Plan ID: H9589-003

What You Need to Know:

  • Clear Spring Health Choice Plan (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 $0, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is $250 (Tier 1 and 2 excluded from the Deductible.).
  • The plan includes an out-of-pocket maximum of $7,550 per year (in-network).
  • Clear Spring Health Choice Plan (PPO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $250 (Tier 1 and 2 excluded from the Deductible.).
  • This plan's Part D Initial Coverage Limit is $0.

$0

Monthly Premium

Medicare Plan Features
Monthly Premium: $0
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:
$0 $0 $0 $0 $0 $250.0 1.0
Gap Coverage: No
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local PPO
Similar Plan: H9589-003
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: $250 (Tier 1 and 2 excluded from the Deductible.)
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Chatham, Georgia: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
less than 10 members Insufficient data to rate this plan. Insufficient data to rate this plan. Insufficient data to rate this plan.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,276 drugs
Number of Members Enrolled in this Plan in Chatham, Georgia: 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 $0.00 $0.00 $0.00
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 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
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)
341 $0.00 543 $12.00 934 $42.00 795 $95.00 663 28%

Other Medicare Advantage Plans in Chatham, Georgia

Plan Name Type Premium MOOP Rx Deduct. Rating
Humana Honor (PPO) (2023)Local PPO *$6,700$-
4
HumanaChoice H5216-238 (PPO) (2023)Local PPO$7,550$0
4
HumanaChoice H5216-241 (PPO) (2023)Local PPO$7,550$445
4
HumanaChoice R3392-001 (Regional PPO) (2023)Regional PPO *$6,700$-
4
Anthem MediBlue Access Basic (PPO) (2023)Local PPO$6,700$150
4
UnitedHealthcare Medicare Advantage Choice (Regional PPO) (2023)Regional PPO$6,700$295
5
Clear Spring Health Select (HMO) (2023)Local HMO$7,550$0
Insufficient data to rate this plan.
Anthem MediBlue Core (HMO) (2023)Local HMO *$7,550$-
5
UnitedHealthcare Medicare Advantage Patriot (Regional PPO (2023)Regional PPO *$6,700$-
5
Clear Spring Health Select Plus (HMO) (2023)Local HMO$7,550$0
Insufficient data to rate this plan.
Humana Gold Choice H8145-069 (PFFS) (2023)PFFS$-$340
4
Anthem MediBlue Essential (HMO) (2023)Local HMO$3,450$95
5
Anthem MediBlue Plus (HMO) (2023)Local HMO$6,700$150
5
HumanaChoice R3392-002 (Regional PPO) (2023)Regional PPO$6,700$340
4
HumanaChoice H5216-157 (PPO) (2023)Local PPO *$6,700$-
4
UnitedHealthcare Medicare Advantage Choice Plan 1 (PPO) (2023)Local PPO$6,700$275
5
Anthem MediBlue Access (PPO) (2023)Local PPO$5,900$95
4
Anthem MediBlue Extra (HMO) (2023)Local HMO$5,900$445
5
WellCare Focus (HMO) (2023)Local HMO$3,450$0
5
Aetna Medicare Preferred Premium Plan (PPO) (2023)Local PPO$6,900$195
New plan - not yet rated.
Aetna Medicare Advantra Preferred Plan (PPO) (2023)Local PPO$7,550$200
4
Aetna Medicare Freedom Plan (PPO) (2023)Local PPO$6,900$200
New plan - not yet rated.
AARP Medicare Advantage Walgreens (HMO) (2023)Local HMO$6,700$275
5
WellCare Premier (PPO) (2023)Local PPO$4,900$75
5
WellCare Endurance (PPO) (2023)Local PPO$4,900$0
5
WellCare Dividend (HMO) (2023)Local HMO$6,700$200
5
Aetna Medicare Eagle Plan (PPO) (2023)Local PPO *$6,900$-
New plan - not yet rated.
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
WellCare Patriot (HMO-POS) (2023)Local HMO *$3,400$-
5
Humana Gold Plus H4141-017 (HMO) (2023)Local HMO$7,550$0
4
Clover Health Choice (PPO) (2023)Local PPO$7,550$0
4
HumanaChoice H5216-142 (PPO) (2023)Local PPO$6,700$250
4
WellCare Compass (HMO) (2023)Local HMO$3,450$445
5
WellCare Prime (PPO) (2023)Local PPO$5,100$0
5
Clover Health Choice Value (PPO) (2023)Local PPO$7,550$445
4
HumanaChoice H5216-154 (PPO) (2023)Local PPO$7,550$400
4
WellCare Value (HMO) (2023)Local HMO$3,450$0
5
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
WellCare Flex Complete (PPO) (2023)Local PPO$2,500$0
5
Medicare Advantage Plans by Clear Spring Health
Clear Spring Health Select (HMO) (2023)Local HMO$7,550$0
Insufficient data to rate this plan.
Clear Spring Health Select Plus (HMO) (2023)Local HMO$7,550$0
Insufficient data to rate this plan.

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