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The 2019 Medicare Advantage Plans in Mercer County PA.



2018 Medicare Advantage Plans in Mercer County Pennsylvania

There are 32 Medicare Advantage Plans available in Mercer County PA from 9 different health insurance providers. 9 of these Medicare Advantage plans offer additional gap coverage. The plan with the lowest out of pocket expense is $3400 and the highest out of pocket is $6700. The highest rated plan available in Mercer County received a 4.5 overall star rating from CMS and the lowest rated plan is 3.5 stars. Mercer County Pennsylvania residents can also pick from 7 Medicare Special Needs Plans.



(Click the Plan Name for More Details)

Name Premium
C+D
Part D
Deductible
 Gap  MOOP Overall Rating Formulary Sign Up
Advantra Basic Medical (HMO)
$0.00 $6,700 Enroll
Advantra Gold (HMO)
$116.00 $0.00 Yes $6,200 FormularyEnroll
Advantra Silver (HMO)
$0.00 $0.00 Yes $6,700 FormularyEnroll
Advantra Silver (PPO)
$66.00 $0.00 Yes $6,700 FormularyEnroll
Advantra Silver Plus (HMO)
$26.00 $0.00 Yes $6,700 FormularyEnroll
Aetna Medicare Gold Plan (PPO)
$156.00 $0.00 Yes $4,500 FormularyEnroll
Aetna Medicare Silver Plan (HMO)
$56.00 $0.00 Yes $6,700 FormularyEnroll
Community Blue Medicare HMO Prestige (HMO)
$197.00 $0.00 Yes $6,700 FormularyEnroll
Community Blue Medicare HMO Signature (HMO)
$0.00 $0.00 No $6,700 FormularyEnroll
Community Blue Medicare PPO Signature (PPO)
$27.00 $0.00 No $6,700 Formulary
Freedom Blue PPO Classic (PPO)
$281.50 $0.00 Yes $6,700 FormularyEnroll
Freedom Blue PPO Select (PPO)
$135.50 $0.00 No $6,700 FormularyEnroll
Freedom Blue PPO ValueRx (PPO)
$76.50 $0.00 No $6,700 FormularyEnroll
Humana Gold Plus H6622-035 (HMO)
$0.00 $0.00 No $6,700 FormularyEnroll
HumanaChoice H5216-051 (PPO)
$43.00 $175.00 No $5,900 FormularyEnroll
HumanaChoice H5216-116 (PPO)
$0.00 $4,500 Enroll
HumanaChoice H5216-119 (PPO)
$123.00 $0.00 No $6,700 FormularyEnroll
HumanaChoice R0923-001 (Regional PPO)
$0.00 $4,500 Enroll
HumanaChoice R0923-002 (Regional PPO)
$95.00 $315.00 No $6,700 FormularyEnroll
Security Blue HMO Basic (HMO)
$61.50 $6,700 Enroll
Security Blue HMO Deluxe (HMO)
$229.50 $0.00 Yes $6,700 FormularyEnroll
Security Blue HMO Standard (HMO)
$189.50 $0.00 No $6,700 FormularyEnroll
Security Blue HMO ValueRx (HMO)
$62.50 $0.00 No $6,700 FormularyEnroll
UPMC for Life (HMO)
$0.00 $3,400
UPMC for Life HMO Deductible with Rx (HMO)
$20.00 $0.00 No $4,000 Formulary
UPMC for Life HMO Rx (HMO)
$81.00 $0.00 No $3,400 Formulary
UPMC for Life HMO Rx Enhanced (HMO)
$263.00 $0.00 No $3,400 Formulary
UPMC for Life PPO High Deductible with Rx (PPO)
$35.00 $0.00 No $6,700 Formulary
UPMC for Life PPO Rx Enhanced (PPO)
$135.00 $0.00 No $6,700 Formulary
Return to 2018 Medicare Advantage Plans in Pennsylvania

* Plan Type does not offer Medicare Part D drug coverage.



2018 Medicare Special Needs Plans in Mercer county Pennsylvania

Plan Name Monthly
Consolidated
Premium C+D
Part D
Deductible
 Gap  Special Needs
Type
Overall Rating
Gateway Health Medicare Assured Diamond (HMO SNP)
(H5932- 001)
   $37.20 $405.00  No Dual-Eligible
Gateway Health Medicare Assured Ruby (HMO SNP)
(H5932- 009)
   $37.20 $405.00  No Dual-Eligible
Humana Gold Plus SNP-DE H6622-038 (HMO SNP)
(H6622- 038)
   $25.00 $230.00  No Dual-Eligible
UPMC for Life Dual (HMO SNP)
(H4279- 001)
   $37.10 $405.00  No Dual-Eligible


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 2018 once you and your plan provider have spent $3750 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 35% of the plans cost for covered brand-name prescription drugs and 44% 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, 2017.

Plans are subject to change as contracts are finalized.

Includes 2018 approved contracts. Employer sponsored 800 series and plans under sanction are excluded. For 2018, 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.

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