 1706 Descanso Avenue San Marcos CA 92078 7602802230 8009207098 7602802230 8009207098 H3563 002 0 2021 Gary and Mary West Senior Services, Inc (PACE) westpace.org 1706 Descanso Avenue San Marcos CA 92078 7602802230 8009207098 7602802230 8009207098 H3613 001 0 2021 McGregor PACE Dual Eligibles (PACE) http://www.mcgregorpace.org/ 26310 Emery Road Warrensville Heights OH 44128 2167913580 2167913580 8003252223 8003252223 2167913580 2167913580 8003252223 8003252223 H3613 002 0 2021 McGregor PACE Medicare Only Eligibles (PACE) http://www.mcgregorpace.org/ 26310 Emery Road Warrensville Heights OH 44128 2162021650 2162021650 8003252223 8003252223 2167913580 2167913580 8003252223 8003252223 H3809 001 0 2021 Providence ElderPlace Portland (dual eligible) (PACE) www.providence.org/elderplace 4400 NE Halsey, Building 1, Suite 200 Portland OR 97213 8554156048 5032156556 8008484442 5032156556 8554156048 5032156556 8008484442 5032156556 H3809 002 0 2021 Providence ElderPlace Portland (private pay) (PACE) www.providence.org/elderplace 4400 NE Halsey, Building 1, Suite 200 Portland OR 97213 8554156048 5032156556 8008484442 5032156556 8554156048 5032156556 8008484442 5032156556 H3908 001 0 2021 Trinity Health LIFE Pennsylvania (PACE) http://www.mercylife-westphila.org 4508 CHESTNUT STREET Philadelphia PA 19139 2677878282 8006545984 2677878282 8006545984 H3908 002 0 2021 Trinity Health LIFE Pennsylvania (PACE) www.trinityhealthpace.org 4508 Chestnut Street Philadelphia PA 19139 2677878282 8006545984 2677878282 8006545984 H3917 001 0 2021 Community LIFE (PACE) http://www.commlife.org/ SUITE # 700, 2400 ARDMORE BOULEVARD PITTSBURGH PA 15221 8664191693 4124642101 711 711 8664191693 4124642101 711 711 H3917 002 0 2021 Community LIFE (PACE) http://www.commlife.org/ SUITE # 700, 2400 ARDMORE BOULEVARD PITTSBURGH PA 15221 8664191693 4124642101 711 711 8664191693 4124642101 711 711 H3918 001 0 2021 LIFE Pittsburgh Dual Eligibles Pharmacy (PACE) LIFEPittsburgh.org 875 Greentree Road, One Parkway Center, Suite 200 Pittsburgh PA 15220 4123888042 4123888042 4123888042 4123888042 4123888042 4123888042 4123888042 4123888042 H3918 002 0 2021 LIFE Pittsburgh Medicare Only Pharmacy (PACE) LIFEPittsburgh.org 875 Greentree Road, One Parkway Center, Suite 200 Pittsburgh PA 15220 4123888042 4123888042 4123888042 4123888042 4123888042 4123888042 4123888042 4123888042 H3919 001 0 2021 Mercy LIFE (PACE) www.mercylife.org 1930 S. Broad Street, Suite 3 Philadelphia PA 19145 2153394747 8006545984 2153394747 8006545984 H3919 002 0 2021 Mercy LIFE (PACE) www.mercylife.org 1930 S. Broad Street, Suite 3 Philadelphia PA 19145 2153394747 8006545984 2153394747 8006545984 H3925 001 0 2021 Senior LIFE Johnstown Dual Eligible (PACE) www.seniorlifepa.com 401 Broad Street Johnstown PA 15906 8779985433 8145356000 8779985433 8145356000 8779985433 8145356000 8779985433 8145356000 H3925 002 0 2021 Senior LIFE Johnstown Medicare Only (PACE) www.seniorlifejohnstown.com 401 Broad Street Johnstown PA 15906 8779985433 8145356000 8779985433 8145356000 8779985433 8145356000 8779985433 8145356000 H3942 001 0 2021 Elderhaus PACE (PACE) www.elderhaus.com 2222 S. 17th Street Wilmington NC 28401 8883438209 9103438209 8883438209 9103438209 8883438209 9103438209 8883438209 9103438209 H3942 002 0 2021 Elderhaus PACE (PACE) www.elderhaus.com 2222 S. 17th Street Wilmington NC 28401 8883438209 9103438209 8883438209 9103438209 8883438209 9103438209 8883438209 9103438209 H3991 001 0 2021 Cherry Blossom PACE - Dual Eligible (PACE) WWW.cherryblossompace.com 1901 N Beauregard St. Ste 110 Alexandria VA 22311 5717890770 8885242060 5717890770 8885242060 H3991 002 0 2021 Cherry Blossom PACE - Medicare Only (PACE) WWW.cherryblossompace.com 1901 N Beauregard St. Ste 110 Alexandria VA 22311 5717890770 8885242060 5717890770 8885242060 H4053 001 0 2021 Prisma Health PACE-Upstate - Dual Eligible (PACE) https://www.ghs.org/healthcareservices/seniorcare/ 32 Centennial Way Greenville SC 29605 8645221950 711 8645221950 711 H4053 002 0 2021 Prisma Health PACE-Upstate - Medicare Only (PACE) https://www.ghs.org/healthcareservices/seniorcare/ 32 Centennial Way Greenville SC 29605 8645221950 711 8645221950 711 H4074 001 0 2021 Mercy LIFE of Alabama (PACE) mercylifeal.com 2900 Springhill Avenue Mobile AL 36607 8553676562 2512878420 8552121552 8552121552 8553676562 2512878420 8552121552 8552121552 H4074 002 0 2021 Mercy LIFE of Alabama (PACE) mercylifeal.com 2900 Springhill Avenue Mobile AL 36607 8553676562 2512878420 8552121552 8552121552 8553676562 2512878420 8552121552 8552121552 H4105 001 0 2021 PACE Organization of Rhode Island (PACE) www.pace-ri.org 225 Chapman Street Providence RI 02905 8777817223 4014906566 8007455555 8007455555 8777817223 4014906566 8007455555 8007455555 H4105 002 0 2021 PACE Organization of Rhode Island (PACE) www.pace-ri.org 225 Chapman Street Providence RI 02905 8777817223 4014906566 8007455555 8007455555 8777817223 4014906566 8007455555 8007455555 H4118 001 0 2021 Huron Valley PACE - Dual Eligible (PACE) www.huronvalleypace.org 2940 Ellsworth Road Ypsilanti MI 48197 8554837223 7345725777 8006493777 8006493777 8554837223 7345725777 8006493777 8006493777 H4118 002 0 2021 Huron Valley PACE - Medicare Only (PACE) www.huronvalleypace.org 2940 Ellsworth Road Ypsilanti MI 48197 8554837223 7345725777 8006493777 8006493777 8554837223 7345725777 8006493777 8006493777 H4142 001 0 2021 Cherokee Elder Care (PACE) http://eldercare.cherokee.org 1387 W 4th St. Tahlequah OK 74464 8002560671 5554 9184535554 8002560671 5554 9184535554 8002560671 5554 9184535554 8002560671 5554 9184535554 H4142 002 0 2021 Cherokee Elder Care (PACE) http://eldercare.cherokee.org 1387 W 4th St. Tahlequah OK 74464 8002560671 5554 9184535554 8002560671 5554 9184535554 8002560671 5554 9184535554 8002560671 5554 9184535554 H4185 001 0 2021 Neighborhood Healthcare PACE Dual Eligible (PACE) www.nhcarepace.org 4371 Latham Street Riverside CA 92501 8446427223 711 8446427223 711 H4185 002 0 2021 Neighborhood Healthcare PACE Medicare Only (PACE) www.nhcarepace.org 4371 Latham Street Riverside CA 92501 8338674642 8338674642 8338674642 8338674642 H4203 001 0 2021 Prisma Health PACE-Midlands - Dual Eligible (PACE) Palmettohealth.org 1308 Laurel Street Columbia SC 29201 8039318175 8039318175 8034347000 8034347000 8039318175 8039318175 8034347000 8034347000 H4203 002 0 2021 Prisma Health PACE-Midlands - Medicare Only (PACE) Palmettohealth.org 1308 Laurel Street Columbia SC 29201 8039318175 8039318175 245 8034347000 8034347000 8039318175 8039318175 8034347000 8034347000 H4235 001 0 2021 Senior Total Life Care Dual (PACE) www.seniorTLC.org 1875 Remount Rd Gastonia NC 28054 8553277852 7048740600 7048743307 7048743307 8553277852 7048740600 7048743307 7048743307 H4235 002 0 2021 Senior Total Life Care Medicare (PACE) www.seniorTLC.org 1875 Remount Rd Gastonia NC 28054 8553277852 7048740600 7048743307 7048743307 8553277852 7048740600 7048743307 7048743307 H4256 001 0 2021 PACE North, Inc (PACE) www.pacenorth.org 2325 N Garfield RD Traverse City MI 49686 2312522767 8334102082 2312522767 8334102082 8334102082 H4256 002 0 2021 PACE North, Inc (PACE) www.pacenorth.org 2325 N Garfield RD Traverse City MI 49686 2312522767 8334102082 2312522767 8334102082 H4305 001 0 2021 Total Life Healthcare Dual (PACE) www.stbernards.info/ 225 East Jackson #92, 712 E. Washington Avenue Jonesboro AR 72401 8552077500 8702077500 8702070527 8552077500 8702077500 8702070527 H4305 002 0 2021 Total Life Healthcare Medicare only (PACE) www.stbernards.info/ 225 East Jackson #92, 712 E Washington Jonesboro AR 72401 8552077500 8702077500 8702070527 8552077500 8702077500 8702070527 H4326 001 0 2021 PACE at Home - dual (PACE) www.pace-at-home.org 1915 Fairgrove Church Road SE Newton NC 28658 8284683980 8284683980 1800735296 1800735296 8284683980 8284683980 1800735296 1800735296 H4326 002 0 2021 PACE at Home - medicare only (PACE) www.pace-at-home.org 1915 Fairgrove Church Road SE Newton NC 28658 8284683980 8284683980 1800735296 1800735296 8284683980 8284683980 1800735296 1800735296 H4393 001 0 2021 ArchCare Senior Life - Dual (PACE) www.ArchCareSeniorLife.org 1432 Fifth Avenue New York NY 10026 8662639083 8662639083 8006621220 8006621220 8662639083 8662639083 8006621220 8006621220 H4393 002 0 2021 ArchCare Senior Life - Medicare only (PACE) www.ArchCareSeniorLife.org 1432 Fifth Avenue New York NY 10026 8662639083 8662639083 8006621220 8006621220 8662639083 8662639083 8006621220 8006621220 H4402 001 0 2021 Alexian Brothers Community Services (PACE) www.alexianpacetn.net 425 Cumberland Street, Suite 110 Chattanooga TN 37404 8004418883 4236980802 8008480298 8008480298 8004418883 4236980802 8008480298 8008480298 H4402 002 0 2021 Alexian Brothers Community Services (PACE) www.alexianpacetn.net 425 Cumberland Street, Suite 110 Chattanooga TN 37404 8004418883 4236980802 8008480298 8008480298 8004418883 4236980802 8008480298 8008480298 H4517 001 0 2021 DUAL ELIGIBLE (PACE) www.janwerneradultdaycare.org 3108 S Fillmore Amarillo TX 79110 8882996401 8063745516 8007352989 8063745516 8882996401 8063748400 8007352989 8063748400 H4517 002 0 2021 MEDICARE ONLY (PACE) www.janwerneradultdaycare.org 3108 S Fillmore Amarillo TX 79110 8882996401 8063745516 8007352989 8063745516 8882996401 8063748400 8007352989 8063748400 H4518 001 0 2021 BSHS Part D, Dual Eligibles (PACE) www.Bienvivir.org 2300 McKinley El Paso TX 79930 9155623444 1801 9155623444 1801 9155623444 1801 9155623444 1801 9155623444 1801 9155623444 1801 9155623444 1801 9155623444 1801 H4518 002 0 2021 BSHS Part D, Medicare Only (PACE) www.Bienvivir.org 2300 McKinley El Paso TX 79930 9155623444 1801 9155623444 1801 9155623444 1801 9155623444 1801 9155623444 1801 9155623444 1801 9155623444 1801 9155623444 1801 H4714 001 0 2021 PACE of the Southern Piedmont - Dual (PACE) www.pacesp.com 6133 The Plaza Charlotte NC 28215 7048873840 7048873840 7048873840 8000 7048873840 8000 7048873840 7048873840 7048873840 8000 7048873840 8000 H4714 002 0 2021 PACE of the Southern Piedmont - Medicare only (PACE) www.pacesp.com 6133 The Plaza Charlotte NC 28215 7048873840 7048873840 7048873840 8000 7048873840 8000 7048873840 7048873840 7048873840 8000 7048873840 8000 H4999 001 0 2021 LIFE Northwestern Pennsylvania (PACE) www.lifenwpa.org LIFE-NWPA Attn: Part-D Administration, 149 West 22nd. St. Erie PA 16502 8444565433 8144565433 8144565433 8144565433 8444565433 8144565433 8144565433 8144565433 H4999 002 0 2021 LIFE Northwestern Pennsylvania (PACE) www.lifenwpa.org LIFE-NWPA Attn: Part-D Administration, 149 West 22nd. St. Erie PA 16502 8444565433 8144565433 8144565433 8144565433 8444565433 8144565433 8144565433 8144565433 H5007 001 0 2021 Providence ElderPlace - Seattle (PACE) washington.providence.org/senior-care/elderplace 4515 Martin Luther King Jr. Way S. Ste. 100 Seattle WA 98108 2063205325 2063205325 2063205325 2063205325 2063205325 2063205325 2063205325 2063205325 H5007 002 0 2021 Providence ElderPlace - Seattle (PACE) washington.providence.org/senior-care/elderplace 4515 Martin Luther King Jr. Way S. Ste. 100 Seattle WA 98108 2063205325 2063205325 2063205325 2063205325 2063205325 2063205325 2063205325 2063205325 H5037 001 0 2021 Mountain Empire PACE - Dual (PACE) www.meoc.org P. O. Box 888 Big Stone Gap VA 24219 8667937223 2765230599 8667937223 2765230599 8667937223 2765230599 8667937223 2765230599 H5037 002 0 2021 Mountain Empire PACE - Medicare only (PACE) www.meoc.org PO Box 888 Big Stone Gap VA 24219 8667937223 2765230599 8667937223 2765230599 8667937223 2765230599 8667937223 2765230599 H5085 003 0 2021 Community PACE at Home, Inc. - Dual Eligible (PACE) www.communitypace.com 231 West Pine Lake Drive Newaygo MI 49337 2316524618 2316896675 2316524618 2316896675 H5085 004 0 2021 Community PACE at Home, Inc - Medicare Only (PACE) www.communitypace.com 231 West Pine Lake Drive Newaygo MI 49337 2316524618 2316896675 2316524618 2316896675 H5124 001 0 2021 Franciscan Senior Health and Wellness (PACE) FranciscanStFrancis.org 8325 E. Southport Rd., Ste. 120 Indianapolis IN 46259 8448177223 3175287223 8007433333 3175286395 8448177223 3175287223 8007433333 3175286395 H5124 002 0 2021 Franciscan Senior Health and Wellness (PACE) FranciscanStFrancis.org 8325 E. Southport Rd., Ste. 120 Indianapolis IN 46259 8448177223 3175287223 8007433333 3175286395 8448177223 3175287223 8007433333 3175286395 H5167 001 0 2021 Rocky Mountain PACE (PACE) rmhcare.org 2502 E Pikes Peak Colorado Springs CO 80909 8552070702 300 7193142327 300 8552070702 300 7193142327 300 8552070702 300 7193142327 300 8552070702 300 7193142327 300 H5167 002 0 2021 Rocky Mountain PACE (PACE) rmhcare.org 2502 E Pikes Peak Colorado Springs CO 80909 8552070702 300 7193142327 300 8552070702 300 7193142327 300 8552070702 300 7193142327 300 8552070702 300 7193142327 300 H5212 001 0 2021 Community Care's PACE Program (PACE) www.communitycareinc.org 205 Bishops Way Brookfield WI 53005 8669926600 4142314000 711 711 8669926600 4142314000 711 711 H5212 002 0 2021 Community Care's PACE Program (PACE) www.communitycareinc.org 205 Bishops Way Brookfield WI 53005 8669926600 4142314000 711 711 8669926600 4142314000 711 711 H5213 001 0 2021 Total Community Care (PACE) www.MyInnovAge.com 8950 E. Lowry Blvd. Denver CO 80230 8447049613 8447049613 8447049613 8447049613 8447049613 711 8447049613 8447049613 711 8447049613 711 H5213 002 0 2021 Total Community Care (PACE) www.myinnovage.com 8950 E. Lowry Blvd. Denver CO 80230 8447049613 8447049613 8447049613 8447049613 8447049613 711 8447049613 8447049613 711 8447049613 711 H5403 001 0 2021 On Lok PACE (Dual Eligibles) (PACE) www.onlok.org/PACE 1333 Bush Street San Francisco CA 94109 8888866565 8888866565 711 8889966565 4152928895 711 H5403 002 0 2021 On Lok PACE (Medicare Only) (PACE) www.onlok.org/PACE 1333 Bush Street San Francisco CA 94109 8888866565 8888866565 711 8889966565 4152928895 711 H5405 001 0 2021 Center for Elders' Independence - Part D (PACE) www.cei.elders.org 510-17th St. Oakland CA 94612 5104331150 5104331150 5104331165 5104331165 5104331150 5104331150 5104331165 5104331165 H5405 002 0 2021 Center for Elders' Independence (PACE) www.cei.elders.org 510-17th St. Oakland CA 94612 5104331150 5104331150 5104331165 5104331165 5104331150 5104331150 5104331165 5104331165 H5406 001 0 2021 Sutter SeniorCare (PACE) www.sutterseniorcare.org 444 North 3rd Street Sacramento CA 95811 8335607223 8335607223 63415 9163931112 9163931112 8335607223 8335607223 63415 9163931112 9163931112 H5406 002 0 2021 Sutter SeniorCare (PACE) www.sutterseniorcare.org 444 North 3rd Street Sacramento CA 95811 8335607223 8335607223 63415 9163931112 9163931112 8335607223 8335607223 63415 9163931112 9163931112 H5493 001 0 2021 LIFE at St. Francis Healthcare, Inc (PACE) www.saintfrancislife.org 1072 Justison Street Wilmington DE 19801 8000000000 3026603351 8006763777 3026603355 8002325460 H5493 002 0 2021 LIFE at St. Francis Healthcare, Inc (PACE) www.stfrancishealthcare.org 1072 Justison Street Wilmington DE 19801 3026603351 8002325460 3026603355 8002325460 H5610 001 0 2021 Care Resources (PACE) www.careresources.org 4150 Kalamazoo Avenue SE Grand Rapids MI 49508 8006106299 6169132006 8006493777 6169132006 8006106299 6169132006 8006493777 6169132006 H5610 003 0 2021 Care Resources (PACE) www.careresources.org 4150 Kalamazoo Avenue SE Grand Rapids MI 49508 8006106299 6169132006 8006493777 6169132006 8006106299 6169132006 8006493777 6169132006 H5629 001 0 2021 St. Paul's PACE (PACE) http://www.stpaulspace.org/ 111 Elm Street San Diego CA 92101 6196773800 8007352922 8007352922 6196773800 8007352922 8007352922 H5629 002 0 2021 St. Paul's PACE (PACE) http://www.stpaulspace.org/ 630 L Street Chula Vista CA 91911 6192717100 8007352922 8007352922 6192717100 8007352922 8007352922 H5822 001 0 2021 Midland Care Connection - Dual Eligibles (PACE) www.midlandcareconnection.org 200 SW Frazier Circle Topeka KS 66606 8007267450 7852322044 711 711 8007267450 7852322044 711 711 H5822 002 0 2021 Midland Care Connection - Medicare Only (PACE) www.midlandcc.org 200 SW Frazier Circle Topeka KS 66606 8004913691 7852322044 711 711 8004913691 7852322044 711 711 H5902 001 0 2021 Senior LIFE Altoona Dual Eligible (PACE) www.seniorlifepa.com 401 Broad Street Johnstown PA 15906 8779985433 8145356000 8779985433 8145356000 8779985433 8145356000 8779985433 8145356000 H5902 002 0 2021 Senior LIFE Altoona Medicare Only (PACE) www.seniorlifepa.com 401 Broad Street Johnstown PA 15906 8779985433 8145356000 8779985433 8145356000 8779985433 8145356000 8779985433 8145356000 H5934 001 0 2021 Hope PACE (PACE) www.hopepace.org 2668 Winkler Avenue Fort Myers FL 33901 8008351673 2399856400 8009558771 8009558771 8008351673 2399856400 8009558771 8009558771 H5934 002 0 2021 Hope PACE (PACE) www.hopepace.org 2668 Winkler Avenue Fort Myers FL 33901 8008351673 2399856400 8009558771 8009558771 8008351673 2399856400 8009558771 8009558771 H5978 001 0 2021 Senior LIFE Lehigh Valley Dual Eligible (PACE) www.seniorlifepa.com 401 Broad Street Johnstown PA 15906 8779985433 8145356000 8779985433 8145356000 8779985433 8145356000 8779985433 8145356000 H5978 002 0 2021 Senior LIFE Lehigh Valley Medicare Only (PACE) www.seniorlifepa.com 401 Broad Street Johnstown PA 15906 8779985433 8145356000 8779985433 8145356000 8779985433 8145356000 8779985433 8145356000 H6059 001 0 2021 PACE of The Triad - Dual (PACE) www.pacetriad.org 1471 East Cone Blvd Greensboro NC 27405 3365504040 3365504040 8007352962 8007352962 3365504040 3365504040 8007352962 8007352962 H6059 002 0 2021 PACE of The Triad - Medicare only (PACE) www.pacetriad.org 1471 East Cone Blvd Greensboro NC 27405 3365504040 3365504040 8007352962 8007352962 3365504040 3365504040 8007352962 8007352962 H6079 001 0 2021 InnovAge California PACE (PACE) www.MyInnovAge.com 8950 E. Lowry Blvd. Denver CO 80230 8447049613 8447049613 8447049613 8447049613 8447049613 711 8447049613 8447049613 711 8447049613 711 H6079 002 0 2021 InnovAge California PACE (PACE) www.MyInnovAge.com 8950 E. Lowry Blvd. Denver CO 80230 8447049613 8447049613 8447049613 8447049613 8447049613 711 8447049613 8447049613 711 8447049613 711 H6188 001 0 2021 VieCare Armstrong, LLC dba LIFE Armstrong County (PACE) www.lutheranseniorlife.org 115 Nolte Drive Ext Kittanning PA 16201 7245458000 711 7245458000 711 H6188 002 0 2021 VieCare Armstrong, LLC dba LIFE Armstrong County (PACE) www.lutheranseniorlife.org 115 Nolte Drive Extension Kittanning PA 16201 7245458000 711 7245458000 711 H6231 001 0 2021 Franciscan PACE, Inc. (PACE) www.ololrmc.com 7436 Bishop Ott Drive, 4200 Essen Lane Baton Rouge LA 70806 8007892863 2254900604 8007892863 2254900604 8007892863 2254900604 8007892863 2254900604 H6231 002 0 2021 Franciscan PACE, Inc. (PACE) www.fmolhs.org 7436 Bishop Ott Drive, 4200 Essen Lane Baton Rouge LA 70806 8007892863 2254900604 8007892863 2254900604 8007892863 2254900604 8007892863 2254900604 H6342 001 0 2021 Complete Health with PACE (PACE) www.completehealthwithpace.com 2100 Pike Avenue North Little Rock AR 72114 5013768852 5016887462 5013768852 5016887462 