2019 Medicare Advantage Plans in
Philadelphia County Pennsylvania

There are 40 Medicare Advantage Plans available in Philadelphia County PA from 12 different health insurance providers. 10 of these Medicare Advantage plans offer additional gap coverage. The plan with the lowest out of pocket expense is $3200 and the highest out of pocket is $6700. Philadelphia County Pennsylvania residents can also pick from 15 Medicare Special Needs Plans. The highest rated plan available in Philadelphia County received a 4.5 overall star rating from CMS and the lowest rated plan is 3 stars


(Click the Plan Name for More Details)
(⇅ Click the Header to Sort)

Name ⇅ Premium Deductible MOOP Gap Click
for
Formulary
Plan
Rating
Sign
Up
Advantra Gold (PPO)
$67.00 $0 $6,600 YesBrowse
Formulary
Enroll
Advantra Silver (HMO)
$0 $0 $6,700 YesBrowse
Formulary
Enroll
Advantra Southeast Prime (HMO)
$0 $0 $6,700 YesBrowse
Formulary
AdvantraOne (PPO)
$0 $395.00 $6,700 YesBrowse
Formulary
Enroll
Aetna Medicare Choice Plan (HMO)
$0 $0 $6,700 YesBrowse
Formulary
Enroll
Aetna Medicare Gold Plan (PPO)
$147.00 $0 $4,500 YesBrowse
Formulary
Enroll
Aetna Medicare Premier Plan (HMO)
$167.00 $0 $6,700 YesBrowse
Formulary
Enroll
Aetna Medicare Silver (PPO)
$0 $0 $6,700 YesBrowse
Formulary
Aetna Medicare Silver Plan (HMO)
$47.00 $0 $6,700 YesBrowse
Formulary
Enroll
Aetna Medicare Standard Plan (HMO)
$73.00 $0 $5,900 YesBrowse
Formulary
Enroll
Allwell Medicare (HMO)
$0 $0 $6,700 NoBrowse
Formulary
Too New
Cigna-HealthSpring Alliance (HMO)
$0 $0 $6,700 NoBrowse
Formulary
Cigna-HealthSpring Preferred (HMO)
$15.00 $280.00 $6,700 NoBrowse
Formulary
Enroll
Cigna-HealthSpring PreferredPlus (HMO)
$125.00 $0 $6,700 NoBrowse
Formulary
Enroll
Clover Health Choice (PPO)
$0 $0 $3,400 NoBrowse
Formulary
Clover Health Choice Value (PPO)
$37.00 $415.00 $3,200 NoBrowse
Formulary
Health Partners Medicare Prime (HMO)
$71.00 $350.00 $6,700 NoBrowse
Formulary
Humana Gold Plus H6622-037 (HMO)
$0 $0 $6,700 NoBrowse
Formulary
Enroll
Humana Gold Plus H6622-039 (HMO)
$0 $350.00 $6,700 NoBrowse
Formulary
Enroll
HumanaChoice H5216-122 (PPO)
$147.00 $0 $6,700 NoBrowse
Formulary
Enroll
HumanaChoice H5525-005 (PPO)
$45.00 $0 $6,700 NoBrowse
Formulary
Enroll
HumanaChoice H5525-038 (PPO)
$0 $0 $6,700 NoBrowse
Formulary
HumanaChoice R0923-002 (Regional PPO)
$75.00 $0 $6,700 NoBrowse
Formulary
Enroll
Keystone 65 Basic Rx (HMO)
$0 $0 $6,700 NoBrowse
Formulary
Keystone 65 Focus Rx (HMO-POS)
$10.00 $0 $6,700 NoBrowse
Formulary
Keystone 65 Preferred Rx (HMO)
$229.00 $0 $4,000 NoBrowse
Formulary
Keystone 65 Select Rx (HMO)
$68.00 $0 $5,500 NoBrowse
Formulary
Personal Choice 65 Rx (PPO)
$289.00 $0 $5,500 NoBrowse
Formulary
UPMC for Life HMO Deductible with Rx (HMO)
$15.00 $0 $5,500 NoBrowse
Formulary
UPMC for Life HMO Rx (HMO)
$55.00 $0 $5,000 NoBrowse
Formulary


