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BIG CHART Summit Medicare Advantage Plans2018 FINAL
BIG CHART Summit Medicare Advantage Plans2018 FINAL
Range of Copays
or Co-insurance
(per prescription
Annual at retail Quality
Plan Name Phone Number Monthly Premium Medical Maximum Out-of-Pocket/Year Deductible pharmacies) Rating
Drug
deductible Please
AARP Medicare Complete Plan I, HMO $170/Health $2-$95 make
(United Healthcare) 800-555-5757 $18 $3,600 In Network $0 29% **** 4 stars
Drug
AARP Medicare Complete Plan 7, HMO $225/Health $3-$100
(United Healthcare) 800-555-5757 $0 $4,500 In Network $0 28% 4
Drug
Aetna Medicare Choice, PPO $98 $4,100 In Network/$7,500 In & Out of $0/Health $2-100
833-859-6031 Network $1,000 33% 4
Drug
Aetna Medicare Ohio Connect Gold, PPO $204 $3,500 In Network/$7,500 In & Out of $0/Health $0-$100
833-859-6031 Network $250 33% 4
Aetna Medicare Ohio Gold Plan 2 PPO $190 $3,500 In Network/$7,500 In & Out of Drug $350/ $2-$100
833-859-6031 Network Health $250 26% 4
Drug
Aetna Medicare Standard, PPO $120 $4,750 In Network/$10,000 In & Out of $0/Health $2-100
833-859-6031 Network $1,500 33% 4
Drug
Aetna Medicare Value, HMO $95/Health $2-100
833-859-6031 $0 $3,600 In Network $0 31% 3.5
plan too
new to
Drug be
Allwell Medicare, HMO $125/Health $0-$90 measur
877-826-5518 $0 $4,900 In Network $0 30% ed
Page 1 of 5
Medicare Advantage Plans
Summit County - 2019
Range of Copays
or Co-insurance
(per prescription
Annual at retail Quality
Plan Name Phone Number Monthly Premium Medical Maximum Out-of-Pocket/Year Deductible pharmacies) Rating
Drug
Anthem MediBlue Access, PPO $6,200 In Network/$10,000 In & Out of $50/Health $0-$95
800-797-5940 $68 Network $1,000 32% 4
Drug
Anthem MediBlue Access Basic, PPO $6,000 In Network/$10,000 In & Out of $200/Health $0-$42
800-797-0560 $70 Network $1,000 29%-41% 3
Drug
Anthem MediBlue Access Plus, PPO $4,300 In Network/$10,000 In & Out of $40/Health $0-$95
800-797-5940 $87 Network $1,000 32% 4
Drug
Anthem MediBlue Essential, HMO $60/Health $0-$95
800-797-5957 $0 $4,900 In Network $0 31% 3.5
Drug
Anthem MediBlue Extra, HMO $6,700 In Network $415/Health $0-$95
800-797-5957 $32.90 $0 25% 3.5
Drug
Anthem MediBlue Plus, HMO $60/Health $0-$95
800-797-5957 $63 $4,100 In Network $0 31% 3.5
Drug
CareSource Advantage Zero Premium, HMO $250/Health $6-$100
844-607-2830 $0 $6,700 In Network $0 28% 2.5
Drug
Humana Choice, PPO $250/Health $7-$100
800-833-2364 $0 $6,700 In & Out of Network $0 28% 4
Page 2 of 5
Medicare Advantage Plans
Summit County - 2019
Range of Copays
or Co-insurance
(per prescription
Annual at retail Quality
Plan Name Phone Number Monthly Premium Medical Maximum Out-of-Pocket/Year Deductible pharmacies) Rating
Drug
Humana Choice, PPO $3,400 In Network/$5,100 In & Out of $125/Health $2-$100
800-833-2364 $15 Network $0 30% 4
Drug
Humana Choice, PPO $6,700 In Network/$10,000 In & Out of $250/Health $7-$100
800-833-2364 $75 Network $1,500 28% 4
Drug
Humana Choice, PPO $3,400 In Network/$3,400 In & Out $100/Health $1-$97
800-833-2364 $155 Network $225 31% 4
Drug
Humana Choice Regional, PPO $6,700 In Network/$10,000 In & Out of $395/Health $9-$100
800-833-2364 $100 Network $1,850 25% 3.5
Drug
Humana Gold Plus, HMO $125/Health $1-$97
800-833-2364 $87 $3,900 In Network $100 30% 4
Drug
MedMutual Advantage Choice, HMO $55/Health $0-$42
866-406-8777 $38 $3,950 In Network $0 32%-50% 3.5
Drug
MedMutual Advantage Classic, HMO $160/Health $0-$42
866-406-8777 $0 $4,300 In Network $0 30%-50% 3.5
Drug
MedMutual Advantage Plus, HMO $55/Health $0-$42
866-406-8777 $99 $3,400 In Network $0 32%-50% 3.5
Drug
MedMutual Advantage Preferred, PPO $5,700 In Network/$10,000 In & Out of $55/Health $0-$42
866-406-8777 $74 Network $1,750 32%-50% 3.5
Drug
MedMutual Advantage Premium, PPO $3,400 In Network/$5,100 In & Out of $55/Health $0-$42
866-406-8777 $119 Network $1,250 32%-50% 3.5
Page 3 of 5
Medicare Advantage Plans
Summit County - 2019
Range of Copays
or Co-insurance
(per prescription
Annual at retail Quality
Plan Name Phone Number Monthly Premium Medical Maximum Out-of-Pocket/Year Deductible pharmacies) Rating
Drug
MedMutual Advantage Select, PPO $6,500 n Network/$10,000 In & Out of $160/Health $0-$42
866-406-8777 $38 Network $2,000 32%-50% 3.5
Drug
Prime Time Health Plan Aultimate, HMO-POS $200/Health $3-$95
855-877-1049 $0 $4,900 In Network $0 29% 4.5
Drug
Prime Time Health Plan Classic, HMO-POS $150/Health $2-$95
855-877-1049 $39 $4,200 In Network $0 30% 4.5
Drug
Prime Time Health Plan Plus, HMO-POS $100/Health $0-$95
855-877-1049 $89 $3,600 In Network $0 31% 4.5
Drug
SummaCare Topaz, HMO $150/Health $0-$100
888-464-8440 $0 $3,800 In Network $0 30% 4.5
Page 4 of 5
Medicare Advantage Plans
Summit County - 2019
Range of Copays
or Co-insurance
(per prescription
Annual at retail Quality
Plan Name Phone Number Monthly Premium Medical Maximum Out-of-Pocket/Year Deductible pharmacies) Rating
No drug
* Anthem MediBlue Access Core, PPO-POS $15 coverage/
800-797-0560 $5,400 In & Out of Network Health $250 N/A 3
No drug
coverage/
* Humana Choice, PPO $6,700 In Network/$10,000 Out of Health
800-833-2364 $0 Network $1,250 N/A 3.5
No drug
* The Health Plan SecureCare Option I, HMO coverage/
877-847-7915 $0 $3,900 In Network Health $0 N/A 3.5
No drug
* Paramount Elite Enhanced Medical Only, HMO coverage/
800-468-3589 $40 $3,400 In Network Health $0 N/A 4
No drug
* Prime Time Health Plan Basic, HMO-POS coverage/
855-877-1049 $0 $3,400 In Network Health $0 N/A 4.5
Page 5 of 5