H6342 002 0 2021 Complete Health with PACE (PACE) www.completehealthwithpace.com 2100 Pike Avenue North Little Rock AR 72114 5013768852 5016887462 5013768852 5016887462 H6371 001 0 2021 Lutheran Senior Healthcare (PACE) www.lifelsmnj.org 377 Jersey Avenue, Suite 310 Jersey City NJ 07302 8775433188 2017062091 8775433188 2017062091 8775433188 2017062091 8775433188 2017062091 H6371 002 0 2021 Lutheran Senior Healthcare (PACE) www.lifelsmnj.org 377 Jersey Avenue, Suite 310 Jersey City NJ 07302 8775433188 2017062091 8775433188 2017062091 8775433188 2017062091 8775433188 2017062091 H6425 001 0 2021 Washington Regional Medicorp PACE of the Ozarks (PACE) www.wregional.com 813 Founders Park Drive East, Suite 107 Springdale AR 72762 4794636600 711 4794636600 711 H6425 002 0 2021 Washington Regional Medicorp PACE of the Ozarks (PACE) www.wregional.com 813 Founders Park Drive East, Suite 107 Springdale AR 72762 4794636600 711 4794636600 711 H6551 001 0 2021 LIFE St. Mary (PACE) http://www.lifestmary.org/ 2500 Northgate Drive Trevose PA 19053 2679917600 2679917600 2679917600 2679917600 2679917600 2679917600 2679917600 2679917600 H6551 002 0 2021 LIFE St. Mary (PACE) www.lifestmary.org 2500 Northgate Drive Trevose PA 19053 2679917600 2679917600 2679917600 2679917600 2679917600 2679917600 2679917600 2679917600 H6596 001 0 2021 Fallon Health Weinberg-PACE (PACE) fallonweinberg.org 461 John James Audubon Pkwy. Amherst NY 14228 8556651113 7168101895 711 711 8556651113 7168101895 711 711 H6596 002 0 2021 Fallon Health Weinberg-PACE (PACE) fallonweinberg.org 461 John James Audubon Pkwy. Amherst NY 14228 8556651113 7168101895 711 711 8556651113 7168101895 711 711 H6787 001 0 2021 VOANS Senior Community Care of Michigan (PACE) http://seniorcommunitycaremi.org 1921 East Miller Road Lansing MI 48911 5173190700 5173190700 5173190700 5173190700 H6787 002 0 2021 VOANS Senior Community Care of Michigan (PACE) http://seniorcommunitycaremi.org 1921 East Miller Road Lansing MI 48911 5173190700 5173190700 5173190700 5173190700 H6846 001 0 2021 CarePartners PACE (PACE) https://missionhealth.org/services-treatments 286 Overlook Road Asheville NC 28803 8000000000 8282138442 8007352962 8007352962 8000000000 8282138442 8007352962 8007352962 H6846 002 0 2021 CarePartners PACE (PACE) https://missionhealth.org/services-treatments 286 Overlook Road Asheville NC 28803 8000000000 8282138442 8007352962 8007352962 8000000000 8282138442 8007352962 8007352962 H6887 001 0 2021 Inspira Health Network LIFE (PACE) http://www.inspirahealthnetwork.org/life-center 2445 Delsea Drive Vineland NJ 08360 8552955433 8563624516 8552955433 8566324516 8552955433 8563624516 8552955433 8566324516 H6887 002 0 2021 Inspira Health Network LIFE (PACE) http://www.inspirahealthnetwork.org/life-center 2445 Delsea Drive Vineland NJ 08360 8552955433 8563624516 8552955433 8563624516 8552955433 8563624516 8552955433 8563624516 H6941 001 0 2021 LIFE PACE Dual Eligible 001 (PACE) www.lifepace.org 5330 E. 31st Street Tulsa OK 74135 9189499969 9189499969 9189499969 9189499969 H6941 002 0 2021 LIFE PACE Medicare Only 002 (PACE) www.lifepace.org 5330 E. 31st Street Tulsa OK 74135 9189499969 9189499969 9189499969 9189499969 H7003 001 0 2021 PACE Nebraska (PACE) Immanuel.com 5755 Sorensen Parkway Omaha NE 68152 4029910330 4029910330 4029910330 4029910330 H7003 002 0 2021 PACE Nebraska (PACE) immanuelpathways.org 5755 Sorensen Parkway Omaha NE 68152 4029910330 4029910330 4029910330 4029910330 H7114 001 0 2021 Dual (PACE) www.valirpace.org 721 NW 6th Oklahoma City OK 73102 8888988020 4056093688 711 711 8888982080 4056093688 711 711 H7114 002 0 2021 Medicare Only (PACE) www.valirpace.org 721 NW 6th Oklahoma City OK 73102 8888988020 4056093688 711 711 8888982080 4056093688 711 711 H7195 001 0 2021 Northland PACE - Dual (PACE) http://www.northlandpace.com 2223 East Rosser Avenue Bismarck ND 58501 8888838959 7017513050 8888388959 7017513050 8888838959 7017513050 8888388959 7017513050 H7195 002 0 2021 Northland PACE - Medicare Only (PACE) http://www.northlandpace.com 2223 East Rosser Avenue Bismarck ND 58501 8888838959 7017513050 8888388959 7017513050 8888838959 7017513050 8888388959 7017513050 H7262 001 0 2021 TRU Community Care (PACE) www.pace.trucare.org 2593 Park Lane Lafayette CO 80026 3036650115 8006592656 3036650115 8006592656 H7262 002 0 2021 TRU Community Care (PACE) www.pace.trucare.org 2593 Park Lane Lafayette CO 80026 3036650115 8006592656 3036650115 8006592656 H7469 001 0 2021 PACE Partners of Northeast Florida (PACE) thepaceplace.org 5450 Ramona Boulevard Jacksonville FL 32205 9044280400 8009558771 9044280400 8009558771 H7469 002 0 2021 PACE Partners of Northeast Florida MO (PACE) @thepaceplace.org 5450 Ramona Boulevard Jacksonville FL 32205 9044076207 6207 8009558771 9044076207 6207 8009558771 H7501 001 0 2021 CalOptima PACE (PACE) www.caloptima.org/PACE 13300 Garden Grove Blvd. Garden Grove CA 92843 8557852584 7144681100 8007352929 7144681063 8557852584 7144681100 8007352929 7144681063 H7501 002 0 2021 CalOptima PACE (PACE) www.caloptima.org/PACE 13300 Garden Grove Blvd. Garden Grove CA 92843 8557852584 7144681100 8007352929 7144681063 8557852584 7144681100 8007352929 7144681063 H7619 001 0 2021 AtlantiCare LIFE Connection (PACE) www.atlanticare.org/services/life-connection/ 1401 Atlantic Ave Atlantic City NJ 08401 8885691000 6094072052 8008527899 8885691000 6095728588 8008527899 H7619 002 0 2021 AtlantiCare LIFE Connection (PACE) www.atlanticare.org/services/life-connection/ 1401 Atlantic Ave Atlantic City NJ 08401 8885691000 6094072052 8008527899 8885691000 6094072052 8008527899 H7660 001 0 2021 VieCare Beaver, LLC dba LIFE Beaver and Lawrence C (PACE) http://www.lutheranseniorlife.org 131 Pleasant Drive, Suite 1 Aliquippa PA 15001 7243785400 711 7243785400 711 H7660 002 0 2021 VieCare Beaver, LLC dba LIFE Beaver and Lawrence C (PACE) www.LutheranSeniorLife.org 131 Pleasant Drive, Suite 1 Aliquippa PA 15001 7243785400 711 7243785400 711 H7855 001 0 2021 Brandman Centers for Senior Care-Dual (PACE) www.brandmanseniorcare.org 7150 Tampa Avenue Reseda CA 91335 8557748444 8187748444 8187743194 8187743194 8557448444 3033 8187748444 3033 8187743194 8187743194 H7855 002 0 2021 Brandman Centers for Senior Care-Medicare Only (PACE) www.brandmanseniorcare.org 7150 Tampa Avenue Reseda CA 91335 8557748444 8187748444 8187743194 8187743194 8557748444 8187748444 8187743194 8187743194 H8082 001 0 2021 Stockton PACE (PACE) https://stocktonpace.welbehealth.com/ 582 E Harding Way Stockton CA 95204 2094426077 2099320357 2094426077 2099320357 H8082 002 0 2021 Stockton PACE - Medicare only (PACE) https://stocktonpace.welbehealth.com/ 582 E Harding Way Stockton CA 95204 2094426077 2099320357 2094426077 2099320357 H8096 001 0 2021 Centra PACE - Dual (PACE) http://www.centrapace.com 407 Federal Street Lynchburg VA 24504 8883169540 4342006516 8008281140 8008281140 8883169540 4342006516 8008281140 8008281140 H8096 002 0 2021 Centra PACE - Medicare only (PACE) http://www.centrapace.com 407 Federal Street Lynchburg VA 24504 8883169540 4342006516 8008281140 8008281140 8883169540 4342006516 8008281140 8008281140 H8424 001 0 2021 Siouxland PACE, INC (PACE) https://www.unitypoint.org/siouxcity/services-pace 1200 Tri View Ave Sioux City IA 51103 8887223713 7122247223 8007352942 8007352942 8887223713 7122247223 8007352942 8007352942 H8424 002 0 2021 Siouxland PACE, INC (PACE) https://www.unitypoint.org/siouxcity/services-pace 1200 Tri View Ave Sioux City IA 51103 8887223713 7122247223 8007352942 8007352942 8887223713 7122247223 8007352942 8007352942 H8655 004 0 2021 InnovAge Virginia PACE II, LLC (PACE) www.MyInnovAge.com 8950 E. Lowry Blvd. Denver CO 80230 8447049613 8447049613 8447049613 8447049613 8447049613 711 8447049613 8447049613 711 8447049613 711 H8655 005 0 2021 InnovAge Virginia PACE II, LLC Medicare ONLY (PACE) www.MyInnovAge.com 8950 E. Lowry Blvd. Denver CO 80230 8447049613 8447049613 8447049613 8447049613 8447049613 711 8447049613 8447049613 711 8447049613 711 H8769 001 0 2021 Genesys PACE of Genesee County (PACE) ascension.org/GenesysPACE 412 E. First Street Flint MI 48502 8102367500 8102367554 8102367500 8102367554 H8769 002 0 2021 Genesys PACE of Genesee County (PACE) ascension.org/GenesysPACE 412 E First Street Flint MI 48502 8102367500 8102367554 8102367500 8102367554 H8777 001 0 2021 Complete Senior Care Dual (PACE) https://www.completeseniorcare.org/ 1302 Main Street Niagara Falls NY 14301 7162858224 220 7162858224 220 7162858224 220 7162858224 220 7162858224 220 7162858224 220 7162858224 220 7162858224 220 H8777 002 0 2021 Complete Senior Care Medicare Only (PACE) https://www.completeseniorcare.org 1302 Main Street Niagara Falls NY 14301 7162858224 220 7162858224 220 7162858224 220 7162858224 220 7162858224 220 7162858224 220 7162858224 220 7162858224 220 H8800 001 0 2021 Total Senior Care - Dual (PACE) www.totalseniorcare.org 519 North Union Street Olean NY 14760 8669398613 7163798474 8006621220 8006621220 8669398613 7163798474 8006621220 8006621220 H8800 002 0 2021 Total Senior Care - Medicare Small Only (PACE) www.totalseniorcare.org 519 North Union Street Olean NY 14760 8669398613 7163798474 8006621220 8006621220 8669398613 7163798474 8006621220 8006621220 H9052 001 0 2021 Dual Eligible PACE 001 (PACE) https://region7aaa.org/ 5229 Lakeshore Road Fort Gratiot MI 48059 8103886300 8103886300 8103886300 8103886300 H9052 002 0 2021 Medicare Only 002 (PACE) https://region7aaa.org/ 5229 Lakeshore Road Fort Gratiot MI 48059 8103886300 8103886300 8103886300 8103886300 H9068 001 0 2021 Albright LIFE (PACE) www.albrightlife.org 90 Maplewood Drive Lewisburg PA 17837 8887910094 5705223880 711 711 8887910094 5705223880 711 711 H9068 002 0 2021 Albright LIFE Medicare Only (PACE) www.albrightlife.org 90 Maplewood Drive Lewisburg PA 17837 8887910094 5705223880 711 711 8887910094 5705223880 711 711 H9185 001 0 2021 Great Lakes PACE - Dual Eligible (PACE) http://www.greatlakespace.org 3378 Fashion Square Blvd Saginaw MI 48603 8444457223 9892727610 8444457223 9892727619 8444457223 9892727610 8444457223 9892727610 H9185 002 0 2021 Great Lakes PACE (PACE) http://www.greatlakespace.org 3378 Fashion Square Blvd Saginaw MI 48603 8444457223 9892727610 8444457223 9892727610 8444457223 9892727610 8444457223 9892727610 H9266 001 0 2021 Piedmont Health SeniorCare - Dual (PACE) http://www.piedmonthealthseniorcare.org/ 1214 Vaughn Road Burlington NC 27217 8777142100 3365320000 8777142100 3365320000 8777142100 9195457341 8007352962 8007352962 H9266 003 0 2021 Piedmont Health SeniorCare - Medicare-only (PACE) http://www.piedmonthealthseniorcare.org/ 1214 Vaughn Road Burlington NC 27217 8777142100 3365320000 8777142100 3365320000 8777142100 9195457341 8007352962 8007352962 H9323 001 0 2021 Beacon of LIFE (PACE) beaconpace.com 1075 Stephenson Avenue Ocean Port NJ 07757 7325923400 7325923400 7325923400 7325923400 7325923400 7325923400 7325323400 7325923400 H9323 002 0 2021 Beacon of LIFE (PACE) beaconpace.com 1075 Stephenson Avenue Ocean Port NJ 07757 7325923400 7325923400 7325923400 7325923400 7325923400 7325923400 7325323400 7325923400 H9438 001 0 2021 Bluestem PACE (PACE) www.bluestempace.org 113 South Ash McPherson KS 67460 8445887223 6205045674 8445887223 6205045674 8445887223 6205045900 6205045900 H9438 002 0 2021 Bluestem PACE (PACE) www.bluestempace.org 113 South Ash McPherson KS 67460 8445887223 6205045900 6205045900 8445887223 6205045900 6205045900 H9592 001 0 2021 Fresno PACE (PACE) www.fresnopace.org 2042 Kern St Fresno CA 93721 8556307223 8556307223 8556307223 8556307223 8556307223 8556307223 8556307223 8556307223 H9592 002 0 2021 Fresno PACE (PACE) www.fresnopace.org 2042 Kern St Fresno CA 93721 8556307223 8556307223 8556307223 8556307223 8556307223 8556307223 8556307223 8556307223 H9616 001 0 2021 San Diego PACE (Duals) (PACE) http://www.syhc.org/sdpace/ 3364 Beyer Boulevard San Ysidro CA 92173 8444737223 6192054585 8007352922 8007352922 8444737223 6192054585 8007352922 8007352922 H9616 002 0 2021 San Diego PACE (Medicare Only) (PACE) http://www.syhc.org/sdpace/ 3364 Beyer Boulevard, Suite 102 San Diego CA 92173 8444737223 6192054585 8007352922 8007352922 8444737223 6192054585 8007352922 8007352922 H9649 001 0 2021 Hope West PACE - Dual Eligible (PACE) https://www.hopewestco.org/ 3090 N 12th Street, Unit B Grand Junction CO 81506 9702557223 8006592656 9702557223 8006592656 H9649 002 0 2021 Hope West Pace - Medicare Only (PACE) https://www.hopewestco.org/ 3090 N 12th Street, Unit B Grand Junction CO 81506 9702557223 8006592656 9702557223 8006592656 H9830 001 0 2021 InnovAge Pennsylvania LIFE, LLC - Dual (PACE) www.MyInnovAge.com 8950 E. Lowry Blvd. Denver CO 80230 8447049613 8447049613 8447049613 8447049613 8447049613 711 8447049613 8447049613 711 8447049613 711 H9830 002 0 2021 InnovAge Pennsylvania LIFE, LLC - Medicare Only (PACE) www.MyInnovAge.com 8950 E. Lowry Blvd. Denver CO 80230 8447049613 8447049613 8447049613 8447049613 8447049613 711 8447049613 8447049613 711 8447049613 711 H9842 001 0 2021 Saint Joseph PACE (PACE) sjmed.com\PACE 250 E. Day Rd. Mishawaka IN 46545 5742478700 5742478701 5742478700 5742478701 H9842 002 0 2021 Saint Joseph PACE - Medicare Only (PACE) sjmed.com\PACE 250 E. Day Rd Mishawaka IN 46545 5742478700 5742478701 5742478700 5742478701 H9998 001 0 2021 Silver Star - Dual (PACE) www.silverstar.org P.O. Box 2828, 4010 22nd Street Lubbock TX 79408 8067671736 8067401500 8067671736 8067401500 8067671736 8067401500 8067671736 8067401500 H9998 002 0 2021 Silver Star - Medicare only (PACE) www.silverstar.org P.O. Box 2828, 4010 22nd Street Lubbock TX 79408 8067671736 8067401500 8067671736 8067401500 8067671736 8067401500 8067671736 8067401500 S5593 002 0 2021 Blue Rx PDP Plus (PDP) medicare.highmark.com Chris.Scarnati@highmark.com Senior Markets Enrollment Department, P.O. Box 535049 Pittsburgh PA 15253 8664351047 8664351047 711 711 8002903914 8002903914 711 711 S5593 003 0 2021 Blue Rx PDP Complete (PDP) medicare.highmark.com Chris.Scarnati@highmark.com Senior Markets Enrollment Department, P.O. Box 535049 Pittsburgh PA 15253 8664351047 8664351047 711 711 8002903914 8002903914 711 711 S5593 801 0 2021 Blue Rx PDP Employer Group Calendar (PDP) medicare.highmark.com Chris.Scarnati@highmark.com Senior Markets Enrollment Department, P.O. Box 535049 Pittsburgh PA 15253 8664351047 8664351047 711 711 8002903914 8002903914 711 711 S5593 802 0 2021 Blue Rx PDP Employer Group Non-Calendar (PDP) medicare.highmark.com Chris.Scarnati@highmark.com Senior Markets Enrollment Department, P.O. Box 535049 Pittsburgh PA 15253 8664351047 8664351047 711 711 8002903914 8002903914 711 711 S5921 348 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 349 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 350 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 351 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 352 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 353 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 354 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 355 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 356 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 357 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 358 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 359 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 360 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 361 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 362 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 363 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 364 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 365 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 366 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 367 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 368 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 369 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 370 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 371 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 372 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 373 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 374 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 375 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 376 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 377 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8668681394 8668681394 711 711 This organization has plans available nationwide.~ S5921 378 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 379 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 380 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8664608854 8664608854 711 711 This organization has plans available nationwide.~ S5921 381 0 2021 AARP MedicareRx Saver Plus (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8667749679 8667749679 711 711 This organization has plans available nationwide.~ S5921 382 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 383 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 384 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 385 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 386 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 387 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 388 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 389 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 390 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 391 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 392 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 393 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 394 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 395 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 396 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 397 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 398 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 399 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 400 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 401 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 402 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 403 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 404 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 405 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 406 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 407 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 408 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 409 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 410 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 411 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 412 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 413 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668703470 8668703470 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 414 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8667749679 8667749679 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 415 0 2021 AARP MedicareRx Walgreens (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8007538004 8007538004 711 711 8668681394 8668681394 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5921 802 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5921 837 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5916 001 0 2021 Regence Medicare Script Basic (PDP) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8005418981 8005418981 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ S5916 002 0 2021 Regence Medicare Script Enhanced (PDP) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693171 8883693171 711 711 8005418981 8005418981 711 711 S5916 802 0 2021 Regence Medicare Script (PDP) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883198904 8883198904 711 711 8883198904 8883198904 711 711 S5916 804 0 2021 Regence Medicare Script 02 (PDP) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883198904 8883198904 711 711 8883198904 8883198904 711 711 S5916 805 0 2021 Regence Medicare Script 03 (PDP) www.regence.