Plan ID: H5454-002

What You Need to Know:

  • Clear Spring Health Essential (HMO) is a Medicare Advantage Health Maintenance Organization Local HMO plan.
  • It must provide all of the same hospital and medical benefits as Medicare Part A and Part B, however, costs may be different.
  • It has additional benefits not included in Medicare Part A and Part B, including prescription drug coverage.
  • The plan's monthly premium is $0, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is .
  • The plan includes an out-of-pocket maximum of $2,900 per year (in-network).
  • Clear Spring Health Essential (HMO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is .
  • This plan's Part D Initial Coverage Limit is $0.

$0

Monthly Premium

Medicare Plan Features
Monthly Premium: $0
Part C Premium: $0
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$0 $0 $0 $0 $0 $0 0.0
Gap Coverage: No
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local HMO
Similar Plan: H5454-001
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: No additional gap coverage, only the Donut Hole Discount
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $2,900
Annual Deductible: NULL
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Kane, Illinois: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
less than 10 members New plan - No summary rating as of yet. New plan - not yet rated. New plan - not yet rated.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,276 drugs
Number of Members Enrolled in this Plan in Kane, Illinois: 56 members
Number of Drugs Per Tier: NULL
Preferred Pharmacy Cost Sharing During Initial Coverage Phase: NULL
Special Needs Plan SNP Eligibility Requirement: NULL
Monthly Premium Split as Follows:
Part C Premium Part D Base Premium Part D Supplemental Premium Total Premium
$0.00 $0.00 $0.00 $0.00
Monthly Premium with Extra Help Low Income Subsidy:
LIS100 Subsidy Total Monthly Premium with LIS Parts CD LIS25 Subsidy Monthly PartD Premium with LIS LIS25 Subsidy Total Monthly Premium with LIS Parts CD LIS50 Monthly PartD Premium with LIS LIS50 Subsidy Total Monthly Premium with LIS Parts CD LIS75 Monthly PartD Premium with LIS LIS75 Subsidy Total Monthly Premium with LIS Parts CD
$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Formulary Drug Details:
Tier 1 # of Drugs per Tier Tier 1 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 2 # of Drugs per Tier Tier 2 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 3 # of Drugs per Tier Tier 3 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 4 # of Drugs per Tier Tier 4 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 5 # of Drugs per Tier Tier 6 Preferred Pharmacy Cost Sharing (initial coverage phase)
341 $3.00 543 $12.00 934 $42.00 795 $95.00 663 33%

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Insufficient data to rate this plan.
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Blue Cross Medicare Advantage Basic Plus (HMO-POS) (2023)Local HMO$3,900$0
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Blue Cross Medicare Advantage Premier Plus (HMO-POS) (2023)Local HMO$4,500$0
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Blue Medicare Advocate Health (HMO) (2023)Local HMO$3,500$0
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Blue Cross Medicare Advantage Choice Plus (PPO) (2023)Local PPO$6,700$445
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Blue Cross Medicare Advantage Choice Premier (PPO) (2023)Local PPO$5,900$0
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AARP Medicare Advantage Walgreens (PPO) (2023)Local PPO$5,900$250
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WellCare Compass (HMO) (2023)Local HMO$3,450$445
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Aetna Medicare Prime (HMO) (2023)Local HMO$3,950$0
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WellCare Plus (HMO) (2023)Local HMO$3,450$445
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Aetna Medicare Premier Plus (PPO) (2023)Local PPO$3,475$0
5
Aetna Medicare Value (PPO) (2023)Local PPO$3,950$0
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UnitedHealthcare Medicare Advantage Assure (PPO) (2023)Local PPO$7,550$445
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Humana Gold Choice H8145-008 (PFFS) (2023)PFFS$-$380
4
WellCare Essential (HMO) (2023)Local HMO$3,450$0
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AARP Medicare Advantage Patriot (PPO) (2023)Local PPO *$5,900$-
5
WellCare Edge (HMO) (2023)Local HMO$3,450$445
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Aetna Medicare DMG Prime (PPO) (2023)Local PPO$3,950$0
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5
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5
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4
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4
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
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4
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5
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AARP Medicare Advantage Choice (PPO) (2023)Local PPO$3,900$195
5
Cigna Premier Medicare (HMO-POS) (2023)Local HMO$4,500$0
5
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5
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5
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4
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4
Medicare Advantage Plans by Clear Spring Health
Clear Spring Health Community Advantage Plan (HMO) (2023)Local HMO$3,950$0
Insufficient data to rate this plan.
Clear Spring Health Community Flex Plan (HMO-POS) (2023)Local HMO$3,950$0
Insufficient data to rate this plan.

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