Return to 2019 Medicare Advantage Plans in Pennsylvania





Medicare Advantage Health Plans Without Drug Coverage

Plan Name ⇅ Premium Type MOOP Overall
Rating
Sign Up
Aetna Medicare Basic Plan (HMO)
$0 Local HMO * $6,700 Enroll
Cigna-HealthSpring Advantage (HMO)
$0 Local HMO * $6,700 Enroll
HumanaChoice H5216-116 (PPO)
$0 Local PPO * $4,500 Enroll
HumanaChoice R0923-001 (Regional PPO)
$0 Regional PPO * $4,500 Enroll
Keystone 65 Preferred Medical Only (HMO)
$178.00 Local HMO * $4,000
Keystone 65 Select Medical Only (HMO)
$47.00 Local HMO * $5,500
Lasso Healthcare (MSA)
MSA * $- NA
Personal Choice 65 Medical Only (PPO)
$184.00 Local PPO * $5,500





2019 Medicare Special Needs Plans in Philadelphia county Pennsylvania

Plan Name ⇅ Monthly
Premium
Part D
Deductible
 Gap  Special Needs
Type
Overall
Rating
Click
for
Formulary
Advantra Cares (HMO SNP)
(H3959- 035)
    $35.50 $270.0  No Dual-EligibleBrowse
Formulary
Allwell Dual Medicare (HMO SNP)
(H2915- 002)
    $37.00 $415.0  No Dual-EligibleToo NewBrowse
Formulary
Cigna-HealthSpring Achieve (HMO SNP)
(H3949- 024)
    $29.00 $0  No Chronic or Disabling ConditionBrowse
Formulary
Cigna-HealthSpring TotalCare (HMO SNP)
(H3949- 009)
    $33.50 $415.0  No Dual-EligibleBrowse
Formulary
Cigna-HealthSpring Traditions (HMO SNP)
(H3949- 016)
    $37.00 $415.0  No InstitutionalBrowse
Formulary
Gateway Health Medicare Assured Diamond (HMO SNP)
(H5932- 001)
    $37.00 $415.0  No Dual-EligibleBrowse
Formulary
Gateway Health Medicare Assured Ruby (HMO SNP)
(H5932- 009)
    $37.00 $415.0  No Dual-EligibleBrowse
Formulary
Health Partners Medicare Special (HMO SNP)
(H9207- 004)
    $37.00 $415.0  No Dual-EligibleBrowse
Formulary
Humana Gold Plus SNP-DE H6622-038 (HMO SNP)
(H6622- 038)
    $31.40 $300.0  No Dual-EligibleBrowse
Formulary
Keystone First VIP Choice (HMO SNP)
(H4227- 001)
    $37.00 $415.0  No Dual-EligibleBrowse
Formulary
Provider Partners Pennsylvania Advantage Plan (HMO SNP)
(H4093- 001)
    $37.00 $415.0  No InstitutionalNABrowse
Formulary
UPMC for Life Dual (HMO SNP)
(H4279- 001)
    $37.00 $415.0  No Dual-EligibleBrowse
Formulary



Plan Type Is the type of organization offering the Medicare Plans.

  • HMO - Health Maintenance Organization
  • PPO - Preferred Provider Organization
  • PDP - Prescription Drug Plan
  • SNP - Special Needs Plan
  • POS - Point of Service
  • PFFS - Private Fee For Service

Monthly Consolidated Premium (Includes Part C + D) Your premium may be lower depending on your eligibility for medical assistance. Call your provider for details.

Part D Total Premium: The Part D Total Premium is the sum of the Basic and Supplemental Premiums. Note: the Part D Total Premium is net of any Part A/B rebates applied to "buy down" the drug premium for Medicare Advantage; for some plans the total premium may be lower than the sum of the basic and supplemental premiums due to negative basic or supplemental premiums.

Benefit Type
  • (EA) Enhanced Alternative may offer additional gap coverage which is calculated as the percentage of generic formulary products with coverage above standard generic coverage gap cost-sharing benefit and/or the percentage of brand formulary products covered in addition to the coverage gap discount for applicable drugs.
  • (DS) Defined Standard Benefit
  • (BA) Basic Alternative
  • (AE) Actuarially Equivalent Standard

GAP

In 2019 once you and your plan provider have spent $3820 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") Once you reach the coverage gap you will pay 25% of the plans cost for covered brand-name prescription drugs and 37% on generic drugs unless your plan offers additional coverage.

Maximum Out-of-Pocket (MOOP) limit on enrollee spending that includes costs for all in-network Part A and Part B Services. NOT Part D - prescription drugs. N/A is defined as Not Applicable



Source: CMS. Data as of September 5, 2018.
Star Rating as of October 10, 2018.
For More Information on Ratings Please See the CMS Tech Notes.
Plans are subject to change as contracts are finalized.
Includes 2019 approved contracts. Employer sponsored 800 series and plans under sanction are excluded. For 2019, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit.


Call For A licensed Sales Agent

1-855-492-4169

  • Mon-Fri 8:30am-8:00pm


Call to Enroll!