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883198904 8883198904 711 711 8883198904 8883198904 711 711 S5753 006 0 2021 WPS MedicareRx Plan 1 (PDP) www.wpsmedicaredrugs.com 1717 W. Broadway, P.O. Box 8190 Madison WI 53708 8007310459 8007310459 711 711 8006881604 8006881604 8007163231 8007163231 S5753 007 0 2021 WPS MedicareRx Plan 2 (PDP) www.wpsmedicaredrugs.com 1717 W. Broadway, P.O. Box 8190 Madison WI 53708 8007310459 8007310459 711 711 8006881604 8006881604 8007163231 8007163231 S5975 801 0 2021 Moda Health Rx (PDP) www.modahealth.com/medicare PharmacyMedicare@modahealth.com PO Box 40327, Attn: PERS Moda Health Rx (PDP) Portland OR 97240 8882172375 5032652975 711 711 8887867509 5032654709 711 711 S0655 801 0 2021 Tufts Medicare Preferred PDP Group (PDP) tuftsmedicarepreferred.org/plans/employer-plans Annette_DiFelice@tufts-health.com 705 Mt Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 S0655 802 0 2021 Tufts Medicare Preferred PDP Group (PDP) tuftsmedicarepreferred.org/plans/employer-plans Annette_DiFelice@tufts-health.com 705 Mt Auburn Street Watertown MA 02472 8772184835 8772184835 711 711 8007019000 8007019000 711 711 S5857 802 0 2021 PriorityMedicare Rx EG Non-Calendar Year (PDP) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8887729596 6164648850 711 711 8883896648 6164648820 711 711 S5857 803 0 2021 PriorityMedicare Rx EG Calendar Year (PDP) www.prioritymedicare.com 1231 East Beltline NE Grand Rapids MI 49525 8887729596 6164648850 711 711 8883896648 6164648820 711 711 S3994 801 0 2021 Medicare Rx EGWP CY (PDP) www.hmsa.com AMS, P.O. Box 860 Honolulu HI 96808 8006204672 8089485555 711 711 8006604672 8089486000 711 711 S3994 802 0 2021 Medicare Rx EGWP NCY (PDP) www.hmsa.com AMS, P.O. Box 860 Honolulu HI 96808 8006204672 8089485555 711 711 8006604672 8089486000 711 711 S5884 101 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 102 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 103 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 104 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 105 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 106 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 107 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 108 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 109 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 110 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 111 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 112 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 113 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 114 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 115 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 116 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 131 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 132 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 133 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 134 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 135 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 136 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 137 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 138 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 139 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 140 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 141 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 142 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 143 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 144 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 145 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 146 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 147 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5884 148 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 149 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 150 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 151 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 152 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 153 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 154 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 155 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 156 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 157 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 158 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 159 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 160 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 161 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 162 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 163 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 164 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 165 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 166 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 167 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 168 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 169 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 170 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 171 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 172 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 173 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 174 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 175 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 176 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 177 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 178 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 179 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 180 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 181 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 182 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 183 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 184 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 185 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 186 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 187 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 188 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 189 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 190 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 191 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 192 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 193 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 194 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 195 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 196 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 197 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 198 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 199 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 200 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 201 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 202 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 203 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 204 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 205 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 206 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 207 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 208 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 209 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 210 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 211 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 212 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 213 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5884 834 0 2021 Humana Medicare Employer (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 This organization has plans available nationwide.~ S5993 001 0 2021 Horizon Medicare Blue Rx Standard (PDP) www.horizonblue.com/Medicare 3 Penn Plaza East, PP-12F Newark NJ 07105 8887657134 8887657134 711 711 8003911906 8003911906 711 711 S5993 003 0 2021 Horizon Medicare Blue Rx Enhanced (PDP) www.horizonblue.com/Medicare 3 Penn Plaza East, PP-09 W Newark NJ 07105 8887657134 8887657134 711 711 8003911906 8003911906 711 711 S5993 007 0 2021 Horizon Medicare Blue Rx Saver (PDP) www.horizonblue.com/Medicare 3 Penn Plaza East, PP-12F Newark NJ 07105 8887657134 8887657134 711 711 8003911906 8003911906 711 711 This plan does not charge an annual deductible for all drugs. The $150.00 annual deductible only applies to drugs on certain tiers.~ S5993 801 0 2021 Horizon Medicare Blue Group Rx (PDP) www.HorizonBlue.com 3 Penn Plaza East, PP-09 W Newark NJ 07105 8887657134 8887657134 711 711 8003911906 8003911906 711 711 S5993 804 0 2021 Horizon Medicare Blue Group Rx Plus (PDP) www.HorizonBlue.com 3 Penn Plaza East, PP-09 W Newark NJ 07105 8887657134 8887657134 711 711 8003911906 8003911906 711 711 S5993 805 0 2021 Horizon Medicare Blue Group Rx Value (PDP) www.HorizonBlue.com 3 Penn Plaza East, PP-09 W Newark NJ 07105 8887657134 8887657134 711 711 8003911906 8003911906 711 711 S1894 001 0 2021 CommunityCare Prescription Drug Plan (PDP) www.ccokadvantage.com ccare@ccok.com Two W 2nd Street, Suite 100 Tulsa OK 74103 8003333275 9185945202 8007220353 8007220353 8003333275 9185945211 8007220353 8007220353 S8067 001 0 2021 SecureRx - Option 3 (PDP) www.avalonsecurerxpdp.com customerservice@securerxpdp.com 2500 Elmerton Avenue Harrisburg PA 17177 8888397330 8888397330 711 711 8772343853 8772343853 711 711 S8067 003 0 2021 SecureRx - Option 1 (PDP) www.avalonsecurerxpdp.com customerservice@securerxpdp.com 2500 Elmerton Avenue Harrisburg PA 17177 8888397330 8888397330 711 711 8772343853 8772343853 711 711 S8067 801 0 2021 SecureRx Group PDP Silver Rx (PDP) www.avalonsecurerxpdp.com customerservice@securerxpdp.com 2500 Elmerton Avenue Harrisburg PA 17177 8888397330 8888397330 711 711 8772343853 8772343853 711 711 S8067 802 0 2021 SecureRx Group PDP Bronze Rx FY (PDP) www.avalonsecurerxpdp.com customerservice@securerxpdp.com 2500 Elmerton Avenue Harrisburg PA 17177 8888397330 8888397330 711 711 8772343853 8772343853 711 711 S8067 803 0 2021 SecureRx Group PDP Gold Rx (PDP) www.avalonsecurerxpdp.com customerservice@securerxpdp.com 2500 Elmerton Avenue, Suite 201 Harrisburg PA 17177 8888397330 8888397330 711 711 8772343853 8772343853 711 711 S8067 804 0 2021 SecureRx Group PDP Bronze Rx (PDP) www.avalonsecurerxpdp.com customerservice@securerxpdp.com 2500 Elmerton Avenue, Suite 201 Harrisburg PA 17177 8888397330 8888397330 711 711 8772343853 8772343853 711 711 S8067 805 0 2021 SecureRx Group PDP Platinum Rx (PDP) www.avalonsecurerxpdp.com customerservice@securerxpdp.com 2500 Elmerton Avenue, Suite 201 Harrisburg PA 17177 8888397330 8888397330 711 711 8772343853 8772343853 711 711 S8067 806 0 2021 SecureRx Group PDP Platinum Rx FY (PDP) www.avalonsecurerxpdp.com customerservice@securerxpdp.com 2500 Elmerton Avenue, Suite 201 Harrisburg PA 17177 8888397330 8888397330 711 711 8772343853 8772343853 711 711 S8067 807 0 2021 SecureRx Group PDP Gold Rx FY (PDP) www.avalonsecurerxpdp.com customerservice@securerxpdp.com 2500 Elmerton Avenue, Suite 201 Harrisburg PA 17177 8888397330 8888397330 711 711 8772343853 8772343853 711 711 S8067 808 0 2021 SecureRx Group PDP Silver Rx FY (PDP) www.avalonsecurerxpdp.com customerservice@securerxpdp.com 2500 Elmerton Avenue, Suite 201 Harrisburg PA 17177 8888397330 8888397330 711 711 8772343853 8772343853 711 711 S5601 002 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $305.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 003 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 004 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $225.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 005 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 006 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $290.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 007 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 008 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 009 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 010 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 011 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 012 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $345.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 013 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 014 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $380.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 015 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 016 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $330.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 017 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 018 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $355.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 019 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 020 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $335.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 021 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 022 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $305.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 023 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 024 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $290.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 025 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 026 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $265.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 027 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 028 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 029 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 030 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $325.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 031 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 032 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $205.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 033 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 034 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $340.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 035 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 036 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $245.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 037 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 038 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $265.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 040 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 041 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 042 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $215.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 044 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $405.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 045 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 046 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $235.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 048 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 049 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 050 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $240.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 051 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 052 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $320.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 053 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 054 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $370.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 055 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 056 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 057 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 058 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 059 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 060 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $260.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 061 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 062 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 063 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 064 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $250.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 065 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 066 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 067 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 068 0 2021 SilverScript Choice (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $230.