Plan ID: H2020-002

What You Need to Know:

  • Clear Spring Health Essential (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 $5,000 per year (in-network).
  • Clear Spring Health Essential (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: Yes
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local PPO
Similar Plan: H2020-003
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): $5,000
Annual Deductible: NULL
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Petersburg City, Virginia: 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 Petersburg City, Virginia: 10 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 $2.00 543 $5.00 934 $42.00 795 $95.00 663 33%

Other Medicare Advantage Plans in Petersburg City, Virginia

Plan Name Type Premium MOOP Rx Deduct. Rating
Humana Gold Plus H6622-072 (HMO) (2023)Local HMO$7,550$415
4
HumanaChoice R1390-001 (Regional PPO) (2023)Regional PPO *$5,400$-
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Humana Gold Plus H5619-044 (HMO) (2023)Local HMO$6,700$265
4
HumanaChoice R1390-002 (Regional PPO) (2023)Regional PPO$7,550$360
4
AARP Medicare Advantage Plan 1 (HMO-POS) (2023)Local HMO$5,900$150
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HumanaChoice H5216-152 (PPO) (2023)Local PPO *$3,400$-
4
Humana Gold Choice H8145-004 (PFFS) (2023)PFFS$-$160
4
AARP Medicare Advantage Plan 2 (HMO-POS) (2023)Local HMO$4,900$0
5
Humana Honor R1390-003 (Regional PPO) (2023)Regional PPO *$6,700$-
4
Humana Gold Choice H8145-042 (PFFS) (2023)PFFS *$-$-
4
Humana Gold Plus H6622-004 (HMO) (2023)Local HMO$3,450$0
4
Aetna Medicare Essential Plan (PPO) (2023)Local PPO$7,550$250
5
Clear Spring Health Essential (HMO) (2023)Local HMO$3,250$0
New plan - not yet rated.
Anthem MediBlue Access (PPO) (2023)Local PPO$7,550$95
5
Optima Medicare Classic (HMO) (2023)Local HMO *$3,400$-
4
HumanaChoice H5216-144 (PPO) (2023)Local PPO$6,700$265
4
Anthem MediBlue Extra (HMO) (2023)Local HMO$5,900$445
4
Optima Medicare Value (HMO) (2023)Local HMO$3,400$150
4
AARP Medicare Advantage Patriot (PPO) (2023)Local PPO *$6,700$-
New plan - not yet rated.
Aetna Medicare Select Plan (HMO) (2023)Local HMO$6,700$195
5
Optima Medicare Prime (HMO) (2023)Local HMO$3,600$130
4
Anthem MediBlue Local (HMO) (2023)Local HMO$3,450$0
4
Anthem MediBlue Smart Fit (HMO) (2023)Local HMO$3,450$0
4
AARP Medicare Advantage Walgreens (PPO) (2023)Local PPO$6,700$195
New plan - not yet rated.
Medicare Advantage Plans by Clear Spring Health
Clear Spring Health Essential (HMO) (2023)Local HMO$3,250$0
New plan - not yet rated.

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