Plan ID: H9387-001

What You Need to Know:

  • Allwell Medicare (PPO) is a Medicare Advantage Health Maintenance Organization Local PPO 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 $4,500 per year (in-network).
  • Allwell Medicare (PPO) 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 PPO
Similar Plan: H9387-002
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): $4,500
Annual Deductible: NULL
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Wyandotte, Kansas: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
45 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: 3,411 drugs
Number of Members Enrolled in this Plan in Wyandotte, Kansas: 164 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)
217 $0.00 410 $9.00 1011 $37.00 902 $90.00 680 33%

Other Medicare Advantage Plans in Wyandotte, Kansas

Plan Name Type Premium MOOP Rx Deduct. Rating
Allwell Medicare Complement (HMO) (2023)Local HMO$3,450$445
3
Allwell Medicare Boost (HMO) (2023)Local HMO$7,550$445
3
Allwell Medicare Simple (HMO) (2023)Local HMO *$3,450$-
3
HumanaChoice H5216-032 (PPO) (2023)Local PPO$6,700$195
4
Humana Community (HMO) (2023)Local HMO$3,450$0
5
Cigna True Choice Medicare (PPO) (2023)Local PPO$6,500$0
New plan - not yet rated.
HumanaChoice R4845-001 (Regional PPO) (2023)Regional PPO *$3,400$-
5
Humana Gold Choice H8145-120 (PFFS) (2023)PFFS *$-$-
4
Aetna Medicare Eagle (HMO) (2023)Local HMO *$5,000$-
4
Aetna Medicare Premier (HMO) (2023)Local HMO$5,000$0
4
HumanaChoice H5216-033 (PPO) (2023)Local PPO$5,900$0
4
Aetna Medicare Premier Preferred (HMO) (2023)Local HMO$5,000$0
4
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
Humana Honor (PPO) (2023)Local PPO *$4,500$-
4
AARP Medicare Advantage Plan 2 (HMO-POS) (2023)Local HMO$5,900$0
5
AARP Medicare Advantage Choice Plan 2 (PPO) (2023)Local PPO$3,900$0
5
HumanaChoice R4845-002 (Regional PPO) (2023)Regional PPO$6,700$395
5
Humana Gold Plus H0028-017 (HMO) (2023)Local HMO$4,900$0
4
AARP Medicare Advantage Plan 1 (HMO-POS) (2023)Local HMO$4,400$0
5
Humana Value Plus H0028-018 (HMO) (2023)Local HMO$7,550$410
4
Blue Medicare Advantage Plus (HMO) (2023)Local HMO$5,200$0
4
Blue Medicare Advantage Complete (HMO) (2023)Local HMO$6,200$0
4
AARP Medicare Advantage Patriot (PPO) (2023)Local PPO *$4,400$-
5
Blue Medicare Advantage Spira Care (HMO) (2023)Local HMO$4,800$0
4
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
HumanaChoice H9070-003 (PPO) (2023)Local PPO$5,900$0
5
Aetna Medicare Premier Plus (PPO) (2023)Local PPO$6,200$0
4
Allwell Medicare Simple (PPO) (2023)Local PPO *$4,400$-
New plan - not yet rated.
Cigna Preferred Medicare (HMO) (2023)Local HMO$5,200$0
4
Cigna Fundamental Medicare (HMO) (2023)Local HMO *$4,900$-
4
Aetna Medicare Elite (PPO) (2023)Local PPO$5,000$0
4
Blue Medicare Advantage Access (PPO) (2023)Local PPO$5,900$0
4
Blue Medicare Advantage Flex (no Part D) (PPO) (2023)Local PPO *$4,000$-
4
Blue Medicare Advantage Essential (PPO) (2023)Local PPO$4,000$0
4
Allwell Medicare (HMO) (2023)Local HMO$5,000$0
3
Medicare Advantage Plans by Allwell
Allwell Medicare Complement (HMO) (2023)Local HMO$3,450$445
3
Allwell Medicare Boost (HMO) (2023)Local HMO$7,550$445
3
Allwell Medicare Simple (HMO) (2023)Local HMO *$3,450$-
3
Allwell Medicare Simple (PPO) (2023)Local PPO *$4,400$-
New plan - not yet rated.
Allwell Medicare (HMO) (2023)Local HMO$5,000$0
3

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