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 107 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 108 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 109 0 2021 SilverScript Plus (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 176 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 177 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 178 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 179 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 180 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 181 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 182 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 183 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 184 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 185 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 186 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 187 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 188 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 189 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 190 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 191 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 192 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 193 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 194 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 195 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 196 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 197 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 198 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 199 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 200 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 201 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 202 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 203 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 204 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 205 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 206 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 207 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 208 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 209 0 2021 SilverScript SmartRx (PDP) www.aetnamedicare.com P.O. Box 30016 Pittsburgh PA 15222 8335262445 8335262445 711 711 8662355660 8662355660 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5601 801 0 2021 SilverScript Group (PDP) www.aetnamedicare.com P.O. Box 53991 Phoenix AZ 85072 8665526106 8665526106 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 802 0 2021 SilverScript Group (PDP) www.aetnamedicare.com P.O. Box 53991 Phoenix AZ 85072 8665526106 8665526106 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 803 0 2021 SilverScript Group FI AET (PDP) www.aetnamedicare.com P.O. Box 53991 Phoenix AZ 85072 8665526106 8665526106 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 804 0 2021 SilverScript Group FI (PDP) www.aetnamedicare.com P.O. Box 53991 Phoenix AZ 85072 8665526106 8665526106 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 805 0 2021 SilverScript Group SF (PDP) www.aetnamedicare.com P.O. Box 53991 Phoenix AZ 85072 8665526106 8665526106 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 806 0 2021 SilverScript Group SF AET (PDP) www.aetnamedicare.com P.O. Box 53991 Phoenix AZ 85072 8665526106 8665526106 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 807 0 2021 SilverScript Group SF (PDP) www.aetnamedicare.com P.O. Box 53991 Phoenix AZ 85072 8665526106 8665526106 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 808 0 2021 SilverScript Group SF - Non Calendar (PDP) www.aetnamedicare.com P.O. Box 53991 Phoenix AZ 85072 8665526106 8665526106 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 809 0 2021 SilverScript Group SF (PDP) www.aetnamedicare.com P.O. Box 53991 Phoenix AZ 85072 8665526106 8665526106 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 810 0 2021 SilverScript Group SF - Non Calendar (PDP) www.aetnamedicare.com P.O. Box 53991 Phoenix AZ 85072 8665526106 8665526106 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 811 0 2021 SilverScript Group - State of NY (PDP) www.aetnamedicare.com P.O. Box 53991 Phoenix AZ 85072 8665526106 8665526106 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 812 0 2021 SilverScript Group SF (PDP) www.aetnamedicare.com P.O. Box 53991 Phoenix AZ 85072 8665526106 8665526106 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 813 0 2021 SilverScript Group SF (PDP) www.aetnamedicare.com P.O. Box 53991 Phoenix AZ 85072 8665526106 8665526106 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 814 0 2021 SilverScript Group SF (PDP) www.aetnamedicare.com P.O. Box 53991 Phoenix AZ 85072 8665526106 8665526106 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 815 0 2021 SilverScript Group SF (PDP) www.aetnamedicare.com P.O. Box 53991 Phoenix AZ 85072 8665526106 8665526106 711 711 8662355660 8662355660 711 711 This organization has plans available nationwide.~ S5601 816 0 2021 Aetna Medicare Rx offered by SilverScript - FI (PDP) www.aetnamedicare.com PO Box 30007 Pittsburgh PA 15222 8665526106 8665526106 711 711 8552226857 8552226857 711 711 This organization has plans available nationwide.~ S5601 818 0 2021 Aetna Medicare Rx offered by SilverScript - SF (PDP) www.aetnamedicare.com PO Box 30007 Pittsburgh PA 15222 8665526106 8665526106 711 711 8552226857 8552226857 711 711 This organization has plans available nationwide.~ S5601 820 0 2021 Aetna Medicare Rx offered by SilverScript - DC (PDP) www.aetnamedicare.com PO Box 30007 Pittsburgh PA 15222 8665526106 8665526106 711 711 8552226857 8552226857 711 711 This organization has plans available nationwide.~ S1140 801 0 2021 Group PDP (PDP) www.nymedicare.com customerservice@bcbswny.com PO Box 80 Buffalo NY 14202 8889899905 8889899905 711 711 8887872390 8887872390 711 711 S1140 802 0 2021 Group PDP Enhanced (PDP) www.nymedicare.com PO Box 80 Buffalo NY 14202 8889899905 8889899905 711 711 8774619218 8774619218 711 711 S5743 001 0 2021 MedicareBlue Rx Standard (PDP) www.YourMedicareSolutions.com MedicareBlue Rx, 4301 Cambridge Road Fort Worth TX 76155 8664342037 8664342037 711 711 8888320075 8888320075 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S5743 004 0 2021 MedicareBlue Rx Premier (PDP) www.YourMedicareSolutions.com MedicareBlue Rx, 4301 Cambridge Road Fort Worth TX 76155 8664342037 8664342037 711 711 8888320075 8888320075 711 711 S5743 802 0 2021 Group MedicareBlue Rx (PDP) www.YourMedicareSolutions.com MedicareBlue Rx Group, 4301 Cambridge Road Fort Worth TX 76155 8664342037 8664342037 711 711 8778383827 8778383827 711 711 S5743 805 0 2021 Group MedicareBlue Rx Self-funded (PDP) www.YourMedicareSolutions.com MedicareBlue Rx Group, 4301 Cambridge Road Fort Worth TX 76155 8664342037 8664342037 711 711 8778383827 8778383827 711 711 S6875 801 0 2021 Select Option Rx Group Option I CY (PDP) http://www.ibxmedicare.com PO Box 41514 Philadelphia PA 19101 8886787009 8886787009 711 711 8886787009 8886787009 711 711 S6875 802 0 2021 Select Option Rx Group Option I Non-CY (PDP) http://www.ibxmedicare.com PO Box 41514 Philadelphia PA 19101 8886787009 8886787009 711 711 8886787009 8886787009 711 711 S5953 001 0 2021 BlueCross Rx Value (PDP) www.scbluesmedadvantage.com/marx21 Laurin.Boggero@BCBSSC.com PO Box 100191 Columbia SC 29223 8009302836 8009302836 711 711 8886456025 8886456025 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ S5953 002 0 2021 BlueCross Rx Plus (PDP) www.scbluesmedadvantage.com/marx21 Laurin.Boggero@BCBSSC.com PO Box 100191 Columbia SC 29223 8009302836 8009302836 711 711 8886456025 8886456025 711 711 S5953 801 0 2021 Group Blue Rx Plus (PDP) www.scbluesmedadvantage.com Laurin.Boggero@BCBSSC.com PO Box 100191 Columbia SC 29223 8009302836 8009302836 711 711 8886456025 8886456025 711 711 S5953 802 0 2021 Group Blue Rx Plus (PDP) www.scbluesmedadvantage.com Laurin.Boggero@BCBSSC.com PO Box 100191 Columbia SC 29223 8009302836 8009302836 711 711 8886456025 8886456025 711 711 S5768 125 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 126 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 127 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 128 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 129 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 130 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 131 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 132 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 133 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 134 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 135 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 136 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 137 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 138 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 139 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 140 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 141 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 142 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 143 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 144 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 145 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 146 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 147 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 148 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 149 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 150 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 151 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 152 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 153 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 154 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 155 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 197 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 198 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5768 200 0 2021 WellCare Medicare Rx Value Plus (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5660 226 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 227 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 228 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 229 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 230 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 231 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 232 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 233 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 234 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 235 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 236 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 237 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 238 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 239 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 240 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 241 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 242 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 243 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 244 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 245 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 246 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 247 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 248 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 249 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 250 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 251 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 801 0 2021 Express Scripts Medicare (PDP) www.Express-ScriptsMedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This organization has plans available nationwide.~ S5660 802 0 2021 Express Scripts Medicare (PDP) www.Express-ScriptsMedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This organization has plans available nationwide.~ S5660 803 0 2021 Express Scripts Medicare (PDP) www.Express-ScriptsMedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This organization has plans available nationwide.~ S5660 804 0 2021 Express Scripts Medicare (PDP) www.Express-ScriptsMedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This organization has plans available nationwide.~ S5660 806 0 2021 Express Scripts Medicare (PDP) www.Express-ScriptsMedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This organization has plans available nationwide.~ S5660 104 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 105 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 106 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 107 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 108 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 109 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 110 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 111 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 112 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 113 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 114 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 115 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 116 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 117 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 118 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 119 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 120 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 121 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 122 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 123 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 124 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 125 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 126 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 127 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 128 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 129 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 130 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 131 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 132 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 133 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 134 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 135 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 136 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 137 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 172 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 176 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 180 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 181 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 182 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 183 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 184 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 185 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 186 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 187 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 190 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 192 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 194 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 195 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 196 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 197 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 198 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 199 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 202 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 203 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 204 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 206 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 207 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 208 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 209 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 210 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 211 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 212 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 213 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 214 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 215 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 216 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 217 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 218 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 219 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 220 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 221 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 222 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 223 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 224 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5660 225 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584574 8007584574 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S2893 001 0 2021 Blue MedicareRx Value Plus (PDP) www.RxMedicarePlans.com P.O. Box 30001 Pittsburgh PA 15222 8774792227 8774792227 711 711 8885434917 8885434917 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S2893 003 0 2021 Blue MedicareRx Premier (PDP) www.RxMedicarePlans.com P.O. Box 30001 Pittsburgh PA 15222 8774792227 8774792227 711 711 8885434917 8885434917 711 711 S2893 801 0 2021 Blue MedicareRx (PDP) Groups.RxMedicareplans.com P.O. Box 30001 Pittsburgh PA 15222 8774792227 8774792227 711 711 8885434917 8885434917 711 711 S2893 802 0 2021 Blue MedicareRx (PDP) Groups.RxMedicareplans.com P.O. Box 30001 Pittsburgh PA 15222 8774792227 8774792227 711 711 8885434917 8885434917 711 711 E4744 801 0 2021 Missouri Department of Transportatio/ Highway Patr (Employer PDP) http://www.modot.org/newsandinfo/GeneralInfo.htm 105 W. Capitol Avenue Jefferson City MO 65102 8778639406 5737512551 711 711 8445136006 8445136006 711 711 S5617 003 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 008 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 013 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 018 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 053 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 068 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 088 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 103 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 108 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 113 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 118 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 123 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 128 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 133 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 138 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 143 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 148 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 153 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 158 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 163 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 214 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 215 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 216 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 217 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 218 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 219 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 220 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 221 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 222 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 223 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 224 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 225 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 226 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 227 0 2021 Cigna Secure Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 246 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 247 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 248 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 249 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 250 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 251 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 252 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 253 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 254 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 255 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 256 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 257 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 258 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 259 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 260 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 261 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 262 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 263 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 264 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 265 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 266 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 267 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 268 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 269 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 270 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 271 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 272 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 273 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 274 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 275 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 276 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 277 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 278 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 279 0 2021 Cigna Secure-Extra Rx (PDP) www.cignamedicare.