Plan ID: H3557-001

What You Need to Know:

  • HealthMate for 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 $110, 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 $4,000 per year (in-network).
  • HealthMate for 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 $15.

$110

Monthly Premium

Medicare Plan Features
Monthly Premium: $110.00
Part C Premium: $94.80
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$110.00 $94.80 $15.20 $0 $15.20 $0 0.0
Gap Coverage: Yes
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local PPO
Similar Plan: H3557-001
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: Yes, some additional gap coverage.
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $4,000
Annual Deductible: NULL
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Newport, Rhode Island: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
547 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: 3,486 drugs
Number of Members Enrolled in this Plan in Newport, Rhode Island: 6,338 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
$94.80 $15.20 $0.00 $110.00
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
$94.80 $11.40 $106.20 $7.60 $102.40 $3.80 $98.60
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)
322 $0.00 967 $0.00 927 $47.00 556 $100.00 714 33%

Other Medicare Advantage Plans in Newport, Rhode Island

Plan Name Type Premium MOOP Rx Deduct. Rating
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
AARP Medicare Advantage Plan 2 (HMO-POS) (2023)Local HMO$4,500$75
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AARP Medicare Advantage Patriot (HMO-POS) (2023)Local HMO *$4,500$-
5
AARP Medicare Advantage Plan 1 (HMO-POS) (2023)Local HMO$5,100$150
5
AARP Medicare Advantage Choice Plan 1 (PPO) (2023)Local PPO$5,900$0
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BlueCHiP for Medicare Core (HMO) (2023)Local HMO *$3,500$-
5
BlueCHiP for Medicare Plus (HMO) (2023)Local HMO$2,800$0
5
BlueCHiP for Medicare Preferred (HMO-POS) (2023)Local HMO$2,250$0
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BlueCHiP for Medicare Standard with Drugs (HMO) (2023)Local HMO$4,500$100
5
BlueCHiP for Medicare Advance (HMO) (2023)Local HMO$5,000$200
5
BlueCHiP for Medicare Extra (HMO-POS) (2023)Local HMO$4,125$0
5
BlueCHiP for Medicare Value (HMO-POS) (2023)Local HMO$5,000$0
5
WellCare Premier (PPO) (2023)Local PPO$5,000$0
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WellCare Absolute (PPO) (2023)Local PPO$7,550$150
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Aetna Medicare Value Plan (HMO) (2023)Local HMO$5,900$0
5
WellCare Value (HMO) (2023)Local HMO$5,000$0
New plan - not yet rated.
Aetna Medicare Explorer Plan (PPO) (2023)Local PPO$5,900$0
5
AARP Medicare Advantage Choice (Regional PPO) (2023)Regional PPO$6,700$295
5
Medicare Advantage Plans by Blue Cross & Blue Shield of Rhode Island
BlueCHiP for Medicare Core (HMO) (2023)Local HMO *$3,500$-
5
BlueCHiP for Medicare Plus (HMO) (2023)Local HMO$2,800$0
5
BlueCHiP for Medicare Preferred (HMO-POS) (2023)Local HMO$2,250$0
5
BlueCHiP for Medicare Standard with Drugs (HMO) (2023)Local HMO$4,500$100
5
BlueCHiP for Medicare Advance (HMO) (2023)Local HMO$5,000$200
5
BlueCHiP for Medicare Extra (HMO-POS) (2023)Local HMO$4,125$0
5
BlueCHiP for Medicare Value (HMO-POS) (2023)Local HMO$5,000$0
5

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