4

4 out of 5 stars* for plan year 2024

Plan ID: H7220-002

What You Need to Know:

  • IU Health Plans Medicare 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 $0, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is no drug coverage.
  • The plan includes an out-of-pocket maximum of $5,000 per year (in-network).
  • IU Health Plans Medicare Select (HMO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is no drug coverage.
  • This plan's Part D Initial Coverage Limit is .

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

$0

Monthly Premium

Medicare Plan Features
Monthly Premium: $0
Part C Premium: NULL
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$0 NULL NULL NULL NULL NULL NULL
Gap Coverage: NULL
Benchmark: NULL
Type of Medicare Health: NULL
Health Plan Type: Local HMO *
Similar Plan: H7220-004
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: NULL
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $5,000
Annual Deductible: no drug coverage
Annual Initial Coverage Limit ICL: NULL
Number of Members enrolled in this plan in Tippecanoe, Indiana: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
83 members 4.5 out of 5 Stars. 4 out of 5 Stars. 4 out of 5 Stars.
Plan Offers Mail Order: NULL
Plan Health Benefits
Total # of Formulary Drugs: NULL
Number of Members Enrolled in this Plan in Tippecanoe, Indiana: 839 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
NULL NULL NULL NULL
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
NULL NULL NULL NULL NULL NULL NULL
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)
NULL NULL NULL NULL NULL NULL NULL NULL NULL NULL

Other Medicare Advantage Plans in Tippecanoe, Indiana

Plan Name Type Premium MOOP Rx Deduct. Rating
AARP Medicare Advantage Plan 1 (HMO-POS) (2023)Local HMO$3,900$0
5
Anthem MediBlue Access Plus (PPO) (2023)Local PPO$6,400$60
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Aetna Medicare Prime (HMO) (2023)Local HMO$4,300$0
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Anthem MediBlue Extra (HMO) (2023)Local HMO$6,700$445
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Aetna Medicare Value (PPO) (2023)Local PPO$5,950$0
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Anthem MediBlue Access (PPO) (2023)Local PPO$6,700$150
5
Aetna Medicare Premier (PPO) (2023)Local PPO$5,700$0
5
Anthem MediBlue Access Preferred (PPO) (2023)Local PPO$4,900$125
5
Anthem MediBlue Access Basic (Regional PPO) (2023)Regional PPO$6,400$100
5
AARP Medicare Advantage Choice Plan 2 (PPO) (2023)Local PPO$5,500$185
5
Anthem MediBlue Plus (HMO) (2023)Local HMO$4,900$75
4
HumanaChoice H5216-111 (PPO) (2023)Local PPO$4,900$100
4
AARP Medicare Advantage Choice Premier (PPO) (2023)Local PPO$7,550$445
5
HumanaChoice R0865-003 (Regional PPO) (2023)Regional PPO$6,700$195
4
Allwell Medicare Complement (HMO) (2023)Local HMO$5,500$445
New plan - not yet rated.
HumanaChoice H5216-192 (PPO) (2023)Local PPO$7,550$250
4
AARP Medicare Advantage Choice Plan 1 (PPO) (2023)Local PPO$5,200$185
5
Humana Gold Plus H5619-049 (HMO) (2023)Local HMO$3,900$0
4
HumanaChoice R0865-001 (Regional PPO) (2023)Regional PPO *$6,200$-
4
Humana Gold Plus H5619-124 (HMO) (2023)Local HMO$3,900$0
4
Allwell Medicare (HMO) (2023)Local HMO$4,100$0
New plan - not yet rated.
HumanaChoice H5216-053 (PPO) (2023)Local PPO$6,200$0
4
IU Health Plans Medicare Choice (HMO-POS) (2023)Local HMO$6,700$200
4
Allwell Medicare Boost (HMO) (2023)Local HMO$7,550$200
New plan - not yet rated.
Allwell Medicare (PPO) (2023)Local PPO$5,500$200
New plan - not yet rated.
IU Health Plans Medicare Select Plus (HMO) (2023)Local HMO$4,950$200
4
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
Humana Honor (PPO) (2023)Local PPO *$6,700$-
4
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
Aetna Medicare Eagle (PPO) (2023)Local PPO *$5,900$-
5
AARP Medicare Advantage Patriot (PPO) (2023)Local PPO *$5,500$-
5
Medicare Advantage Plans by Indiana University Health Plans - Medicare
IU Health Plans Medicare Choice (HMO-POS) (2023)Local HMO$6,700$200
4
IU Health Plans Medicare Select Plus (HMO) (2023)Local HMO$4,950$200
4

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