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 280 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 281 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 282 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 283 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 284 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 285 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 286 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 287 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 288 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 289 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 290 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 291 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 292 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 293 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 294 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 295 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 296 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 297 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 298 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 299 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 300 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 301 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 302 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 303 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 304 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 305 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 306 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 307 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 308 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 309 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 310 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 311 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 312 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 313 0 2021 Cigna Secure-Essential Rx (PDP) www.cignamedicare.com seniors@cigna.com P O Box 269005 Weston FL 33326 8007351459 8007351459 711 711 8002226700 8002226700 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5617 801 0 2021 Cigna Rx Medicare (PDP) www.cignamedicare.com P O Box 42005 Phoenix AZ 85080 8005589562 8005589562 711 711 8005589562 8005589562 711 711 This organization has plans available nationwide.~ S5617 802 0 2021 Cigna Rx Medicare FY (PDP) www.cignamedicare.com P O Box 42005 Phoenix AZ 85080 8005589562 8005589562 711 711 8005589562 8005589562 711 711 This organization has plans available nationwide.~ S5617 805 0 2021 Cigna Rx Medicare (PDP) www.cignamedicare.com P O Box 42005 Phoenix AZ 85080 8005589562 8005589562 711 711 8005589562 8005589562 711 711 This organization has plans available nationwide.~ S5617 806 0 2021 Cigna Rx Medicare FY (PDP) www.cignamedicare.com P O Box 42005 Phoenix AZ 85080 8005589562 8005589562 711 711 8005589562 8005589562 711 711 This organization has plans available nationwide.~ S3285 801 0 2021 VibrantRx (PDP) https://www.medimpact.com PO Box 509097 San Diego CA 92150 8448263451 8448263451 711 711 8448263451 8448263451 711 711 S3285 802 0 2021 VibrantRx (PDP) https://www.medimpact.com PO Box 509097 San Diego CA 92150 8448263451 8448263451 711 711 8448263451 8448263451 711 711 S3285 803 0 2021 VibrantRx (PDP) https://www.medimpact.com PO Box 509097 San Diego CA 92150 8448263451 8448263451 711 711 8448263451 8448263451 711 711 S3285 804 0 2021 VibrantRx (PDP) https://www.medimpact.com PO Box 509097 San Diego CA 92150 8448263451 8448263451 711 711 8448263451 8448263451 711 711 S3285 805 0 2021 VibrantRx (PDP) https://www.medimpact.com PO Box 509097 San Diego CA 92150 8448263451 8448263451 711 711 8448263451 8448263451 711 711 S3285 806 0 2021 VibrantRx (PDP) https://www.medimpact.com PO Box 509097 San Diego CA 92150 8448263451 8448263451 711 711 8448263451 8448263451 711 711 S3285 807 0 2021 VibrantRx (PDP) https://www.medimpact.com PO Box 509097 San Diego CA 92150 8448263451 8448263451 711 711 8448263451 8448263451 711 711 S5795 002 0 2021 BlueMedicare Premier Rx (PDP) www.arkansasbluecross.com/medicare P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8663903369 8663903369 711 711 S5795 003 0 2021 BlueMedicare Value Rx (PDP) www.arkansasbluecross.com/medicare P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8663903369 8663903369 711 711 This plan does not charge an annual deductible for all drugs. The $310.00 annual deductible only applies to drugs on certain tiers.~ S5795 008 0 2021 BlueMedicare Saver Rx (PDP) www.arkansasbluecross.com/medicare P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8663903369 8663903369 711 711 This plan does not charge an annual deductible for all drugs. The $325.00 annual deductible only applies to drugs on certain tiers.~ S5795 804 0 2021 Arkansas BCBS Std Def Employer CY 4 (PDP) www.arkansasbluecross.com P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8663903369 8663903369 711 711 S5795 809 0 2021 Arkansas BCBS Std Def Employer NCY 4 (PDP) www.arkansasbluecross.com P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8663903369 8663903369 711 711 S5795 811 0 2021 ABCBS Group Basic CY (PDP) www.arkansasbluecross.com P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8663903369 8663903369 711 711 S5795 812 0 2021 ABCBS Group Basic PY (PDP) www.arkansasbluecross.com P O Box 3648 Little Rock AR 72203 8886050322 8886050322 711 711 8663903369 8663903369 711 711 S5552 004 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This organization has plans available nationwide.~ S5552 005 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5552 006 0 2021 Humana Walmart Value Rx Plan (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8007060872 8007060872 711 711 8002816918 8002816918 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5552 801 0 2021 Humana Medicare Employer (PDP) www.humana.com/medicare 500 West Main Street Louisville KY 40202 8008248242 8008248242 711 711 8663968810 8663968810 711 711 This organization has plans available nationwide.~ S3389 802 0 2021 UPMC Employer Group (PDP) http://www.upmchealthplan.com/medicare/ upmchp@msx.upmc.edu 600 Grant Street Pittsburgh PA 15219 8773813765 8773813765 711 711 8775393080 8775393080 711 711 S3389 803 0 2021 UPMC Employer Group (PDP) http://www.upmchealthplan.com/medicare/ upmchp@msx.upmc.edu 600 Grant Street Pittsburgh PA 15219 8773813765 8773813765 711 711 8775393080 8775393080 711 711 S3521 801 0 2021 Simply Prescriptions- Employer Group (PDP) www.SimplyPrescriptions.com P.O. Box 211316 Eagan MN 55121 8778839577 8778839577 8006621220 8006621220 8778839577 8778839577 8006621220 8006621220 S3875 802 0 2021 Granite Alliance (PDP) www.mygraniterx.com GAICHelp@magellanhealth.com 170 South Main Street, Suite 900 Salt Lake City UT 84101 8555862573 8555862573 711 711 8555862573 8555862573 711 711 S3875 803 0 2021 Granite Alliance Non-CY (PDP) www.mygraniterx.com GAICHelp@magellanhealth.com 170 South Main Street, Suite 900 Salt Lake City UT 84101 8555862573 8555862573 711 711 8555862573 8555862573 711 711 S3875 804 0 2021 Granite Alliance (PDP) www.mygraniterx.com GAICHelp@magellanhealth.com 170 South Main Street, Suite 900 Salt Lake City UT 84101 8555862573 8555862573 711 711 8555862573 8555862573 711 711 S3875 805 0 2021 Granite Alliance Non-CY (PDP) www.mygraniterx.com GAICHelp@magellanhealth.com 170 South Main Street, Suite 900 Salt Lake City UT 84101 8555862573 8555862573 711 711 8555862573 8555862573 711 711 S3875 806 0 2021 Granite Alliance (PDP) www.mygraniterx.com GAICHelp@magellanhealth.com 170 South Main Street, Suite 900 Salt Lake City UT 84101 8555862573 8555862573 711 711 8555862573 8555862573 711 711 S3875 807 0 2021 Granite Alliance Non-CY (PDP) www.mygraniterx.com GAICHelp@magellanhealth.com 170 South Main Street, Suite 900 Salt Lake City UT 84101 8555862573 8555862573 711 711 8555862573 8555862573 711 711 S3875 808 0 2021 Granite Alliance (PDP) www.mygraniterx.com GAICHelp@magellanhealth.com 170 South Main Street, Suite 900 Salt Lake City UT 84101 8555862573 8555862573 711 711 8555862573 8555862573 711 711 S3875 809 0 2021 Granite Alliance Non-CY (PDP) www.mygraniterx.com GAICHelp@magellanhealth.com 170 South Main Street, Suite 900 Salt Lake City UT 84101 8555862573 8555862573 711 711 8555862573 8555862573 711 711 S3875 810 0 2021 Granite Alliance (PDP) www.mygraniterx.com GAICHelp@magellanhealth.com 170 South Main Street, Suite 900 Salt Lake City UT 84101 8555862573 8555862573 711 711 8555862573 8555862573 711 711 S3875 811 0 2021 Granite Alliance Non-CY (PDP) www.mygraniterx.com GAICHelp@magellanhealth.com 170 South Main Street, Suite 900 Salt Lake City UT 84101 8555862573 8555862573 711 711 8555862573 8555862573 711 711 S4219 801 0 2021 Health Alliance Group Medicare Prescription Plan (PDP) www.Healthalliancemedicare.org MemberServices@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8883829771 8883829771 711 711 8552919311 8552919311 711 711 S4219 802 0 2021 Medicare Employer PDP - non calendar year (PDP) www.Healthalliancemedicare.org MemberServices@healthalliance.org 3310 Fields South Drive Champaign IL 61822 8883829771 8883829771 711 711 8552919311 8552919311 711 711 S8677 803 0 2021 Providence Medicare Part D Group Plan (PDP) www.providencehealthassurance.com phpcustomerservice@providence.org P.O. Box 4327 Portland OR 97208 8004576064 5035745551 711 711 8006032340 5035748000 711 711 S6946 001 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 4016 Scranton PA 18505 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 002 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 003 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 004 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 005 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 006 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 007 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 008 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 009 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 010 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 011 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 012 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 013 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 014 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 015 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 016 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 017 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 018 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 019 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 020 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 021 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 022 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 023 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 024 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 025 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 026 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 027 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 028 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 029 0 2021 Clear Spring Health Value Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 S6946 030 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S6946 031 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S6946 032 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S6946 033 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S6946 034 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S6946 035 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S6946 036 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S6946 037 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S6946 038 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S6946 039 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S6946 040 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S6946 041 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S6946 042 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S6946 043 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S6946 044 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S6946 045 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S6946 046 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S6946 047 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S6946 048 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S6946 049 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S6946 050 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S6946 051 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S6946 052 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S6946 053 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S6946 054 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S6946 055 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S6946 056 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S6946 057 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S6946 058 0 2021 Clear Spring Health Premier Rx (PDP) www.clearspringhealthcare.com P.O. BOX 278470 Miramar FL 33027 8773176082 8773176082 711 711 8773176082 8773176082 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7694 001 0 2021 Elixir RxSecure (PDP) https://elixirinsurance.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 002 0 2021 Elixir RxSecure (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 003 0 2021 Elixir RxSecure (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 004 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 005 0 2021 Elixir RxSecure (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 006 0 2021 Elixir RxSecure (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 007 0 2021 Elixir RxSecure (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 008 0 2021 Elixir RxSecure (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 009 0 2021 Elixir RxSecure (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 010 0 2021 Elixir RxSecure (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 011 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 012 0 2021 Elixir RxSecure (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 014 0 2021 Elixir RxSecure (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 015 0 2021 Elixir RxSecure (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 016 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 017 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 018 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 019 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 020 0 2021 Elixir RxSecure (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 021 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 022 0 2021 Elixir RxSecure (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 023 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 024 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 025 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 026 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 027 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 028 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 029 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 030 0 2021 Elixir RxSecure (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 031 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 032 0 2021 Elixir RxSecure (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 033 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 034 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 070 0 2021 Elixir RxSecure (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 105 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 106 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This organization has plans available nationwide.~ S7694 121 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S7694 122 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S7694 123 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S7694 124 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S7694 125 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S7694 126 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S7694 127 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S7694 128 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S7694 129 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S7694 130 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S7694 131 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S7694 132 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S7694 133 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S7694 134 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S7694 135 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S7694 136 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S7694 137 0 2021 Elixir RxPlus (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd., Suite 201 Twinsburg OH 44087 8883771439 8883771439 711 711 8662502005 8662502005 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S7694 801 0 2021 Employer Plan Calendar Year (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd, Suite 201 Twinsburg OH 44087 8442934760 8442934760 711 711 8442934760 8442934760 711 711 This organization has plans available nationwide.~ S7694 802 0 2021 Employer Group Non-Calendar Year (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd, Suite 201 Twinsburg OH 44087 8442934760 8442934760 711 711 8442934760 8442934760 711 711 This organization has plans available nationwide.~ S7694 803 0 2021 Retiree RxCare 4TC (PDP) retireerxcare.amwins.com 50 Whitecap Drive North Kingstown RI 02852 8556933921 8556933921 711 711 8556933921 8556933921 711 711 This organization has plans available nationwide.~ S7694 804 0 2021 Retiree RxCare 5TC (PDP) retireerxcare.amwins.com 50 Whitecap Drive North Kingstown RI 02852 8556933921 8556933921 711 711 8556933921 8556933921 711 711 This organization has plans available nationwide.