2020 St Clair County Illinois
Medicare Advantage Plans

There are 27 Medicare Advantage Plans available in St Clair County IL from 7 different health insurance providers. 7 of these Medicare Advantage plans offer additional gap coverage. The plan with the lowest out of pocket expense is $1700 and the highest out of pocket is $6700. St Clair County Illinois residents can also pick from 0 Medicare Special Needs Plans. The highest rated plan available in St Clair County received a 4.5 overall star rating from CMS and the lowest rated plan is 3.5 stars

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Name ⇅ Premium Deductible MOOP Gap Plan
AARP Medicare Advantage (HMO-POS)
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$0 $0 $2,900 NoEnroll
AARP Medicare Advantage Choice Plan 1 (PPO)
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$29.00 $150.00 $4,400 NoEnroll
AARP Medicare Advantage Walgreens (PPO)
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$0 $0 $3,900 NoEnroll
Aetna Medicare Advantra 1 (HMO-POS)
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$33.00 $0 $5,200 YesEnroll
Aetna Medicare Advantra 2 (HMO)
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$81.00 $0 $2,900 YesEnroll
Aetna Medicare Elite (PPO)
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$0 $0 $3,400 YesEnroll
Aetna Medicare Gold Advantage Prime (HMO)
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$0 $0 $2,800 YesEnroll
Aetna Medicare Premier Advantra (PPO)
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$51.00 $200.00 $6,000 YesEnroll
Clear Spring Health Essential (HMO)
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$0 $0 $2,900 NoToo NewEnroll
Clear Spring Health Essential Plus (HMO)
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$49.00 $0 $2,500 NoToo NewEnroll
Essence Advantage (HMO)
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$0 $0 $1,900 NoEnroll
Essence Advantage Plus (HMO)
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$73.00 $0 $1,700 YesEnroll
Essence Advantage Select (HMO)
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$0 $0 $2,900 NoEnroll
Humana Gold Choice H8145-008 (PFFS)
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$166.00 $380.00 $- NoEnroll
Humana Gold Plus H0028-014 (HMO)
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$0 $0 $2,900 NoEnroll
HumanaChoice H5216-032 (PPO)
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$82.00 $195.00 $6,700 NoEnroll
HumanaChoice H5216-033 (PPO)
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$0 $0 $3,600 NoEnroll
HumanaChoice R5361-002 (Regional PPO)
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$139.00 $420.00 $6,700 NoEnroll
WellCare Choice (HMO-POS)
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$39.00 $0 $3,400 YesEnroll
WellCare Plus (HMO)
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$13.20 $435.00 $3,400 NoEnroll
WellCare Rx (HMO)
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$12.60 $435.00 $3,400 NoEnroll
WellCare Value (HMO-POS)
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$0 $0 $3,900 NoEnroll

Return to 2020 Medicare Advantage Plans in Illinois

Medicare Advantage Health Plans Without Drug Coverage

Plan Name ⇅ Premium Type MOOP Overall
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Humana Gold Choice H8145-121 (PFFS)
$75.00 PFFS * $- Enroll
Humana Honor (PPO)
$0 Local PPO * $4,900 Enroll
HumanaChoice R5361-001 (Regional PPO)
$0 Regional PPO * $6,700 Enroll
Lasso Healthcare (MSA)
MSA * $- NA
WellCare Advance (HMO-POS)
$0 Local HMO * $3,900

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


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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