2015 Medicare Advantage Plans in Waukesha County Wisconsin


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The 2020 Medicare Advantage Plans in Waukesha County WI.

2015 Medicare Advantage Plans in Waukesha County Wisconsin

There are 14 Medicare Advantage Plans available in Waukesha County WI from 7 health insurance providers and 12 Special Needs Plans available. 3 Advantage plans offer additional gap coverage. The plan with the lowest out of pocket expense is $1200 and the highest out of pocket is $6700. The highest rated plan available in Waukesha County received a 4.5 overall star rating from CMS and the lowest rated plan is 3.5 stars.

(Click the Plan Name for More Details)

Plan Name Type Premium
Part D
 Gap  Max Out of
Overall Rating Formulary
Return to Counties In Wisconsin
AARP MedicareComplete (HMO)
Local HMO $25.00 $245.00 No $4,900 Browse
AARP MedicareComplete Essential (HMO)
Local HMO * $0.00 $4,900
Advocare Essence (HMO-POS)
Local HMO * $15.00 $3,400
Advocare Essence Rx (HMO-POS)
Local HMO $77.00 $0.00 No $3,400 Browse
Advocare Spirit (HMO-POS)
Local HMO * $160.00 $1,200
Advocare Spirit Rx (HMO-POS)
Local HMO $225.00 $0.00 No $1,200 Browse
Anthem MediBlue Select (HMO)
Local HMO $23.00 $131.00 No $6,700 NABrowse
Care Improvement Plus Medicare Advantage (PPO)
Local PPO $29.00 $315.00 No $6,700 Browse
Humana Gold Choice H8145-006 (PFFS)
PFFS $89.00 $320.00 Yes N/A Browse
Humana Gold Plus H6622-002 (HMO)
Local HMO $27.00 $320.00 Yes $5,500 Browse
HumanaChoice H5216-001 (PPO)
Local PPO $83.00 $320.00 Yes $5,500 Browse
HumanaChoice R5826-009 (Regional PPO)
Regional PPO $123.00 $320.00 No $6,700 Browse
HumanaChoice R5826-023 (Regional PPO)
Regional PPO * $0.00 $6,700
Network Prime (MSA)

* Plan Type Indicates plan does not offer Part D drug coverage.

Medicare Special Needs Plans in Waukesha county Wisconsin

Plan Name Consolidated
Premium C+D
Part D
 Gap  Special Needs
Overall Rating Formulary
Anthem Dual Advantage (HMO SNP)
(H9525- 003)
   $35.30 $320.00  No Dual-EligibleNABrowse
Care Improvement Plus Dual Advantage (PPO SNP)
(H0294- 006)
   $33.40 $320.00  No Dual-EligibleBrowse
Care Improvement Plus Gold Rx (PPO SNP)
(H0294- 002)
   $0.00 $315.00  No Chronic or Disabling ConditionBrowse
Community Care's Partnership Program (HMO SNP)
(H5207- 001)
   $35.30 $320.00  No Dual-EligibleNABrowse
Community Care's Partnership Program Disabled (HMO SNP)
(H2034- 002)
   $35.30 $320.00  No Dual-EligibleNABrowse
iCare Medicare Plan (HMO SNP)
(H2237- 001)
   $35.30 $320.00  No Dual-EligibleBrowse
Managed Health Services Advantage (HMO SNP)
(H8189- 001)
   $35.30 $320.00  No Dual-EligibleBrowse
Molina Medicare Options Plus (HMO SNP)
(H2879- 001)
   $35.30 $320.00  No Dual-EligibleToo NewBrowse
UnitedHealthcare Assisted Living Plan (HMO SNP)
(H3794- 003)
   $11.70 $235.00  No InstitutionalToo NewBrowse
UnitedHealthcare Dual Complete LP (HMO SNP)
(H5253- 024)
   $35.30 $320.00  No Dual-EligibleBrowse
UnitedHealthcare Dual Complete LP1 (HMO SNP)
(H3794- 002)
   $35.30 $320.00  No Dual-EligibleToo NewBrowse
UnitedHealthcare Nursing Home Plan (HMO-POS SNP)
(H5253- 007)
   $31.80 $320.00  No InstitutionalBrowse

Source: CMS.

Plans as of September 2, 2014.

Plans are subject to change as contracts are finalized.

Includes 2015 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded. For 2015, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.

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 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.


In 2015 once you and your plan provider have spent $2,960 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 45% of the plan's cost for covered brand-name prescription drugs unless your plan offers additional coverage. You will still receive a 55% discount on brand-name drugs and a 35% discount on generic drugs.

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

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