4

4 out of 5 stars* for plan year 2024

Plan ID: H1463-038

What You Need to Know:

  • OSF MedAdvantage Select (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 $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 $3,400 per year (in-network).
  • OSF MedAdvantage Select (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 $44.

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.

$110

Monthly Premium

Medicare Plan Features
Monthly Premium: $110.00
Part C Premium: $28.30
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 $28.30 $44.20 $37.50 $81.70 $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: H1463-039
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): $3,400
Annual Deductible: NULL
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Henderson, Illinois: 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 Henderson, Illinois: 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
$28.30 $44.20 $37.50 $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
$82.60 $74.80 $103.10 $68.00 $96.30 $61.10 $89.40
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%

Other Medicare Advantage Plans in Henderson, Illinois

Plan Name Type Premium MOOP Rx Deduct. Rating
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
Aetna Medicare Eagle (PPO) (2023)Local PPO *$5,900$-
5
HumanaChoice H5525-004 (PPO) (2023)Local PPO$5,500$250
4
AARP Medicare Advantage Walgreens (PPO) (2023)Local PPO$5,900$250
5
Health Alliance Medicare HMO 40 Rx (HMO) (2023)Local HMO$4,700$0
4
Health Alliance Medicare POS 10 Rx (HMO-POS) (2023)Local HMO$4,500$0
4
Health Alliance Medicare HMO Basic (HMO) (2023)Local HMO *$6,700$-
4
UnitedHealthcare Medicare Advantage Assure (PPO) (2023)Local PPO$7,550$445
5
Aetna Medicare Explorer Value (PPO) (2023)Local PPO$5,900$0
5
Health Alliance Medicare HMO 20 Rx (HMO) (2023)Local HMO$4,000$0
4
Health Alliance Medicare POS Basic Rx (HMO-POS) (2023)Local HMO$6,700$0
4
AARP Medicare Advantage Patriot (PPO) (2023)Local PPO *$5,900$-
5
Aetna Medicare Premier Advantra (PPO) (2023)Local PPO$5,500$0
5
OSF MedAdvantage Core (HMO) (2023)Local HMO$4,000$0
4
Aetna Medicare Value Advantra (PPO) (2023)Local PPO$5,900$0
5
OSF MedAdvantage Open (HMO-POS) (2023)Local HMO$4,500$0
4
Health Alliance Medicare POS Basic (HMO-POS) (2023)Local HMO *$6,700$-
4
HumanaChoice R5361-002 (Regional PPO) (2023)Regional PPO$6,700$420
5
OSF MedAdvantage Plus (HMO-POS) (2023)Local HMO$3,400$0
4
AARP Medicare Advantage (HMO-POS) (2023)Local HMO$3,900$0
5
HumanaChoice R5361-001 (Regional PPO) (2023)Regional PPO *$6,700$-
5
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
Health Alliance Medicare HMO Basic Rx (HMO) (2023)Local HMO$6,700$0
4
Health Alliance Medicare POS 30 Rx (HMO-POS) (2023)Local HMO$5,500$0
4
AARP Medicare Advantage Choice (PPO) (2023)Local PPO$3,400$0
5
Medicare Advantage Plans by Health Alliance Medicare
Health Alliance Medicare HMO 40 Rx (HMO) (2023)Local HMO$4,700$0
4
Health Alliance Medicare POS 10 Rx (HMO-POS) (2023)Local HMO$4,500$0
4
Health Alliance Medicare HMO Basic (HMO) (2023)Local HMO *$6,700$-
4
Health Alliance Medicare HMO 20 Rx (HMO) (2023)Local HMO$4,000$0
4
Health Alliance Medicare POS Basic Rx (HMO-POS) (2023)Local HMO$6,700$0
4
OSF MedAdvantage Core (HMO) (2023)Local HMO$4,000$0
4
OSF MedAdvantage Open (HMO-POS) (2023)Local HMO$4,500$0
4
Health Alliance Medicare POS Basic (HMO-POS) (2023)Local HMO *$6,700$-
4
OSF MedAdvantage Plus (HMO-POS) (2023)Local HMO$3,400$0
4
Health Alliance Medicare HMO Basic Rx (HMO) (2023)Local HMO$6,700$0
4
Health Alliance Medicare POS 30 Rx (HMO-POS) (2023)Local HMO$5,500$0
4

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