4

4 out of 5 stars* for plan year 2024

Plan ID: H3916-012

What You Need to Know:

  • Freedom Blue PPO Basic (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 $66, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is no drug coverage.
  • The plan includes an out-of-pocket maximum of $5,900 per year (in-network).
  • Freedom Blue PPO Basic (PPO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is no drug coverage.
  • This plan's Part D Initial Coverage Limit is .

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

$66

Monthly Premium

Medicare Plan Features
Monthly Premium: $66.00
Part C Premium: NULL
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$66.00 NULL NULL NULL NULL NULL NULL
Gap Coverage: NULL
Benchmark: NULL
Type of Medicare Health: NULL
Health Plan Type: Local PPO *
Similar Plan: H3916-015
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: NULL
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $5,900
Annual Deductible: no drug coverage
Annual Initial Coverage Limit ICL: NULL
Number of Members enrolled in this plan in Montour, Pennsylvania: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
less than 10 members 4.5 out of 5 Stars. 4 out of 5 Stars. 4 out of 5 Stars.
Plan Offers Mail Order: NULL
Plan Health Benefits
Total # of Formulary Drugs: NULL
Number of Members Enrolled in this Plan in Montour, Pennsylvania: 177 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
NULL NULL NULL NULL
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
NULL NULL NULL NULL NULL NULL NULL
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)
NULL NULL NULL NULL NULL NULL NULL NULL NULL NULL

Other Medicare Advantage Plans in Montour, Pennsylvania

Plan Name Type Premium MOOP Rx Deduct. Rating
Vibra Health Plan Enhanced Complete (PPO) (2023)Local PPO$5,800$0
3
UPMC for Life PPO Rx Enhanced (PPO) (2023)Local PPO$7,550$0
3
Vibra Essential Advocate (PPO) (2023)Local PPO$6,700$0
3
Aetna Medicare Advantra Credit Value (PPO) (2023)Local PPO$7,550$250
5
Aetna Medicare Value (PPO) (2023)Local PPO$7,550$0
5
HumanaChoice R0923-001 (Regional PPO) (2023)Regional PPO *$4,900$-
3
HumanaChoice H5525-007 (PPO) (2023)Local PPO$6,700$0
4
Aetna Medicare Advantra Premier Plus (PPO) (2023)Local PPO$4,900$0
5
Humana Gold Choice H8145-052 (PFFS) (2023)PFFS$-$360
4
Humana Gold Choice H8145-055 (PFFS) (2023)PFFS *$-$-
4
Aetna Medicare Advantra Silver (PPO) (2023)Local PPO$7,550$0
5
HumanaChoice H5525-038 (PPO) (2023)Local PPO$6,700$0
4
HumanaChoice H5216-120 (PPO) (2023)Local PPO$6,700$0
4
HumanaChoice R0923-002 (Regional PPO) (2023)Regional PPO$6,700$0
3
UPMC for Life PPO High Deductible with Rx (PPO) (2023)Local PPO$7,550$0
3
Humana Honor (PPO) (2023)Local PPO *$6,700$-
4
Aetna Medicare Gold Plan (PPO) (2023)Local PPO$7,550$0
5
BlueJourney Premier (HMO) (2023)Local HMO$3,400$0
3
BlueJourney Value (HMO) (2023)Local HMO$4,500$0
3
BlueJourney Essential (HMO) (2023)Local HMO$6,700$0
3
Geisinger Gold Classic Essential Rx (HMO) (2023)Local HMO$7,550$0
4
HumanaChoice H5216-116 (PPO) (2023)Local PPO *$3,900$-
4
Geisinger Gold Classic Advantage (HMO) (2023)Local HMO *$3,450$-
4
Aetna Medicare Advantra Gold (HMO) (2023)Local HMO$7,550$0
5
Humana Value Plus H5216-117 (PPO) (2023)Local PPO$6,700$420
4
Aetna Medicare Advantra Premier (HMO) (2023)Local HMO$7,550$0
5
Geisinger Gold Preferred Advantage Rx (PPO) (2023)Local PPO$4,000$0
3
Geisinger Gold Classic Advantage Rx (HMO) (2023)Local HMO$3,450$0
4
Aetna Medicare Advantra Eagle (HMO) (2023)Local HMO *$4,000$-
5
Geisinger Gold Preferred Complete Rx (PPO) (2023)Local PPO$6,700$0
3
Freedom Blue PPO Deluxe (PPO) (2023)Local PPO$4,500$0
4
Community Blue Medicare PPO Distinct (PPO) (2023)Local PPO$6,500$0
4
Geisinger Gold Classic Complete Rx (HMO) (2023)Local HMO$4,900$0
4
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
UPMC for Life HMO Rx (HMO) (2023)Local HMO$7,550$0
4
Geisinger Gold Preferred Enhanced Rx (PPO) (2023)Local PPO$6,700$0
3
Community Blue Medicare PPO Signature (PPO) (2023)Local PPO$7,550$0
4
UPMC for Life HMO Deductible with Rx (HMO) (2023)Local HMO$7,550$0
4
Freedom Blue PPO Standard (PPO) (2023)Local PPO$5,000$0
4
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
BlueJourney Classic (PPO) (2023)Local PPO$6,700$0
5
UPMC for Life HMO No Rx (HMO) (2023)Local HMO *$7,550$-
4
Aetna Medicare Silver (HMO) (2023)Local HMO$7,550$0
5
BlueJourney Prime (PPO) (2023)Local PPO$4,000$0
5
Freedom Blue PPO ValueRx (PPO) (2023)Local PPO$5,500$0
4
UPMC for Life HMO Rx Choice (HMO) (2023)Local HMO$7,550$0
4
BlueJourney Select (PPO) (2023)Local PPO$6,700$0
5
UPMC for Life HMO Rx Enhanced (HMO) (2023)Local HMO$7,550$0
4
Medicare Advantage Plans by Highmark Inc
Freedom Blue PPO Deluxe (PPO) (2023)Local PPO$4,500$0
4
Community Blue Medicare PPO Distinct (PPO) (2023)Local PPO$6,500$0
4
Community Blue Medicare PPO Signature (PPO) (2023)Local PPO$7,550$0
4
Freedom Blue PPO Standard (PPO) (2023)Local PPO$5,000$0
4
Freedom Blue PPO ValueRx (PPO) (2023)Local PPO$5,500$0
4

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