Plan ID: H3499-008

What You Need to Know:

  • Allwell Medicare Complement (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 $30, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is $445 (Tier 1 excluded from the Deductible.).
  • The plan includes an out-of-pocket maximum of $5,500 per year (in-network).
  • Allwell Medicare Complement (HMO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $445 (Tier 1 excluded from the Deductible.).
  • This plan's Part D Initial Coverage Limit is $30.

$30

Monthly Premium

Medicare Plan Features
Monthly Premium: $29.60
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:
$29.60 $0 $29.60 $0 $29.60 $445.0 1.0
Gap Coverage: No
Benchmark: below the regional benchmark
Type of Medicare Health: Basic Alternative
Health Plan Type: Local HMO
Similar Plan: H3499-002
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): $5,500
Annual Deductible: $445 (Tier 1 excluded from the Deductible.)
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Vanderburgh, Indiana: 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. 4 out of 5 Stars.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,394 drugs
Number of Members Enrolled in this Plan in Vanderburgh, 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
$0.00 $29.60 $0.00 $29.60
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 $22.20 $22.20 $14.80 $14.80 $7.40 $7.40
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)
408 $2.00 410 $8.00 1011 $47.00 893 45% 672 25%

Other Medicare Advantage Plans in Vanderburgh, Indiana

Plan Name Type Premium MOOP Rx Deduct. Rating
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Aetna Medicare Value (PPO) (2023)Local PPO$5,700$0
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Anthem MediBlue Extra (HMO) (2023)Local HMO$6,700$445
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Anthem MediBlue Access Basic (Regional PPO) (2023)Regional PPO$6,400$100
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Aetna Medicare Premier (PPO) (2023)Local PPO$4,800$0
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AARP Medicare Advantage Choice (PPO) (2023)Local PPO$4,500$50
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Anthem MediBlue Access Preferred (PPO) (2023)Local PPO$4,900$125
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Anthem MediBlue Plus (HMO) (2023)Local HMO$4,400$0
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Humana Gold Choice H8145-032 (PFFS) (2023)PFFS$-$225
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
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HumanaChoice H5216-111 (PPO) (2023)Local PPO$4,900$100
4
Ascension Complete St Vincent Secure (HMO) (2023)Local HMO$4,500$0
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MyTruAdvantage Select (HMO) (2023)Local HMO$4,500$0
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IU Health Plans Medicare Select (HMO) (2023)Local HMO *$5,000$-
4
MyTruAdvantage Choice (PPO) (2023)Local PPO$5,000$100
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HumanaChoice R0865-001 (Regional PPO) (2023)Regional PPO *$6,200$-
4
HumanaChoice H5216-192 (PPO) (2023)Local PPO$7,550$250
4
Humana Gold Plus H5619-050 (HMO) (2023)Local HMO$5,000$125
4
Ascension Complete St Vincent Access (PPO) (2023)Local PPO$5,200$100
New plan - not yet rated.
Allwell Medicare (HMO) (2023)Local HMO$4,100$0
New plan - not yet rated.
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.
IU Health Plans Medicare Select Plus (HMO) (2023)Local HMO$4,950$200
4
HumanaChoice H5216-054 (PPO) (2023)Local PPO$5,900$0
4
Allwell Medicare (PPO) (2023)Local PPO$5,500$200
New plan - not yet rated.
Ascension Complete St Vincent Reward (HMO) (2023)Local HMO$7,550$390
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AARP Medicare Advantage Patriot (PPO) (2023)Local PPO *$5,500$-
5
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
Medicare Advantage Plans by Allwell
Allwell Medicare (HMO) (2023)Local HMO$4,100$0
New plan - not yet rated.
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.

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