Plan ID: H6672-004

What You Need to Know:

  • Clear Spring Health 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 .
  • The plan includes an out-of-pocket maximum of $7,550 per year (in-network).
  • Clear Spring Health Select (HMO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is .
  • 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 $0 0.0
Gap Coverage: No
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local HMO
Similar Plan: H6672-005
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 Heard, 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. 2 out of 5 Stars.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,276 drugs
Number of Members Enrolled in this Plan in Heard, 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 33%

Other Medicare Advantage Plans in Heard, Georgia

Plan Name Type Premium MOOP Rx Deduct. Rating
Humana Honor (PPO) (2023)Local PPO *$6,700$-
4
UnitedHealthcare Medicare Advantage Choice (Regional PPO) (2023)Regional PPO$6,700$295
5
UnitedHealthcare Medicare Advantage Patriot (Regional PPO (2023)Regional PPO *$6,700$-
5
Anthem MediBlue Access Basic (PPO) (2023)Local PPO$6,700$150
4
HumanaChoice H5216-241 (PPO) (2023)Local PPO$7,550$445
4
Anthem MediBlue Core (HMO) (2023)Local HMO *$7,550$-
5
Clear Spring Health Choice Plan (PPO) (2023)Local PPO$7,550$250
Insufficient data to rate this plan.
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 Plus (HMO) (2023)Local HMO$6,700$150
5
HumanaChoice R3392-002 (Regional PPO) (2023)Regional PPO$6,700$340
4
HumanaChoice R3392-001 (Regional PPO) (2023)Regional PPO *$6,700$-
4
HumanaChoice H5525-024 (PPO) (2023)Local PPO$6,700$295
4
Anthem MediBlue Access (PPO) (2023)Local PPO$5,900$95
4
Anthem MediBlue Extra (HMO) (2023)Local HMO$5,900$445
5
HumanaChoice H5216-203 (PPO) (2023)Local PPO$7,550$0
4
Aetna Medicare Preferred Premium Plan (PPO) (2023)Local PPO$6,900$195
New plan - not yet rated.
Clover Health Choice Value (PPO) (2023)Local PPO$7,550$445
4
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
WellCare Flex Complete (PPO) (2023)Local PPO$2,500$0
5
HumanaChoice H5216-154 (PPO) (2023)Local PPO$7,550$400
4
WellCare Dividend (HMO) (2023)Local HMO$6,700$200
5
WellCare Premier (PPO) (2023)Local PPO$4,900$75
5
WellCare Patriot (HMO-POS) (2023)Local HMO *$3,400$-
5
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
HumanaChoice H5216-157 (PPO) (2023)Local PPO *$6,700$-
4
WellCare Compass (HMO) (2023)Local HMO$3,450$445
5
WellCare Prime (PPO) (2023)Local PPO$5,100$0
5
WellCare Endurance (PPO) (2023)Local PPO$4,900$0
5
WellCare Value (HMO) (2023)Local HMO$3,450$0
5
Aetna Medicare Eagle Plan (PPO) (2023)Local PPO *$6,900$-
New plan - not yet rated.
Clover Health Choice (PPO) (2023)Local PPO$7,550$0
4
Aetna Medicare Freedom Plan (PPO) (2023)Local PPO$6,900$250
New plan - not yet rated.
Medicare Advantage Plans by Clear Spring Health
Clear Spring Health Choice Plan (PPO) (2023)Local PPO$7,550$250
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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