Plan ID: H9861-002

What You Need to Know:

  • Reliance Cardinal Plan (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 $40, 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).
  • Reliance Cardinal Plan (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 $40.

$40

Monthly Premium

Medicare Plan Features
Monthly Premium: $40.00
Part C Premium: $0.40
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$40.00 $0.40 $39.60 $0 $39.60 $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: H9861-001
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): $4,500
Annual Deductible: NULL
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Genesee, Michigan: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
29 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: 4,162 drugs
Number of Members Enrolled in this Plan in Genesee, Michigan: NULL
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
$0.40 $39.60 $0.00 $40.00
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
$9.90 $32.10 $32.50 $24.60 $25.00 $17.00 $17.40
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)
459 $2.00 1353 $10.00 302 $47.00 1043 $100.00 1005 33%

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Aetna Medicare Premier Plus (PPO) (2023)Local PPO$5,100$0
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BCN Advantage HMO-POS Classic (HMO-POS) (2023)Local HMO$3,800$0
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BCN Advantage HMO-POS Prestige (HMO-POS) (2023)Local HMO$3,400$0
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PriorityMedicare Select (PPO) (2023)Local PPO$3,500$0
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HAP Senior Plus (HMO) (2023)Local HMO$5,000$0
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HAP Senior Plus Medical Only (HMO) (2023)Local HMO *$4,000$-
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PriorityMedicare Ideal (PPO) (2023)Local PPO$5,800$125
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HAP Senior Plus Option 1 (HMO-POS) (2023)Local HMO$4,200$0
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HAP Senior Plus Option 2 (HMO-POS) (2023)Local HMO$4,000$0
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PriorityMedicare Vital (PPO) (2023)Local PPO$6,000$350
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Reliance Principle Plan (HMO) (2023)Local HMO$5,900$125
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PriorityMedicare Value (HMO-POS) (2023)Local HMO$4,900$75
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Humana Gold Plus H8908-001 (HMO) (2023)Local HMO$3,900$0
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Ascension Complete Michigan Reward (HMO) (2023)Local HMO$5,900$390
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Humana Gold Plus H8908-004 (HMO) (2023)Local HMO$5,200$0
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HumanaChoice R3887-001 (Regional PPO) (2023)Regional PPO *$5,500$-
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Ascension Complete Michigan Secure (HMO) (2023)Local HMO$3,800$0
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Medicare Plus Blue PPO Assure (PPO) (2023)Local PPO$3,425$0
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HAP Senior Plus Option 4 (PPO) (2023)Local PPO$4,000$0
4
HumanaChoice R3887-002 (Regional PPO) (2023)Regional PPO$5,300$380
5
Medicare Plus Blue PPO Signature (PPO) (2023)Local PPO$4,700$0
5
Medicare Plus Blue PPO Essential (PPO) (2023)Local PPO$6,000$100
5
HAP Senior Plus Option 3 (PPO) (2023)Local PPO$4,500$0
4
PriorityMedicare Key (HMO-POS) (2023)Local HMO$5,500$100
3
PriorityMedicare (HMO-POS) (2023)Local HMO$4,500$0
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HAP Senior Plus Option 1 (PPO) (2023)Local PPO$6,000$0
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PriorityMedicare Edge (PPO) (2023)Local PPO$5,300$0
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BCN Advantage Community Value (HMO-POS) (2023)Local HMO$4,500$0
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BCN Advantage HMO-POS Elements (HMO-POS) (2023)Local HMO *$4,500$-
5
WellCare Essential (HMO-POS) (2023)Local HMO$3,450$0
5
BCN Advantage Prime Value (HMO-POS) (2023)Local HMO$4,500$50
5
Humana Value Plus H8087-002 (PPO) (2023)Local PPO$7,550$260
5
WellCare Elite Smile (HMO-POS) (2023)Local HMO$3,450$0
5
HAP Senior Plus Option 2 (PPO) (2023)Local PPO$5,000$0
4
WellCare Explore (HMO-POS) (2023)Local HMO$3,450$0
5
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Medicare Advantage Plans by Reliance Medicare Advantage
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