5

5 out of 5 stars* for plan year 2024

Plan ID: H5106-029

What You Need to Know:

  • Freedom Blue PPO Distinct (PPO) is a Medicare Advantage Health Maintenance Organization Local PPO 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 $35, 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 $7,550 per year (in-network).
  • Freedom Blue PPO Distinct (PPO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is .
  • This plan's Part D Initial Coverage Limit is $35.

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

$35

Monthly Premium

Medicare Plan Features
Monthly Premium: $35.00
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:
$35.00 $0 $35.00 $0 $35.00 $0 0.0
Gap Coverage: No
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local PPO
Similar Plan: H5106-013
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): $7,550
Annual Deductible: NULL
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Ritchie, West Virginia: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
15 members 3.5 out of 5 Stars. 5 out of 5 Stars. 4 out of 5 Stars.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,669 drugs
Number of Members Enrolled in this Plan in Ritchie, West Virginia: 2,510 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 $35.00 $0.00 $35.00
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
$0.00 $26.20 $26.20 $17.50 $17.50 $8.70 $8.70
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)
323 $0.00 1127 $5.00 637 $47.00 713 $100.00 869 33%

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Humana Gold Choice H8145-055 (PFFS) (2023)PFFS *$-$-
4
AARP Medicare Advantage Choice Plan 3 (PPO) (2023)Local PPO$6,700$150
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HumanaChoice H5216-182 (PPO) (2023)Local PPO$6,700$195
4
The Health Plan SecureChoice - Option II (PPO) (2023)Local PPO$6,700$100
5
HumanaChoice H5216-052 (PPO) (2023)Local PPO$5,500$100
4
Aetna Medicare Advantra Value (PPO) (2023)Local PPO$7,550$0
4
AARP Medicare Advantage Choice Plan 1 (PPO) (2023)Local PPO$5,900$200
5
HumanaChoice R0923-001 (Regional PPO) (2023)Regional PPO *$4,900$-
3
AARP Medicare Advantage Choice Plan 2 (PPO) (2023)Local PPO$5,400$100
5
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
Humana Honor (PPO) (2023)Local PPO *$6,700$-
4
HumanaChoice H5216-105 (PPO) (2023)Local PPO *$4,500$-
4
Aetna Medicare Advantra Silver (HMO) (2023)Local HMO$7,550$0
5
HumanaChoice R0923-002 (Regional PPO) (2023)Regional PPO$6,700$0
3
The Health Plan SecureCare - Option II (HMO) (2023)Local HMO$6,700$100
5
HumanaChoice H5216-124 (PPO) (2023)Local PPO$6,700$0
4
The Health Plan SecureCare - Option I, MA Only (HMO) (2023)Local HMO *$6,700$-
5
AARP Medicare Advantage Patriot (PPO) (2023)Local PPO *$5,400$-
5
Aetna Medicare Advantra Elite (HMO) (2023)Local HMO$7,000$0
5
Aetna Medicare Advantra Gold (PPO) (2023)Local PPO$6,500$0
4
Humana Gold Choice H8145-021 (PFFS) (2023)PFFS$-$360
4
Humana Value Plus H5216-125 (PPO) (2023)Local PPO$7,550$445
4
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
Freedom Blue PPO Standard (PPO) (2023)Local PPO$6,500$0
5
Aetna Medicare Advantra Credit Value (PPO) (2023)Local PPO$7,550$195
4
Medicare Advantage Plans by Highmark Inc
Freedom Blue PPO Standard (PPO) (2023)Local PPO$6,500$0
5

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