3

3 out of 5 stars* for plan year 2024

Plan ID: H9808-004

What You Need to Know:

  • HealthTeam Advantage Plan I (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 .
  • The plan includes an out-of-pocket maximum of $3,400 per year (in-network).
  • HealthTeam Advantage Plan I (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 $0.

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

$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: Yes
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local PPO
Similar Plan: H9808-005
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: Yes, some additional gap coverage.
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $3,400
Annual Deductible: NULL
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Davidson, North Carolina: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
67 members 3.5 out of 5 Stars. 3 out of 5 Stars. 3 out of 5 Stars.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,782 drugs
Number of Members Enrolled in this Plan in Davidson, North Carolina: 14,067 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)
670 $5.00 865 $15.00 581 $45.00 1010 $90.00 656 33%

Other Medicare Advantage Plans in Davidson, North Carolina

Plan Name Type Premium MOOP Rx Deduct. Rating
Humana Gold Choice H8145-004 (PFFS) (2023)PFFS$-$160
4
Cigna Preferred Medicare (HMO) (2023)Local HMO$4,900$0
4
AARP Medicare Advantage Plan 2 (HMO-POS) (2023)Local HMO$4,500$95
5
Aetna Medicare Premier Plus Plan (PPO) (2023)Local PPO$5,000$150
5
Cigna Fundamental Medicare (HMO) (2023)Local HMO *$4,900$-
4
Blue Medicare Medical Only (HMO) (2023)Local HMO *$4,400$-
5
HumanaChoice R1390-002 (Regional PPO) (2023)Regional PPO$7,550$360
4
Cigna Preferred Plus Medicare (HMO) (2023)Local HMO$3,900$0
4
AARP Medicare Advantage Patriot (HMO-POS) (2023)Local HMO *$3,600$-
5
Aetna Medicare Eagle Plan (PPO) (2023)Local PPO *$6,500$-
5
HealthTeam Advantage Plan II (PPO) (2023)Local PPO$3,100$0
3
Blue Medicare Essential Plus (HMO) (2023)Local HMO$4,200$195
5
Aetna Medicare Value Plus Plan (HMO) (2023)Local HMO$5,500$195
New plan - not yet rated.
Aetna Medicare Prime (HMO) (2023)Local HMO$4,500$0
New plan - not yet rated.
Humana Honor R1390-003 (Regional PPO) (2023)Regional PPO *$6,700$-
4
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
Humana Gold Plus H1036-291 (HMO) (2023)Local HMO$3,900$0
4
AARP Medicare Advantage Walgreens (HMO-POS) (2023)Local HMO$6,700$435
5
AARP Medicare Advantage Choice (PPO) (2023)Local PPO$3,900$50
5
HumanaChoice H5216-211 (PPO) (2023)Local PPO$6,700$160
4
Cigna True Choice Medicare (PPO) (2023)Local PPO$5,750$0
New plan - not yet rated.
HumanaChoice R1390-001 (Regional PPO) (2023)Regional PPO *$5,400$-
4
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
Aetna Medicare Premier Plan (PPO) (2023)Local PPO$7,000$150
5
AARP Medicare Advantage Plan 1 (HMO-POS) (2023)Local HMO$3,600$50
5
Blue Medicare PPO Enhanced (PPO) (2023)Local PPO$5,900$0
4
Medicare Advantage Plans by CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA
HealthTeam Advantage Plan II (PPO) (2023)Local PPO$3,100$0
3

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