~ S7694 805 0 2021 Retiree RxCare 4TO (PDP) retireerxcare.amwins.com 50 Whitecap Drive North Kingstown RI 02852 8556933921 8556933921 711 711 8556933921 8556933921 711 711 This organization has plans available nationwide.~ S7694 806 0 2021 Retiree RxCare 5TO (PDP) retireerxcare.amwins.com 50 Whitecap Drive North Kingstown RI 02852 8556933921 8556933921 711 711 8556933921 8556933921 711 711 This organization has plans available nationwide.~ S7694 807 0 2021 Retiree RxCare Bronze (PDP) retireerxcare.amwins.com 50 Whitecap Drive North Kingstown RI 02852 8556933921 8556933921 711 711 8556933921 8556933921 711 711 This organization has plans available nationwide.~ S7694 808 0 2021 Employer Group Broad (PDP) https://envisionrxplus.com CustomerService@envisionrxplus.com 2181 E. Aurora Rd, Suite 201 Twinsburg OH 44087 8442934760 8442934760 711 711 8442934760 8442934760 711 711 This organization has plans available nationwide.~ E0654 801 0 2021 IBT Voluntary Employee Benefits Trust (Employer PDP) www.teamstarpartd.com 3700 S. Stonebridge Drive, P.O. Box 8080 McKinney TX 75070 8665244173 8665244173 711 711 8665244173 8665244173 711 711 S5960 167 0 2021 Medicare Rx Basic (PDP) shop.unicare.com/medicare Enrollment Processing Center, P.O. Box 659404 San Antonio TX 78265 8557931940 8557931940 711 711 8442096374 8442096374 711 711 S5960 801 0 2021 MedicareRx Rewards (PDP) shop.unicare.com/medicare Enrollment Processing Center, P.O. Box 110 Fond du Lac WI 54936 8332854638 8332854638 711 711 8664706265 8664706265 711 711 S5960 803 0 2021 MedicareRx Rewards (PDP) shop.unicare.com/medicare Enrollment Processing Center, P.O. Box 110 Fond du Lac WI 54936 8332854638 8332854638 711 711 8664706265 8664706265 711 711 S5596 084 0 2021 Anthem MediBlue Rx Enhanced (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931938 8557931938 711 711 8667552776 8667552776 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ S5596 803 0 2021 Blue MedicareRx (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 110 Fond du Lac WI 54936 8332854636 8332854636 711 711 8668300174 8668300174 711 711 S5596 804 0 2021 Blue MedicareRx (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 110 Fond du Lac WI 54936 8332854636 8332854636 711 711 8668300174 8668300174 711 711 S5596 001 0 2021 Anthem MediBlue Rx Plus (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931938 8557931938 711 711 8667552776 8667552776 711 711 S5596 005 0 2021 Anthem MediBlue Rx Standard (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931938 8557931938 711 711 8667552776 8667552776 711 711 S5596 006 0 2021 Anthem MediBlue Rx Plus (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931938 8557931938 711 711 8667552776 8667552776 711 711 S5596 009 0 2021 Anthem MediBlue Rx Standard (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659404 San Antonio TX 78265 8557931938 8557931938 711 711 8009286201 8009286201 711 711 S5596 010 0 2021 Anthem MediBlue Rx Plus (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659404 San Antonio TX 78265 8557931938 8557931938 711 711 8009286201 8009286201 711 711 S5596 013 0 2021 Anthem MediBlue Rx Standard (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931938 8557931938 711 711 8667552776 8667552776 711 711 S5596 014 0 2021 Anthem MediBlue Rx Plus (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931938 8557931938 711 711 8667552776 8667552776 711 711 S5596 017 0 2021 Anthem MediBlue Rx Standard (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931938 8557931938 711 711 8667552776 8667552776 711 711 S5596 018 0 2021 Anthem MediBlue Rx Plus (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931938 8557931938 711 711 8667552776 8667552776 711 711 S5596 033 0 2021 Anthem Blue Cross MediBlue Rx Standard (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659404 San Antonio TX 78265 8557931938 8557931938 711 711 8009286201 8009286201 711 711 S5596 034 0 2021 Anthem Blue Cross MediBlue Rx Plus (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659404 San Antonio TX 78265 8557931938 8557931938 711 711 8009286201 8009286201 711 711 S5596 043 0 2021 Blue MedicareRx Value (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931938 8557931938 711 711 8667552776 8667552776 711 711 S5596 044 0 2021 Blue MedicareRx Plus (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931938 8557931938 711 711 8667552776 8667552776 711 711 S5596 046 0 2021 Anthem MediBlue Rx Standard (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931938 8557931938 711 711 8667552776 8667552776 711 711 S5596 056 0 2021 Anthem MediBlue Rx Standard (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931938 8557931938 711 711 8667552776 8667552776 711 711 S5596 057 0 2021 Anthem MediBlue Rx Plus (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931938 8557931938 711 711 8667552776 8667552776 711 711 S5596 059 0 2021 Anthem MediBlue Rx Standard (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931938 8557931938 711 711 8667552776 8667552776 711 711 S5596 060 0 2021 Anthem MediBlue Rx Plus (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931938 8557931938 711 711 8667552776 8667552776 711 711 S5596 062 0 2021 Anthem MediBlue Rx Standard (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931938 8557931938 711 711 8332854639 8332854639 711 711 S5596 063 0 2021 Anthem MediBlue Rx Plus (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931938 8557931938 711 711 8667552776 8667552776 711 711 S5596 066 0 2021 Anthem MediBlue Rx Enhanced (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931938 8557931938 711 711 8332854639 8332854639 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ S5596 068 0 2021 Anthem MediBlue Rx Enhanced (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931938 8557931938 711 711 8332854639 8332854639 711 711 This plan does not charge an annual deductible for all drugs. The $330.00 annual deductible only applies to drugs on certain tiers.~ S5596 070 0 2021 Anthem MediBlue Rx Enhanced (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659404 San Antonio TX 78265 8557931938 8557931938 711 711 8009286201 8009286201 711 711 This plan does not charge an annual deductible for all drugs. The $310.00 annual deductible only applies to drugs on certain tiers.~ S5596 072 0 2021 Anthem MediBlue Rx Enhanced (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931938 8557931938 711 711 8667552776 8667552776 711 711 This plan does not charge an annual deductible for all drugs. The $340.00 annual deductible only applies to drugs on certain tiers.~ S5596 074 0 2021 Anthem MediBlue Rx Enhanced (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931938 8557931938 711 711 8667552776 8667552776 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ S5596 076 0 2021 Anthem Blue Cross MediBlue Rx Enhanced (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659404 San Antonio TX 78265 8557931938 8557931938 711 711 8009286201 8009286201 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ S5596 078 0 2021 Blue MedicareRx Enhanced (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931938 8557931938 711 711 8667552776 8667552776 711 711 This plan does not charge an annual deductible for all drugs. The $240.00 annual deductible only applies to drugs on certain tiers.~ S5596 080 0 2021 Anthem MediBlue Rx Enhanced (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931938 8557931938 711 711 8667552776 8667552776 711 711 This plan does not charge an annual deductible for all drugs. The $290.00 annual deductible only applies to drugs on certain tiers.~ S5596 082 0 2021 Anthem MediBlue Rx Enhanced (PDP) https://shop.anthem.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931938 8557931938 711 711 8667552776 8667552776 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ S5726 013 0 2021 Blue MedicareRx Value (PDP) https://shop.partdkansas.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931939 8557931939 711 711 8667552776 8667552776 711 711 S5726 014 0 2021 Blue MedicareRx Plus (PDP) https://shop.partdkansas.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931939 8557931939 711 711 8667552776 8667552776 711 711 S5726 019 0 2021 Blue MedicareRx Enhanced (PDP) https://shop.partdkansas.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931939 8557931939 711 711 8667552776 8667552776 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ S5726 805 0 2021 Blue MedicareRx (PDP) https://shop.partdkansas.com/medicare Enrollment Processing Center, P.O. Box 110 Fond du Lac WI 54936 8333485338 8333485338 711 711 8668300174 8668300174 711 711 S5584 001 0 2021 Prescription Blue Select (PDP) www.bcbsm.com/medicare 600 East Lafayette Blvd., MC TC1302 Detroit MI 48226 8554257720 8554257720 711 711 8005651770 8005651770 711 711 S5584 002 0 2021 Prescription Blue Premium (PDP) www.bcbsm.com/medicare 600 East Lafayette Blvd., MC TC1302 Detroit MI 48226 8554257720 8554257720 711 711 8005651770 8005651770 711 711 S5584 801 0 2021 Prescription Blue Employer Plan CY (PDP) www.bcbsm.com/medicare 600 East Lafayette Blvd., MC TC1302 Detroit MI 48226 8666848216 8666848216 711 711 8666848216 8666848216 711 711 S5584 802 0 2021 Prescription Blue Employer Plan non-CY (PDP) www.bcbsm.com/medicare 600 East Lafayette Blvd., MC TC1302 Detroit MI 48226 8666848216 8666848216 711 711 8666848216 8666848216 711 711 S1030 001 0 2021 BlueRx Enhanced Plus (PDP) www.bluerxalatenn.com 450 Riverchase Parkway East Birmingham AL 35244 8772333555 8772333555 711 711 8003273998 8003273998 711 711 S1030 006 0 2021 BlueRx Essential (PDP) www.bluerxalatenn.com 450 Riverchase Parkway East Birmingham AL 35244 8772333555 8772333555 711 711 8003273998 8003273998 711 711 S1030 010 0 2021 BlueRx Enhanced (PDP) www.bluerxalatenn.com 450 Riverchase Parkway East Birmingham AL 35244 8772333555 8772333555 711 711 8003273998 8003273998 711 711 S1030 801 0 2021 BlueRx Employer Group Plan 801 (PDP) www.bluerxalatenn.com 450 Riverchase Parkway East Birmingham AL 35244 8772333555 8772333555 711 711 8003773998 8003773998 711 711 S1030 802 0 2021 BlueRx Employer Group Plan 802 (PDP) www.bluerxalatenn.com 450 Riverchase Parkway East Birmingham AL 35244 8772333555 8772333555 711 711 8003773998 8003773998 711 711 S1030 803 0 2021 BlueRx Employer Group Plan 803 (PDP) www.bluerxalatenn.com 450 Riverchase Parkway East Birmingham AL 35244 8772333555 8772333555 711 711 8003273998 8003273998 711 711 S1030 804 0 2021 BlueRx Employer Group Plan 804 (PDP) www.bluerxalatenn.com 450 Riverchase Parkway East Birmingham AL 35244 8772333555 8772333555 711 711 8003273998 8003273998 711 711 S1030 805 0 2021 BlueRx Employer Group Plan 805 (PDP) www.bluerxalatenn.com 450 Rivierchase Parkway Birmingham AL 35244 8554535185 8554535185 711 711 8554535185 8554535185 711 711 S1822 801 0 2021 HealthPartners Retiree National Choice CY (PDP) healthpartners.com/medicare 8170 33rd Avenue South Bloomington MN 55425 8669937428 9528837428 711 711 8778169539 9528837373 711 711 S1822 802 0 2021 HealthPartners Retiree National Choice NCY (PDP) healthpartners.com/medicare 8170 33rd Avenue South Bloomington MN 55425 8669937428 9528837428 711 711 8778169539 9528837373 711 711 S6506 001 0 2021 Blue MedicareRx Value (PDP) www.YourAZMedicareSolutions.com 25 Lakeview Drive Jessup PA 18434 8004220761 8004220761 711 711 8332293593 8332293593 711 711 S6506 002 0 2021 Blue MedicareRx Enhanced (PDP) www.YourAZMedicareSolutions.com 25 Lakeview Drive Jessup PA 18434 8004220761 8004220761 711 711 8332293593 8332293593 711 711 S6506 003 0 2021 Blue MedicareRx Essential (PDP) www.YourAZMedicareSolutions.com 25 Lakeview Drive Jessup PA 18434 8004220761 8004220761 711 711 8332293593 8332293593 711 711 This plan does not charge an annual deductible for all drugs. The $180.00 annual deductible only applies to drugs on certain tiers.~ S6506 801 0 2021 Blue MedicareRx for Groups (PDP) www.YourAZMedicareSolutions.com 25 Lakeview Drive Jessup PA 18434 8004220761 8004220761 711 711 8332293593 8332293593 711 711 S5715 001 0 2021 Blue Cross MedicareRx Value (PDP) www.getblueil.com/pdp PO Box 3897 Scranton PA 18505 8772131817 8772131817 711 711 8882852249 8882852249 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S5715 002 0 2021 Blue Cross MedicareRx Plus (PDP) www.getblueil.com/pdp PO Box 3897 Scranton PA 18505 8772131817 8772131817 711 711 8882852249 8882852249 711 711 S5715 003 0 2021 Blue Cross MedicareRx Value (PDP) www.getbluenm.com/pdp PO Box 3897 Scranton PA 18505 8772131817 8772131817 711 711 8882852249 8882852249 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S5715 004 0 2021 Blue Cross MedicareRx Plus (PDP) www.getbluenm.com/pdp PO Box 3897 Scranton PA 18505 8772131817 8772131817 711 711 8882852249 8882852249 711 711 S5715 005 0 2021 Blue Cross MedicareRx Value (PDP) www.getbluetx.com/pdp PO Box 3897 Scranton PA 18505 8772131817 8772131817 711 711 8882852249 8882852249 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S5715 006 0 2021 Blue Cross MedicareRx Plus (PDP) www.getbluetx.com/pdp PO Box 3897 Scranton PA 18505 8772131817 8772131817 711 711 8882852249 8882852249 711 711 S5715 010 0 2021 Blue Cross MedicareRx Value (PDP) www.getblueok.com/pdp PO Box 3897 Scranton PA 18505 8772131817 8772131817 711 711 8882852249 8882852249 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S5715 012 0 2021 Blue Cross MedicareRx Basic (PDP) www.getblueil.com/pdp PO Box 3897 Scranton PA 18505 8772131817 8772131817 711 711 8882852249 8882852249 711 711 S5715 013 0 2021 Blue Cross MedicareRx Basic (PDP) www.getbluenm.com/pdp PO Box 3897 Scranton PA 18505 8772131817 8772131817 711 711 8882852249 8882852249 711 711 S5715 014 0 2021 Blue Cross MedicareRx Basic (PDP) www.getbluetx.com/pdp PO Box 3897 Scranton PA 18505 8772131817 8772131817 711 711 8882852249 8882852249 711 711 S5715 015 0 2021 Blue Cross MedicareRx Basic (PDP) www.getblueok.com/pdp PO Box 3897 Scranton PA 18505 8772131817 8772131817 711 711 8882852249 8882852249 711 711 S5715 018 0 2021 Blue Cross MedicareRx Choice (PDP) www.getblueok.com/pdp PO Box 3897 Scranton PA 18505 8772131817 8772131817 711 711 8882852249 8882852249 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S5715 801 0 2021 Blue Cross Group MedicareRx Plan (PDP) www.hcsc.com PO Box 3897 Scranton PA 18505 8772131817 8772131817 711 711 8778383833 8778383833 711 711 S5715 802 0 2021 Blue Cross Group MedicareRx Plan (PDP) www.hcsc.com PO Box 3897 Scranton PA 18505 8772131817 8772131817 711 711 8778383833 8778383833 711 711 S5715 803 0 2021 Blue Cross Group MedicareRx Plan (PDP) www.hcsc.com PO Box 3897 Scranton PA 18505 8772131817 8772131817 711 711 8778383833 8778383833 711 711 S5715 807 0 2021 Blue Cross Group MedicareRx Plan (PDP) www.hcsc.com PO Box 3897 Scranton PA 18505 8772131817 8772131817 711 711 8778383833 8778383833 711 711 S5715 809 0 2021 Blue Cross Group MedicareRx Plan (PDP) www.hcsc.com PO Box 3897 Scranton PA 18505 8772131817 8772131817 711 711 8778383833 8778383833 711 711 S5715 811 0 2021 Blue Cross Group MedicareRx Plan (PDP) www.hcsc.com PO Box 3897 Scranton PA 18505 8772131817 8772131817 711 711 8778383833 8778383833 711 711 S5715 813 0 2021 Blue Cross Group MedicareRx Plan (PDP) www.hcsc.com PO Box 3897 Scranton PA 18505 8772131817 8772131817 711 711 8778383833 8778383833 711 711 S5715 815 0 2021 Blue Cross Group MedicareRx Plan (PDP) www.hcsc.com PO Box 3897 Scranton PA 18505 8772131817 8772131817 711 711 8778383833 8778383833 711 711 S5715 817 0 2021 Blue Cross Group MedicareRx Plan (PDP) www.hcsc.com PO Box 3897 Scranton PA 18505 8772131817 8772131817 711 711 8778383833 8778383833 711 711 S5715 818 0 2021 Blue Cross Group MedicareRx Plan (PDP) www.hcsc.com PO Box 3897 Scranton PA 18505 8772131817 8772131817 711 711 8778383833 8778383833 711 711 S5715 819 0 2021 Blue Cross Group MedicareRx Plan (PDP) www.hcsc.com PO Box 3897 Scranton PA 18505 8772131817 8772131817 711 711 8778383833 8778383833 711 711 S5715 820 0 2021 Blue Cross Group MedicareRx Plan (PDP) www.hcsc.com PO Box 3897 Scranton PA 18505 8772131817 8772131817 711 711 8778383833 8778383833 711 711 S5715 821 0 2021 Blue Cross Group MedicareRx Plan (PDP) www.hcsc.com PO Box 3897 Scranton PA 18505 8772131817 8772131817 711 711 8778383833 8778383833 711 711 S5715 822 0 2021 Blue Cross Group MedicareRx Plan (PDP) www.hcsc.com PO Box 3897 Scranton PA 18505 8772131817 8772131817 711 711 8778383833 8778383833 711 711 S9701 801 0 2021 Navitus MedicareRx (PDP) https://medicarerx.navitus.com/ 1025 West Navitus Drive Appleton WI 54913 8662703877 8662703877 711 711 8662703877 8662703877 711 711 S9701 802 0 2021 Navitus MedicareRx (PDP) https://medicarerx.navitus.com/ 1025 West Navitus Drive Appleton WI 54913 8662703877 8662703877 711 711 8662703877 8662703877 711 711 S9701 803 0 2021 Navitus MedicareRx (PDP) https://medicarerx.navitus.com/ 1025 West Navitus Drive Appleton WI 54913 8662703877 8662703877 711 711 8662703877 8662703877 711 711 S9701 804 0 2021 Navitus MedicareRx (PDP) https://medicarerx.navitus.com/ 1025 West Navitus Drive Appleton WI 54913 8662703877 8662703877 711 711 8662703877 8662703877 711 711 S9701 807 0 2021 Navitus MedicareRx (PDP) https://medicarerx.navitus.com/ 1025 West Navitus Drive Appleton WI 54913 8662703877 8662703877 711 711 8662703877 8662703877 711 711 S4802 012 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 013 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 014 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 020 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 021 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 069 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 070 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 071 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 072 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 073 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 074 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 075 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 076 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 077 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 078 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 079 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 080 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 081 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 082 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 083 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 084 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 085 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 086 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 087 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 088 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 089 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 090 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 091 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 092 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 093 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 094 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 095 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 096 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 097 0 2021 WellCare Classic (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This organization has plans available nationwide.