Plan ID: H8390-012

What You Need to Know:

  • CareSource Advantage (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 $22, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is $75 (Tier 1 and 2 excluded from the Deductible.).
  • The plan includes an out-of-pocket maximum of $5,600 per year (in-network).
  • CareSource Advantage (HMO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $75 (Tier 1 and 2 excluded from the Deductible.).
  • This plan's Part D Initial Coverage Limit is $22.

$22

Monthly Premium

Medicare Plan Features
Monthly Premium: $22.10
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:
$22.10 $0 $22.10 $0 $22.10 $75.00 1.0
Gap Coverage: No
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local HMO
Similar Plan: H8390-013
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): $5,600
Annual Deductible: $75 (Tier 1 and 2 excluded from the Deductible.)
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Oglethorpe, Georgia: 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: 3,710 drugs
Number of Members Enrolled in this Plan in Oglethorpe, Georgia: 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
$0.00 $22.10 $0.00 $22.10
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 $16.60 $16.60 $11.00 $11.00 $5.50 $5.50
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)
296 $4.00 1744 $10.00 428 $45.00 362 $100.00 788 31%

Other Medicare Advantage Plans in Oglethorpe, Georgia

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HumanaChoice H5216-241 (PPO) (2023)Local PPO$7,550$445
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HumanaChoice R3392-001 (Regional PPO) (2023)Regional PPO *$6,700$-
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HumanaChoice R3392-002 (Regional PPO) (2023)Regional PPO$6,700$340
4
UnitedHealthcare Medicare Advantage Patriot (Regional PPO (2023)Regional PPO *$6,700$-
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Clear Spring Health Select Plus (HMO) (2023)Local HMO$7,550$0
Insufficient data to rate this plan.
Clear Spring Health Choice Plan (PPO) (2023)Local PPO$7,550$250
Insufficient data to rate this plan.
HumanaChoice H5216-157 (PPO) (2023)Local PPO *$6,700$-
4
HumanaChoice H5216-203 (PPO) (2023)Local PPO$7,550$0
4
HumanaChoice H5216-154 (PPO) (2023)Local PPO$7,550$400
4
Aetna Medicare Preferred Premium Plan (PPO) (2023)Local PPO$6,900$195
New plan - not yet rated.
Cigna Preferred Medicare (HMO) (2023)Local HMO$6,500$0
4
Aetna Medicare Freedom Plan (PPO) (2023)Local PPO$7,000$200
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Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
Aetna Medicare Eagle Plan (PPO) (2023)Local PPO *$6,900$-
New plan - not yet rated.
Humana Gold Plus H4141-017 (HMO) (2023)Local HMO$7,550$0
4
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
HumanaChoice H5216-142 (PPO) (2023)Local PPO$6,700$250
4
Cigna Preferred GA Medicare (HMO) (2023)Local HMO$7,500$300
4
Cigna Premier Medicare (HMO-POS) (2023)Local HMO$5,700$0
4
Medicare Advantage Plans by CareSource
CareSource Advantage Zero Premium (HMO) (2023)Local HMO$7,550$150
New plan - not yet rated.

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