2020 Madera County California
Medicare Advantage Plans

There are 6 Medicare Advantage Plans available in Madera County CA from 4 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. Madera County California residents can also pick from 6 Medicare Special Needs Plans. The highest rated plan available in Madera County received a 5 overall star rating from CMS and the lowest rated plan is 4 stars



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2020 Medicare Special Needs Plans in Madera county California

Plan Name ⇅ Monthly
Premium
Part D
Deductible
 Gap  Special Needs
Type
Overall
Rating
Anthem MediBlue Dual Advantage (HMO D-SNP)     $12.90 $435.0  Yes Dual-Eligible
Anthem MediBlue Dual Plus (HMO D-SNP)     $26.50 $435.0  Yes Dual-Eligible
Anthem MediBlue ESRD (PPO C-SNP)     $16.40 $130.0  Yes Chronic or Disabling Condition
Humana Gold Plus SNP-DE H5619-038 (HMO D-SNP)     $6.50 $435.0  No Dual-Eligible
Senior Advantage Medicare Medi-Cal Plan North (HMO D-SNP)     $31.10 $435.0  No Dual-Eligible
UnitedHealthcare Dual Complete (HMO D-SNP)     $30.30 $435.0  No Dual-EligibleToo New



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 2020 once you and your plan provider have spent $4020 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 25% 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 3, 2019.
Star Rating as of October 11, 2019.
For More Information on Ratings Please See the CMS Tech Notes.
Plans are subject to change as contracts are finalized.
Includes 2020 approved contracts. Employer sponsored 800 series and plans under sanction are excluded. For 2020, 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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