Plan ID: H4676-001

What You Need to Know:

  • Troy Medicare (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 $5,900 per year (in-network).
  • Troy Medicare (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: H4676-001
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): $5,900
Annual Deductible: NULL
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Iredell, North Carolina: 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: No
Plan Health Benefits
Total # of Formulary Drugs: 3,501 drugs
Number of Members Enrolled in this Plan in Iredell, North Carolina: 683 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)
602 $0.00 1667 $5.00 216 $25.00 247 $100.00 769 33%

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AARP Medicare Advantage Patriot (HMO-POS) (2023)Local HMO *$3,600$-
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HumanaChoice R1390-002 (Regional PPO) (2023)Regional PPO$7,550$360
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Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
Humana Honor R1390-003 (Regional PPO) (2023)Regional PPO *$6,700$-
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Aetna Medicare Value Plan (HMO) (2023)Local HMO$5,500$0
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Blue Medicare Essential Plus (HMO) (2023)Local HMO$4,200$195
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WellCare Absolute (PPO) (2023)Local PPO$7,550$200
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HumanaChoice R1390-001 (Regional PPO) (2023)Regional PPO *$5,400$-
4
HumanaChoice H5216-211 (PPO) (2023)Local PPO$6,700$160
4
WellCare Value (HMO) (2023)Local HMO$5,500$150
5
Humana Gold Plus H1036-137 (HMO) (2023)Local HMO$4,400$0
4
WellCare Patriot (PPO) (2023)Local PPO *$5,500$-
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AARP Medicare Advantage Plan 1 (HMO-POS) (2023)Local HMO$3,600$50
5
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
Blue Medicare PPO Enhanced (PPO) (2023)Local PPO$5,900$0
4
Cigna True Choice Medicare (PPO) (2023)Local PPO$5,750$0
New plan - not yet rated.
Aetna Medicare Premier Plan (PPO) (2023)Local PPO$7,000$150
5

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