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The 2019 Medicare Advantage Plans in St. Clair County IL.
2014 Medicare Advantage Plans in St. Clair County Illinois
There are 19 Medicare Advantage Plans available in St. Clair County IL from 7 health insurance providers and 2 Special Needs Plans available. 4 Advantage plans offer additional gap coverage. The plan with the lowest out of pocket expense is $1975 and the highest out of pocket is $6700. The highest rated plan available in St. Clair 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)
|Plan Name||Type||Premium C+D||Part D
|Gap||Max Out of Pocket||Overall Rating|
|Return to Counties In Illinois|
|AARP MedicareComplete (HMO)
|Local HMO||$0||$0||No Gap Coverage||$3,500|
|AARP MedicareComplete Choice (PPO)
|Local PPO||$25.00||$0||No Gap Coverage||$4,500|
|AARP MedicareComplete Essential (HMO)
|Local HMO *||$0||$3,500|
|AARP MedicareComplete Plus Plan 1 (HMO-POS)
|Local HMO||$0||$0||No Gap Coverage||$2,950|
|Local PPO||$36.00||$0||No Gap Coverage||$3,400|
|Advantra Option 1 (HMO)
|Local HMO||$30.00||$0||No Gap Coverage||$4,500|
|Advantra Option 2 (HMO-POS)
|Local HMO||$96.00||$0||No Gap Coverage||$2,900|
|Care Improvement Plus Medicare Advantage (PPO)
|Local PPO||$0||$0||No Gap Coverage||$6,700|
|Essence Advantage (HMO)
|Local HMO||$0||$0||No Gap Coverage||$2,250|
|Essence Advantage Plus (HMO)
|Local HMO||$70.00||$0||Many Generics||$1,975|
|Gold Advantage (HMO)
|Local HMO||$0||$0||No Gap Coverage||$2,300|
|Humana Gold Choice H8145-008 (PFFS)
|PFFS||$152.00||$0||Few Generics, Few Brands||N/A|
|Humana Gold Choice H8145-121 (PFFS)
|HumanaChoice H1716-006 (PPO)
|Local PPO||$80.00||$0||Few Generics, Few Brands||$6,000|
|HumanaChoice H1716-020 (PPO)
|Local PPO||$68.00||$225.00||Few Generics||$6,700|
|HumanaChoice R5826-009 P (Regional PPO)
|Regional PPO||$112.00||$310.00||No Gap Coverage||$6,700|
|HumanaChoice R5826-023 P (Regional PPO)
|Regional PPO *||$0||$4,500|
|WellCare Rx (HMO)
|Local HMO||$0||$0||No Gap Coverage||$3,900|
|WellCare Value (HMO-POS)
|Local HMO||$0||$0||No Gap Coverage||$4,000|
* Plan Type Indicates plan does not offer Part D drug coverage.
Medicare Special Needs Plans in St. Clair county Illinois
|Plan Name||Type||Consolidated Premium C+D||Part D
|Gap||Special Needs Type||Overall Rating|
|Care Improvement Plus Gold Rx (PPO SNP)
|Local PPO||$0||$0||No Gap Coverage||Chronic or Disabling Condition|
|WellCare Access (HMO SNP)
|Local HMO||$8.90||$310.00||No Gap Coverage||Dual-Eligible|
Plans as of September 3, 2013.
Plans are subject to change as contracts are finalized.
Includes 2014 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.
Plan Type Is the type of organization offering the Medicare Plans.
- HMO - Health Maintenance Organization
- PPO - Preferred Provider Organization
- PDP - Prescrition 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 plan 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 plans; 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
Enhanced Alternative plans 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.GAP
Coverage gap ("donut hole"). This means there's a temporary limit on what the drug plan will cover for drugs. (Unless you get the low-income subsidy) Once you reach the coverage gap in 2014, you will pay 47.5% of the plan's cost for covered brand-name prescription drugs. You get these savings if you buy your prescriptions at a pharmacy or order them through the mail.
Additional gap coverage levels are determined separately for formulary generic and brand products and are described as follows:
- All: 100% of formulary drugs are covered through the gap
- Many: 65% to 100% of formulary drugs are covered through the gap
- Some: 10% to 65 % of formulary drugs are covered through the gap
- Few: 0% to 10% of formulary drugs are covered through the gap (and must also be >15 "brand" products covered through the gap)
- No Gap Coverage: 0% of formulary drugs are covered through the gap (or 15 "brand" products covered through the gap)
- All Formulary Drugs: cover 100% of “generic” and 100% of “brand” products (either by covering all formulary drug products in the gap or by having no initial coverage limit)
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