5

5 out of 5 stars* for plan year 2024

Plan ID: H3335-014

What You Need to Know:

  • Medicare BlueSecure (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 $101, 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 $6,700 per year (in-network).
  • Medicare BlueSecure (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 $42.

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

$101

Monthly Premium

Medicare Plan Features
Monthly Premium: $101.00
Part C Premium: $58.80
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$101.00 $58.80 $42.20 $0 $42.20 $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: H3335-015
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): $6,700
Annual Deductible: NULL
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Herkimer, New York: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
218 members 4.5 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: 4,388 drugs
Number of Members Enrolled in this Plan in Herkimer, New York: NULL
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
$58.80 $42.20 $0.00 $101.00
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
$58.80 $31.60 $90.40 $21.10 $79.90 $10.50 $69.30
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)
240 $0.00 1633 $8.00 712 $42.00 776 $95.00 1027 33%

Other Medicare Advantage Plans in Herkimer, New York

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HumanaChoice H5970-015 (PPO) (2023)Local PPO$6,500$250
4
Humana Gold Plus H3533-013 (HMO) (2023)Local HMO$6,700$275
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Humana Honor (PPO) (2023)Local PPO *$4,500$-
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HumanaChoice H5970-018 (PPO) (2023)Local PPO$7,550$310
4
Fidelis Medicare Advantage Flex (HMO-POS) (2023)Local HMO$7,550$445
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Fidelis Medicare $0 Premium (HMO) (2023)Local HMO$7,550$0
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HumanaChoice H5970-019 (PPO) (2023)Local PPO$5,500$0
4
Fidelis Medicare Advantage without Rx (HMO-POS) (2023)Local HMO *$7,550$-
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CDPHP Choice (HMO) (2023)Local HMO *$5,000$-
5
Aetna Medicare Credit Plan (PPO) (2023)Local PPO$7,550$250
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CDPHP Choice Rx (HMO) (2023)Local HMO$5,000$0
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CDPHP Value Rx (HMO) (2023)Local HMO$5,800$0
5
CDPHP Vital Rx (PPO) (2023)Local PPO$7,500$350
5
CDPHP Flex Rx (PPO) (2023)Local PPO$5,500$0
5
CDPHP Basic RX (HMO) (2023)Local HMO$6,700$0
5
Medicare Bassett (HMO-POS) (2023)Local HMO$6,700$0
4
Aetna Medicare Eagle Plan (PPO) (2023)Local PPO *$7,550$-
5
WellCare Today's Options Premier 300 (PFFS) (2023)PFFS *$-$-
5
MVP SmartFund (MSA) (2023)MSA *$-$-
4
CDPHP Flex (PPO) (2023)Local PPO *$5,500$-
5
CDPHP $0 Medicare Rx (HMO) (2023)Local HMO$7,500$300
5
MVP Medicare Secure with Part D (HMO-POS) (2023)Local HMO$7,550$150
4
WellCare Absolute (PPO) (2023)Local PPO$7,550$150
5
Aetna Medicare Premier Plan (PPO) (2023)Local PPO$7,550$200
5
Medicare BlueEnhanced (PPO) (2023)Local PPO$5,000$0
5
Humana Gold Plus H3533-001 (HMO) (2023)Local HMO$7,200$350
4
WellCare Today's Options Advantage Plus 150A (PPO) (2023)Local PPO$3,400$0
5
WellCare Summit (PPO) (2023)Local PPO$6,700$445
5
Medicare BlueClassic (PPO) (2023)Local PPO$7,200$0
5
MVP Medicare Preferred Gold without Part D (HMO-POS) (2023)Local HMO *$7,550$-
4
Medicare BlueBasic (PPO) (2023)Local PPO *$4,500$-
5
Aetna Medicare Value Plan (HMO) (2023)Local HMO$7,550$0
5
WellCare Today's Options Premier Plus 250A (PFFS) (2023)PFFS$-$0
5
Medicare BlueEssential (PPO) (2023)Local PPO$7,550$150
5
MVP Medicare Preferred Gold with Part D (HMO-POS) (2023)Local HMO$5,800$0
4
WellCare Today's Options Advantage Plus 550B (PPO) (2023)Local PPO$6,700$0
5
WellCare Today's Options Premier Plus 650B (PFFS) (2023)PFFS$-$0
5
MVP Medicare Secure Plus with Part D (HMO-POS) (2023)Local HMO$7,550$0
4
WellCare Today's Options Premier 200 (PFFS) (2023)PFFS *$-$-
5
Medicare Advantage Plans by Excellus Health Plan, Inc
Medicare Bassett (HMO-POS) (2023)Local HMO$6,700$0
4
Medicare BlueEnhanced (PPO) (2023)Local PPO$5,000$0
5
Medicare BlueClassic (PPO) (2023)Local PPO$7,200$0
5
Medicare BlueBasic (PPO) (2023)Local PPO *$4,500$-
5
Medicare BlueEssential (PPO) (2023)Local PPO$7,550$150
5

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