Simplete Riverside 3 (HMO-POS) in Benton, Indiana (2023)
Simplete Riverside 3 (HMO-POS) in Benton County, Indiana costs $70/mo. This affordable Regional PPO plan (H1463-034) is a top choice for those living in Benton County with a $0 prescription deductible and out-of-pocket limits at $4,950. Learn more about Medicare Part C by AARP in Benton County, Indiana below.
UPDATED: Sep 20, 2023
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4 out of 5 stars* for plan year 2024
Plan ID: H1463-034
What You Need to Know:
- Simplete Riverside 3 (HMO-POS) 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 $70, 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 $4,950 per year (in-network).
- Simplete Riverside 3 (HMO-POS) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is .
- This plan's Part D Initial Coverage Limit is $42.
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.
$70
Monthly Premium
Medicare Plan Features | |||||||||
---|---|---|---|---|---|---|---|---|---|
Monthly Premium: | $70.00 | ||||||||
Part C Premium: | $28.40 | ||||||||
Monthly Premium: | Part C Premium: | Part D Drug Premium: | Part D Supplemental Premium: | Total Part D Premium: | Drug Deductible: | Tiers with No Deductible: | |||
$70.00 | $28.40 | $41.60 | $0 | $41.60 | $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: | H1463-035 | ||||||||
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): | $4,950 | ||||||||
Annual Deductible: | NULL | ||||||||
Annual Initial Coverage Limit ICL: | $4,130 | ||||||||
Number of Members enrolled in this plan in Benton, Indiana: | Plans Summary Star Rating: | Customer Service Rating: | Drug Cost Rating: | ||||||
less than 10 members | 4 out of 5 Stars. | 4 out of 5 Stars. | 4 out of 5 Stars. | ||||||
Plan Offers Mail Order: | Yes | ||||||||
Plan Health Benefits | |||||||||
Total # of Formulary Drugs: | 3,850 drugs | ||||||||
Number of Members Enrolled in this Plan in Benton, Indiana: | less than 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 | ||||||
$28.40 | $41.60 | $0.00 | $70.00 | ||||||
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 | |||
$42.60 | $34.70 | $63.10 | $27.90 | $56.30 | $21.00 | $49.40 | |||
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) |
813 | $2.00 | 1374 | $15.00 | 295 | $47.00 | 499 | 50% | 869 | 33% |
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