~ S4802 132 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 133 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 134 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 135 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 136 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 137 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 138 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 139 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 140 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 141 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 142 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 143 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 144 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 145 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 146 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 147 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 148 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 149 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 150 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 151 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 152 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 153 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 154 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 155 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 156 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 157 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 158 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 159 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 160 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 161 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 162 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 163 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 164 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 165 0 2021 WellCare Value Script (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 170 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 171 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 172 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 173 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 174 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 175 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 176 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 177 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 178 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 179 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 180 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 181 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 182 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 183 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 184 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 185 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 186 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 187 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 188 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 189 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 190 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 191 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 192 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 193 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 194 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 195 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 196 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 197 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 198 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 199 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 200 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 201 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 202 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4802 203 0 2021 WellCare Wellness Rx (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8885505252 8885505252 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S4501 812 0 2021 Pharmacy Benefit Dimensions PDP-12 (WD) (PDP) www.pbdrx.com memberservice@servicing.independenthealth.com 511 Farber Lakes Dr Buffalo NY 14221 8006651502 7162504401 711 711 8006675936 7165044444 711 711 S4501 813 0 2021 Pharmacy Benefit Dimensions PDP-13 (WD) (PDP) www.pbdrx.com memberservice@servicing.independenthealth.com 511 Farber Lakes Dr Buffalo NY 14221 8006651502 7162504401 711 711 8006675936 7165044444 711 711 S4501 814 0 2021 Pharmacy Benefit Dimensions PDP-14 (PDP) www.pbdrx.com memberservice@servicing.independenthealth.com 511 Farber Lakes Dr Buffalo NY 14221 8006651502 7162504401 711 711 8006675936 7165044444 711 711 S4501 815 0 2021 Pharmacy Benefit Dimensions PDP-15 (PDP) www.pbdrx.com memberservice@servicing.independenthealth.com 511 Farber Lakes Dr Buffalo NY 14221 8006651502 7162504401 711 711 8006675936 7165044444 711 711 S4501 816 0 2021 Pharmacy Benefit Dimensions PDP-16 (PDP) www.pbdrx.com memberservice@servicing.independenthealth.com 511 Farber Lakes Dr Buffalo NY 14221 8006651502 7162504401 711 711 8006675936 7165044444 711 711 S4501 801 0 2021 Pharmacy Benefit Dimensions PDP-1 (PDP) independenthealth.com/medicare memberservice@servicing.independenthealth.com 511 Farber Lakes Drive Buffalo NY 14221 8009584405 7166354900 711 711 8006675936 7165044444 711 711 S4501 802 0 2021 Pharmacy Benefit Dimensions PDP-2 (PDP) www.independenthealth.com memberservice@servicing.independenthealth.com 511 Farber Lakes Dr Buffalo NY 14221 8006651502 7162504401 711 711 8006675936 7165044444 711 711 S4501 803 0 2021 Pharmacy Benefit Dimensions PDP-3 (PDP) independenthealth.com memberservice@servicing.independenthealth.com 511 Farber Lakes Dr Buffalo NY 14221 8006651502 7162504401 711 711 8006675936 7165044444 711 711 S4501 804 0 2021 Pharmacy Benefit Dimensions PDP-4 (PDP) www.independenthealth.com memberservice@servicing.independenthealth.com 511 Farber Lakes Dr Buffalo NY 14221 8006651502 7162504401 711 711 8006675936 7165044444 711 711 S4501 805 0 2021 Pharmacy Benefit Dimensions PDP-5 (PDP) www.independenthealth.com memberservice@servicing.independenthealth.com 511 Farber Lakes Dr Buffalo NY 14221 8006651502 7162504401 711 711 8006675936 7165044444 711 711 S4501 806 0 2021 Pharmacy Benefit Dimensions PDP-6 (PDP) www.independenthealth.com memberservice@servicing.independenthealth.com 511 Farber Lakes Dr Buffalo NY 14221 8006651502 7162504401 711 711 8006675936 7165044444 711 711 S4501 807 0 2021 Pharmacy Benefit Dimensions PDP-7 (PDP) www.independenthealth.com memberservice@servicing.independenthealth.com 511 Farber Lakes Dr Buffalo NY 14221 8006651502 7162504401 711 711 8006675936 7165044444 711 711 S4501 808 0 2021 Pharmacy Benefit Dimemsions PDP-8 (WD) (PDP) www.pbdrx.com memberservice@servicing.independenthealth.com 511 Farber Lakes Dr Buffalo NY 14221 8006651502 7162504401 711 711 8006675936 7165044444 711 711 S4501 809 0 2021 Pharmacy Benefit Dimensions PDP-9 (WD) (PDP) www.pbdrx.com memberservice@servicing.independenthealth.com 511 Farber Lakes Dr Buffalo NY 14221 8006651502 7162504401 711 711 8006675936 7165044444 711 711 S4501 810 0 2021 Pharmacy Benefit Dimensions PDP-10 (WD) (PDP) www.pbdrx.com memberservice@servicing.independenthealth.com 511 Farber Lakes Dr Buffalo NY 14221 8006651502 7162504401 711 711 8006675936 7165044444 711 711 S4501 811 0 2021 Pharmacy Benefit Dimensions PDP-11 (WD) (PDP) www.pbdrx.com memberservice@servicing.independenthealth.com 511 Farber Lakes Dr Buffalo NY 14221 8006651502 7162504401 711 711 8006675936 7165044444 711 711 S5450 801 0 2021 BlueScripts (PDP) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8884765072 8884765072 711 711 8008180962 8008180962 711 711 S5450 802 0 2021 BlueScripts (PDP) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8884765072 8884765072 711 711 8008180962 8008180962 711 711 S5450 803 0 2021 BlueScripts (PDP) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8884765072 8884765072 711 711 8008180962 8008180962 711 711 S5450 804 0 2021 BlueScripts (PDP) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8884765072 8884765072 711 711 8008180962 8008180962 711 711 S5450 805 0 2021 BlueScripts (PDP) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8884765072 8884765072 711 711 8008180962 8008180962 711 711 S5450 806 0 2021 BlueScripts (PDP) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8884765072 8884765072 711 711 8008180962 8008180962 711 711 S5450 807 0 2021 BlueScripts (PDP) bcbstmedicare.com 1 Cameron Hill Circle Chattanooga TN 37402 8884765072 8884765072 711 711 8008180962 8008180962 711 711 S2668 005 0 2021 Farm Bureau Essential Rx (PDP) www.fbhealthplans.com/part-d P.O. Box 266380 Weston FL 33326 8443688738 8443688738 711 711 8666436924 8666436924 711 711 S2668 006 0 2021 Farm Bureau Select Rx (PDP) www.fbhealthplans.com/part-d/ P.O. Box 266380 Weston FL 33326 8443688738 8443688738 711 711 8666436924 8666436924 711 711 S5820 817 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 818 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 819 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 820 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 821 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 822 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 823 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 824 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 825 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 826 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 827 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 828 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 829 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 830 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 831 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 832 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 833 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 834 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.AARPMedicareRx.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 835 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.AARPMedicareRx.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 836 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.AARPMedicareRx.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 001 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 002 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 003 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 004 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 005 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 006 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 007 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 008 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 009 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 010 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 011 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 012 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 013 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 014 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 015 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 016 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 017 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 018 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 019 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 020 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 021 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 022 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 023 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 024 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 025 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 026 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 027 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 028 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 029 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 030 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 031 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 032 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8667749679 8667749679 711 711 This organization has plans available nationwide.~ S5820 033 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8668681394 8668681394 711 711 This organization has plans available nationwide.~ S5820 034 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8775217035 8775217035 711 711 This organization has plans available nationwide.~ S5820 035 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8775217034 8775217034 711 711 This organization has plans available nationwide.~ S5820 036 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8775217034 8775217034 711 711 This organization has plans available nationwide.~ S5820 037 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 038 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5820 803 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 804 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 807 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 808 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 810 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 811 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 812 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 813 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 814 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 815 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5820 816 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S2468 003 0 2021 Blue Shield Rx Plus (PDP) blueshieldca.com/medicare 6300 Canoga Avenue Woodland Hills CA 91367 8882927591 8882927591 711 711 8882396469 8882396469 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S2468 004 0 2021 Blue Shield Rx Enhanced (PDP) blueshieldca.com/medicare 6300 Canoga Avenue Woodland Hills CA 91367 8882927591 8882927591 711 711 8882396469 8882396469 711 711 S2468 801 0 2021 Blue Shield of California Medicare Rx Plan (PDP) blueshieldca.com/medicare 6300 Canoga Avenue Woodland Hills CA 91367 8882396469 8882396469 711 711 8882396469 8882396469 711 711 S2468 802 0 2021 Blue Shield of California Medicare Rx Plan (PDP) blueshieldca.com/medicare 6300 Canoga Avenue Woodland Hills CA 91367 8882396469 8882396469 711 711 8882396469 8882396469 711 711 S7126 001 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 711 711 8558646797 8558646797 8007163231 8007163231 S7126 002 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 003 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 004 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 005 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 006 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 007 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 008 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 009 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 010 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 011 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 012 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 013 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 014 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 015 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 016 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 017 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 018 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 019 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 020 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 021 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 022 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 023 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 024 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 025 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 026 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 027 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 028 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 029 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 030 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 031 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 032 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 033 0 2021 Mutual of Omaha Rx Plus (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 S7126 071 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 072 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 073 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 074 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 075 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 076 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 077 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 078 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 079 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 080 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 081 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 082 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 083 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 084 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 085 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 086 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 087 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 088 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 089 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 090 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 091 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 092 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 093 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 094 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 095 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 096 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 097 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 098 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 099 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 100 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 101 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 102 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S7126 103 0 2021 Mutual of Omaha Rx Premier (PDP) www.mutualofomaharx.com PO Box 66535 St. Louis MO 63166 8009619006 8009619006 8005846939 8005846939 8558646797 8558646797 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~ S5588 802 0 2021 Paramount Std. Prescription Drug Plan Empl (PDP) paramounthealthcare.com brianna.eighmey@promedica.org P.O. Box 928 Toledo OH 43697 8004623589 4198872525 8887405670 8887405670 8004623589 4198872525 8887405670 8887405670 S5588 803 0 2021 Paramount Enh. Prescription Drug Plan Empl (PDP) paramounthealthcare.com brianna.eighmey@promedica.org P.O. Box 928 Toledo OH 43697 8004623589 4198872525 8887405670 8887405670 8004623589 4198872525 8887405670 8887405670 S5609 001 0 2021 Asuris Medicare Script Basic (PDP) www.asuris.