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The 2019 Medicare Advantage Plans in Worcester County MA.



2018 Medicare Advantage Plans in Worcester County Massachusetts

There are 27 Medicare Advantage Plans available in Worcester County MA from 6 different health insurance providers. 3 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 Worcester County received a 5 overall star rating from CMS and the lowest rated plan is 3.5 stars. Worcester County Massachusetts 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
Aetna Medicare Freedom Plan (PPO)
$35.00 $0.00 Yes $6,700 Formulary
Aetna Medicare Value Plan (HMO)
$0.00 $125.00 Yes $6,700 Formulary
Fallon Senior Plan Flex Enhanced Rx (HMO)
$0.00 $300.00 No $6,700 Formulary
Fallon Senior Plan Plus Enhanced RX (HMO)
$264.00 $0.00 No $3,400 Formulary
Fallon Senior Plan Saver (HMO)
$88.00 $6,700
Fallon Senior Plan Saver Enhanced Rx (HMO-POS)
$97.00 $300.00 No $5,000 Formulary
Fallon Senior Plan Standard Enhanced Rx (HMO)
$207.00 $200.00 No $6,700 Formulary
Fallon Senior Plan Super Saver Rx (HMO)
$17.00 $405.00 No $6,700 Formulary
Harvard Pilgrim Stride Value Rx (HMO)
$61.00 $320.00 No $3,400 FormularyEnroll
Harvard Pilgrim Stride Value Rx Plus (HMO)
$157.00 $0.00 Yes $3,400 FormularyEnroll
Medicare HMO Blue FlexRx (HMO-POS)
$106.00 $260.00 No $3,900 Formulary
Medicare HMO Blue PlusRx (HMO)
$292.00 $200.00 No $3,400 Formulary
Medicare HMO Blue ValueRx (HMO)
$56.00 $320.00 No $4,900 Formulary
Medicare PPO Blue PlusRx (PPO)
$262.00 $200.00 No $3,400 Formulary
Medicare PPO Blue SaverRx (PPO)
$0.00 $405.00 No $6,700 Formulary
Medicare PPO Blue ValueRx (PPO)
$86.00 $320.00 No $4,900 Formulary
Tufts Medicare Preferred HMO Basic No Rx (HMO)
$40.00 $3,400
Tufts Medicare Preferred HMO Basic Rx (HMO)
$68.00 $350.00 No $3,400 Formulary
Tufts Medicare Preferred HMO Prime No Rx (HMO)
$152.00 $3,400
Tufts Medicare Preferred HMO Prime Rx (HMO)
$186.00 $0.00 No $3,400 Formulary
Tufts Medicare Preferred HMO Saver Rx (HMO)
$0.00 $400.00 No $4,500 Formulary
Tufts Medicare Preferred HMO Value No Rx (HMO)
$112.00 $3,400
Tufts Medicare Preferred HMO Value Rx (HMO)
$147.00 $300.00 No $3,400 Formulary
Return to 2018 Medicare Advantage Plans in Massachusetts

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



2018 Medicare Special Needs Plans in Worcester county Massachusetts

Plan Name Monthly
Consolidated
Premium C+D
Part D
Deductible
 Gap  Special Needs
Type
Overall Rating
NaviCare (HMO SNP)
(H9001- 019)
   $35.60 $405.00  No Dual-Eligible
Senior Care Options Program (HMO SNP)
(H2225- 001)
   $35.60 $405.00  No Dual-Eligible
Senior Whole Health (HMO SNP)
(H2224- 001)
   $35.60 $405.00  No Dual-Eligible
Senior Whole Health NHC (HMO SNP)
(H2224- 003)
   $35.60 $405.00  No Dual-Eligible
Tufts Health Plan Senior Care Options (HMO SNP)
(H2256- 029)
   $35.60 $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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