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The 2023 Medicare Advantage Plans in Durham County NC.



2022 Durham County North Carolina
Medicare Advantage Plans

There are 35 Medicare Advantage Plans available in Durham County NC from 9 different health insurance providers. 11 of these Medicare Advantage plans offer additional gap coverage. The plan with the lowest out of pocket expense is $3450 and the highest out of pocket is $7550. Durham County North Carolina residents can also pick from 14 Medicare Special Needs Plans. The best Medicare Advantage plan in Durham County North Carolina received a 5 overall star rating from CMS and the lowest rated plan is 3 stars.



(Click the Plan Name for More Details)
(⇅ Click the Header to Sort)

Name ⇅ Premium Deductible MOOP Gap Plan
Rating
Click
for
Formulary
AARP Medicare Advantage Choice (PPO)
(H2577-017)

$0$250.00$6,700YesBrowse
Formulary
AARP Medicare Advantage Plan 1 (HMO-POS)
(H5253-102)

$38.00$0$4,900YesBrowse
Formulary
AARP Medicare Advantage Plan 2 (HMO-POS)
(H5253-039)

$0$170.00$5,400YesBrowse
Formulary
Aetna Medicare Essential Plan (PPO)
(H5521-168)

$0$150.00$6,800YesBrowse
Formulary
Aetna Medicare Value Plan (HMO-POS)
(H3146-004)

$0$0$5,500YesBrowse
Formulary
Blue Medicare Enhanced (HMO)
(H3449-024)

$19.00$0$3,900YesBrowse
Formulary
Blue Medicare Essential (HMO)
(H3449-027)

$0$375.00$5,900YesBrowse
Formulary
Blue Medicare Essential Plus (HMO)
(H3449-023)

$0$195.00$4,200YesBrowse
Formulary
Blue Medicare PPO Enhanced (PPO)
(H3404-003)

$29.00$0$5,900YesBrowse
Formulary
Cigna Preferred Medicare (HMO)
(H9725-007)

$0$0$4,600NoBrowse
Formulary
Cigna True Choice Medicare (PPO)
(H7849-046)

$0$0$7,000NoBrowse
Formulary
Experience Health Medicare Advantage (HMO)
(H3777-001)

$0$0$4,200YesBrowse
Formulary
Humana Gold Plus H6622-060 (HMO)
(H6622-060)

$0$0$4,200NoBrowse
Formulary
HumanaChoice H5216-211 (PPO)
(H5216-211)

$50.00$160.00$6,700NoBrowse
Formulary
HumanaChoice H5525-035 (PPO)
(H5525-035)

$0$265.00$7,550NoBrowse
Formulary
HumanaChoice R1390-002 (Regional PPO)
(R1390-002)

$98.80$480.00$7,550NoBrowse
Formulary
Wellcare Assist Open (PPO)
(H7175-003)

$32.90$480.00$4,500NoBrowse
Formulary
Wellcare Giveback Open (PPO)
(H7175-004)

$0$200.00$7,550YesBrowse
Formulary
Wellcare No Premium (HMO)
(H4073-001)

$0$150.00$4,500NoToo NewBrowse
Formulary
Wellcare No Premium Open (PPO)
(H7175-001)

$0$150.00$5,500NoBrowse
Formulary
Wellcare No Premium Value (HMO)
(H0712-023)

$0$150.00$6,000NoBrowse
Formulary
Wellcare Premium Enhanced Open (PPO)
(H7175-006)

$55.00$100.00$4,500NoBrowse
Formulary
Wellcare Premium Ultra Open (PPO)
(H7175-007)

$99.00$100.00$3,450NoBrowse
Formulary


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Edgecombe County Medicare Advantage





Medicare Advantage Health Plans Without Drug Coverage





2022 Medicare Special Needs Plans in Durham county North Carolina

Plan Name ⇅ Monthly
Premium
Part D
Deductible
 Gap  Special Needs
Type
Overall
Rating
Aetna Medicare Assure Plan (HMO D-SNP) $29.70$425.0No Gap CoverageDual-Eligible
Cigna TotalCare (HMO D-SNP) $35.80$480.0No Gap CoverageDual-Eligible
Healthy Blue + Medicare (HMO D-SNP) $35.80$480.0Few GenericsDual-EligibleToo New
HumanaChoice SNP-DE H5525-036 (PPO D-SNP) $33.70$480.0No Gap CoverageDual-Eligible
Longevity Health Plan (HMO I-SNP) $35.80$480.0No Gap CoverageInstitutionalToo New
PruittHealth Premier (HMO I-SNP) $35.80$480.0No Gap CoverageInstitutionalNA
UnitedHealthcare Assisted Living Plan (HMO-POS I-SNP) $35.80$200.0No Gap CoverageInstitutional
UnitedHealthcare Dual Complete (HMO-POS D-SNP) $35.80$480.0No Gap CoverageDual-Eligible
UnitedHealthcare Dual Complete RP (Regional PPO D-SNP) $35.70$480.0No Gap CoverageDual-Eligible
UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP) $35.80$480.0No Gap CoverageInstitutional
UnitedHealthcare Nursing Home Plan (PPO I-SNP) $35.80$480.0No Gap CoverageInstitutional
Wellcare Dual Access (HMO D-SNP) $30.70$480.0No Gap CoverageDual-EligibleToo New
Wellcare Dual Access Medicare (HMO D-SNP) $34.00$480.0No Gap CoverageDual-Eligible
Wellcare Dual Liberty Open (PPO D-SNP) $35.80$480.0No Gap CoverageDual-Eligible



Plan Type Is the type of organization offering the Medicare Plan.

  • 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
  • Many - Many Generics and Some Brands
  • Some - Some Generics and Few Brands

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 1, 2021.
Plans are subject to change as contracts are finalized.
Includes 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded. For 2022, 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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Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Enrollment depends on the plan’s contract renewal.

Every year, Medicare evaluates plans based on a 5-star rating system.