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693172 8883693172 711 711 8005418981 8005418981 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~ S5609 002 0 2021 Asuris Medicare Script Enhanced (PDP) www.asuris.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883693172 8883693172 711 711 8005418981 8005418981 711 711 S5609 802 0 2021 Asuris Medicare Script (PDP) www.asuris.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883198904 8883198904 711 711 8883198904 8883198904 711 711 S5609 804 0 2021 Asuris Medicare Script 02 (PDP) www.asuris.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883198904 8883198904 711 711 8883198904 8883198904 711 711 S5609 805 0 2021 Asuris Medicare Script 03 (PDP) www.asuris.com/medicare PO Box 1827, M/S B32G Medford OR 97501 8883198904 8883198904 711 711 8883198904 8883198904 711 711 S5966 003 0 2021 EmblemHealth VIP Rx (PDP) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8774447241 8774447241 711 711 S5966 004 0 2021 EmblemHealth VIP Rx Plus (PDP) emblemhealth.com/medicare PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8774447241 8774447241 711 711 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~ S5966 803 0 2021 EmblemHealth National Drug Plan (PDP) www.emblemhealth.com PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8005855786 8005855786 711 711 S5966 804 0 2021 EmblemHealth National Drug Plan (PDP) www.emblemhealth.com PO Box 4001 Farmington CT 06034 8004479169 8004479169 711 711 8005855786 8005855786 711 711 E3014 801 0 2021 PSERS Health Options Program (Employer PDP) www.hopbenefits.com 1280 N. Plum St. Lancaster PA 17601 8007737725 8007737725 8004985428 8004985428 8882391301 8882391301 8004985428 8004985428 E3014 802 0 2021 PSERS Health Options Program Value (Employer PDP) www.hopbenefits.com 1280 N. Plum St. Lancaster PA 17601 8007737725 8007737725 8004985428 8004985428 8882391301 8882391301 8004985428 8004985428 X0001 010 0 2021 Limited Income NET Program (Point-of-Sale CTR) www.humana.com/LINET P.O. Box 14310 Lexington KY 40512 8007831307 8007831307 711 711 8007831307 8007831307 711 711 X0001 011 0 2021 Limited Income NET Program (Point-of-Sale CTR) www.humana.com/LINET P.O. Box 14310 Lexington KY 40512 8007831307 8007831307 711 711 8007831307 8007831307 711 711 S5540 002 0 2021 Blue Medicare Rx Standard (PDP) https://www.bluecrossnc.com/medicare PO Box 17509 Winston Salem NC 27116 8006615518 8006615518 711 711 8882474142 8882474142 711 711 This plan does not charge an annual deductible for all drugs. The $365.00 annual deductible only applies to drugs on certain tiers.~ S5540 004 0 2021 Blue Medicare Rx Enhanced (PDP) https://www.bluecrossnc.com/medicare PO Box 17509 Winston Salem NC 27116 8006615518 8006615518 711 711 8882474142 8882474142 711 711 S5540 801 0 2021 Blue Medicare Rx EGWP (PDP) https://www.bluecrossnc.com/medicare PO Box 17509 Winston Salem NC 27116 8006615518 8006615518 711 711 8882474142 8882474142 711 711 S5540 802 0 2021 Blue Medicare Rx EGWP Value (PDP) https://www.bluecrossnc.com/medicare PO Box 17509 Winston Salem NC 27116 8006615518 8006615518 711 711 8882474142 8882474142 711 711 S5540 803 0 2021 Blue Medicare Rx EGWP Complete (PDP) https://www.bluecrossnc.com/medicare P.O. Box 17509 Winston Salem NC 27116 8006615518 8006615518 711 711 8882474142 8882474142 711 711 S2874 001 0 2021 Humana Premier Rx Plan (PDP) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8006813625 8006813625 711 711 8667735959 8667735959 711 711 This plan does not charge an annual deductible for all drugs. The $305.00 annual deductible only applies to drugs on certain tiers.~ S2874 004 0 2021 Humana Basic Rx Plan (PDP) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8006813625 8006813625 711 711 8667735959 8667735959 711 711 S2874 801 0 2021 Humana Medicare Employer (PDP) www.humana.com/medicare MedicarePRTeam@humana.com PO Box 195560 San Juan PR 00919 8667735959 8667735959 711 711 8667735959 8667735959 711 711 S0586 801 0 2021 MVP RxCare - Employer Group (PDP) www.mvphealthcare.com memberservices@mvphealthcare.com 220 Alexander St., Medicare Sales Rochester NY 14607 8003243899 8003243899 8006621220 8006621220 8664948829 8664948829 711 711 S5810 035 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 036 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 037 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 038 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 039 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 040 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 041 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 042 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 043 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 044 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 045 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 046 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 047 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 048 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 049 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 050 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 051 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 052 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 053 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 054 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 055 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 056 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 057 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 058 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 059 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 060 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 061 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 062 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 063 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 064 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 065 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 066 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 067 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 068 0 2021 WellCare Medicare Rx Saver (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This organization has plans available nationwide.~ S5810 276 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 277 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 278 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $345.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 279 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $425.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 280 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $415.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 281 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 282 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $365.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 283 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 284 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 285 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 286 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 287 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $315.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 288 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 289 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $415.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 290 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 291 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 292 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $385.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 293 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $415.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 294 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 295 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $385.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 296 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 297 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $330.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 298 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 299 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $415.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 300 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 301 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $400.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 302 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 303 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 304 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 305 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 306 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 307 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $425.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 308 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5810 309 0 2021 WellCare Medicare Rx Select (PDP) www.wellcare.com/PDP ricardo.morales@wellcare.com Attn: Pre Enrollment, PO Box 31685 Tampa FL 33631 8668599084 8668599084 711 711 8332074241 8332074241 711 711 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S8841 803 0 2021 OptumRx CORE Silver 2021 - CY (PDP) www.optum.com 2441 Warrenville Road Lisle IL 60532 8664431095 8664431095 711 711 8664431095 8664431095 711 711 S8841 804 0 2021 OptumRx CORE Silver 2021 - NCY (PDP) www.optum.com 2441 Warrenville Road Lisle IL 60532 8664431095 8664431095 711 711 8664431095 8664431095 711 711 S8841 807 0 2021 OptumRx CORE Bronze 2021 - CY (PDP) www.optum.com 2441 Warrenville Road Lisle IL 60532 8664431095 8664431095 711 711 8664431095 8664431095 711 711 S8841 808 0 2021 OptumRx CORE Bronze 2021 - NCY (PDP) www.optum.com 2441 Warrenville Road Lisle IL 60532 8664431095 8664431095 711 711 8664431095 8664431095 711 711 S8841 810 0 2021 MPSERS 2021 (PDP) www.optum.com 2441 Warrenville Road Lisle IL 60532 8555776517 8555776517 711 711 8555776517 8555776517 711 711 S8841 812 0 2021 OptumRx CORE Gold 5-Tier 2021 - CY (PDP) www.optum.com 2441 Warrenville Rd Lisle IL 60532 8664431095 8664431095 711 711 8664431095 8664431095 711 711 S8841 813 0 2021 OptumRx CORE Gold 5-Tier 2021 - NCY (PDP) www.optum.com 2441 Warrenville Rd Lisle IL 60532 8664431095 8664431095 711 711 8664431095 8664431095 711 711 S8841 814 0 2021 OptumRx CORE PDP 2021 - CY (PDP) www.optum.com 2441 Warrenville Road Lisle IL 60532 8664431095 8664431095 711 711 8664431095 8664431095 711 711 S8841 815 0 2021 OptumRx CORE PDP 2021 - NCY (PDP) www.optum.com 2441 Warrenville Road Lisle IL 60532 8664431095 8664431095 711 711 8664431095 8664431095 711 711 S8841 816 0 2021 OptumRx CORE Copper 2021 - CY (PDP) www.optum.com 2441 Warrenville Road Lisle IL 60532 8664431095 8664431095 711 711 8664431095 8664431095 711 711 S8841 817 0 2021 OptumRx CORE Copper 2021 - NCY (PDP) www.optum.com 2441 Warrenwille Road Lisle IL 60532 8664431095 8664431095 711 711 8664431095 8664431095 711 711 S5983 004 0 2021 Express Scripts Medicare - Value (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584570 8007584570 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $445 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5983 006 0 2021 Express Scripts Medicare - Choice (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584570 8007584570 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5983 007 0 2021 Express Scripts Medicare - Saver (PDP) www.express-scriptsmedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584570 8007584570 8007163231 8007163231 This plan does not charge an annual deductible for all drugs. The $285.00 annual deductible only applies to drugs on certain tiers.~This organization has plans available nationwide.~ S5983 805 0 2021 Express Scripts Medicare (PDP) www.Express-ScriptsMedicare.com PO Box 66535 ST LOUIS MO 63166 8664775704 8664775704 8007163231 8007163231 8007584570 8007584570 8007163231 8007163231 This organization has plans available nationwide.~ S5805 001 0 2021 AARP MedicareRx Preferred (PDP) www.AARPMedicarePlans.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8888675575 8888675575 711 711 This organization has plans available nationwide.~ S5805 803 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 804 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 807 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 808 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 809 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 810 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 811 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 812 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 813 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 814 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 815 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 816 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 818 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 819 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 820 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 821 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 822 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 823 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 824 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 825 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 826 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 827 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 828 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 829 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 830 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 831 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 832 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 833 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 834 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 835 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.UHCRetiree.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 836 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.AARPMedicareRx.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 837 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.AARPMedicareRx.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5805 838 0 2021 UnitedHealthcare MedicareRx for Groups (PDP) www.AARPMedicareRx.com P.O. Box 30770 Salt Lake City UT 84130 8888675564 8888675564 711 711 8885566648 8885566648 711 711 This organization has plans available nationwide.~ S5877 803 0 2021 Alpine School District Retiree Plan (PDP) www.emihealth.com 5101 South Commerce Drive Murray UT 84107 8006625851 8012627476 8006625851 8012627476 8006625851 8012627476 8006625851 8012627476 S5877 804 0 2021 Educators Mutual Retiree Plan (PDP) www.emihealth.com 5101 South Commerce Drive Murray UT 84107 8006625851 8012627476 8006625851 8012627476 8006625851 8012627476 8006625851 8012627476 S5904 001 0 2021 BlueMedicare Premier Rx (PDP) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 This plan does not charge an annual deductible for all drugs. The $405.00 annual deductible only applies to drugs on certain tiers.~ S5904 002 0 2021 BlueMedicare Complete Rx (PDP) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 S5904 801 0 2021 BlueMedicare Group Rx (PDP) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 S5904 802 0 2021 BlueMedicare Group Rx (PDP) FloridaBlue.com/medicare 4800 Deerwood Campus Pkwy, DCC Bldg 400 / 3rd Floor Jacksonville FL 32246 8556019465 8556019465 8009558770 8009558770 8009266565 8009266565 8009558770 8009558770 S8182 001 0 2021 Amerivantage Rx Basic (PDP) shop.amerigroup.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931941 8557931941 711 711 8442095420 8442095420 711 711 S8182 002 0 2021 Amerivantage Rx Enhanced (PDP) shop.amerigroup.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931941 8557931941 711 711 8442095420 8442095420 711 711 This plan does not charge an annual deductible for all drugs. The $340.00 annual deductible only applies to drugs on certain tiers.~ S8182 003 0 2021 Amerivantage Rx Basic (PDP) shop.amerigroup.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931941 8557931941 711 711 8442095420 8442095420 711 711 S8182 004 0 2021 Amerivantage Rx Enhanced (PDP) shop.amerigroup.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931941 8557931941 711 711 8442095420 8442095420 711 711 This plan does not charge an annual deductible for all drugs. The $350.00 annual deductible only applies to drugs on certain tiers.~ S8182 005 0 2021 Amerivantage Rx Plus (PDP) shop.amerigroup.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931941 8557931941 711 711 8442095420 8442095420 711 711 S8182 006 0 2021 Amerivantage Rx Plus (PDP) shop.amerigroup.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8557931941 8557931941 711 711 8442095420 8442095420 711 711 S3375 001 0 2021 Blue Rx Standard (PDP) shop.bluerxny.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8555230689 8555230689 711 711 8335521045 8335521045 711 711 S3375 002 0 2021 Blue Rx Plus (PDP) shop.bluerxny.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8555230689 8555230689 711 711 8335521045 8335521045 711 711 S3375 003 0 2021 Blue Rx Enhanced (PDP) shop.bluerxny.com/medicare Enrollment Processing Center, P.O. Box 659403 San Antonio TX 78265 8555230689 8555230689 711 711 8335521045 8335521045 711 711 This plan does not charge an annual deductible for all drugs. The $325.00 annual deductible only applies to drugs on certain tiers.~ S9325 001 0 2021 Exemplar Health Enhanced (PDP) https://www.exemplar-health.com member.services@exemplarhpo.com 1107 West Market Center Drive High Point NC 27260 8882172376 8882172376 711 711 8882172376 8882172376 711 711 S9325 002 0 2021 Exemplar Health Basic (PDP) https://www.exemplar-health.com member.services@exemplarhpo.com 1107 West Market Center Drive High Point NC 27260 8882172376 8882172376 711 711 8882172376 8882172376 711 711 S9325 003 0 2021 Exemplar Health Enhanced (PDP) https://www.exemplar-health.com member.services@exemplarhpo.com 1107 West Market Center Drive High Point NC 27260 8882172376 8882172376 711 711 8882172376 8882172376 711 711 S9325 004 0 2021 Exemplar Health Basic (PDP) https://www.exemplar-health.com member.services@exemplarhpo.com 1107 West Market Center Drive High Point NC 27260 8882172376 8882172376 711 711 8882172376 8882172376 711 711 S2465 801 0 2021 Optima Medicare - Calendar Year (PDP) www.optimahealth.com/medicare KRBROGAN@sentara.com 4417 Corporation Lane Virginia Beach VA 23462 8445634201 8445634201 8008281140 711 8009276048 8009276048 8008281140 711 S2465 802 0 2021 Optima Medicare Non-Calendar Year (PDP) www.optimahealth.com/medicare KRBROGAN@sentara.com 4417 Corporation Lane Virginia Beach VA 23462 8445634201 8445634201 8008281140 711 8009276048 8009276048 8008281140 711