|
County |
Organization Name |
Plan Name |
Type of Medicare Health Plan |
Monthly Consolidated Premium
(Includes
Part C + D) |
Monthly Drug Premium |
Annual Drug Deductible |
Drug
Benefit
Type |
Type of
Extra Coverage Offered in the Gap |
Offers Variable Drug
Co-payments |
Drug Benefit Type Detail |
Demo Type |
Contract ID |
Plan ID |
Segment ID |
|
Fairfield |
Aetna Health Inc. |
Aetna Golden Medicare Value Plan |
Local HMO |
$0.00 |
$0.00 |
$0 |
Basic |
|
· |
BA |
|
H5793 |
001 |
0 |
|
Fairfield |
Aetna Health Inc. |
Aetna Golden Medicare Standard Plan |
Local HMO |
$43.00 |
$19.40 |
$0 |
Enhanced |
Generics |
· |
EA |
|
H5793 |
002 |
0 |
|
Fairfield |
Aetna Health Inc. |
Aetna Golden Medicare Premier Plan |
Local HMO |
$88.00 |
$42.70 |
$0 |
Enhanced |
Generics |
· |
EA |
|
H5793 |
003 |
0 |
|
Fairfield |
Anthem Blue Cross and Blue Shield |
MediBlue HMO Essential |
Local HMO * |
$0.00 |
|
|
|
|
|
|
|
H5854 |
004 |
0 |
|
Fairfield |
Anthem Blue Cross and Blue Shield |
MediBlue HMO Plus |
Local HMO |
$23.00 |
$19.10 |
$0 |
Enhanced |
Generics |
· |
EA |
|
H5854 |
002 |
0 |
|
Fairfield |
Anthem Blue Cross and Blue Shield |
MediBlue HMO Select |
Local HMO |
$90.00 |
$19.10 |
$0 |
Enhanced |
Generics |
· |
EA |
|
H5854 |
003 |
0 |
|
Fairfield |
Fresenius Medical Care Health Plan |
Fresenius Medical Care Health Plan |
Demo * |
$0.00 |
|
|
|
|
|
|
ESRDI Demo |
H5909 |
001 |
0 |
|
Fairfield |
Health Net of Connecticut |
Health Net Green |
Local HMO * |
$0.00 |
|
|
|
|
|
|
|
H0755 |
023 |
0 |
|
Fairfield |
Health Net of Connecticut |
Health Net Ruby Option 2 |
Local HMO |
$0.00 |
$0.00 |
$0 |
Basic |
|
· |
BA |
|
H0755 |
022 |
0 |
|
Fairfield |
Health Net of Connecticut |
Health Net Ruby Option 3 |
Local HMO |
$45.00 |
$21.20 |
$0 |
Basic |
|
· |
BA |
|
H0755 |
024 |
0 |
|
Fairfield |
Health Net of Connecticut |
Health Net Ruby Option 1 |
Local HMO |
$99.00 |
$19.90 |
$0 |
Enhanced |
Generics |
· |
EA |
|
H0755 |
001 |
0 |
|
Fairfield |
Health Net of Connecticut |
Health Net Navy |
Local HMO |
$119.00 |
$21.20 |
$0 |
Basic |
|
· |
BA |
|
H0755 |
020 |
0 |
|
Fairfield |
Today's Option |
Today's Options Value |
PFFS * |
$15.00 |
|
|
|
|
|
|
|
H3333 |
029 |
0 |
|
Fairfield |
Today's Option |
Today's Options Value Plus |
PFFS |
$43.00 |
$27.70 |
$0 |
Basic |
|
· |
BA |
|
H3333 |
025 |
0 |
|
Fairfield |
Today's Option |
Today's Options Premier |
PFFS * |
$46.00 |
|
|
|
|
|
|
|
H3333 |
030 |
0 |
|
Fairfield |
Today's Option |
Today's Options Premier Plus |
PFFS |
$85.00 |
$39.00 |
$0 |
Enhanced |
Generics |
· |
EA |
|
H3333 |
027 |
0 |
|
Fairfield |
WellCare |
WellCare Advance |
Local HMO * |
$0.00 |
|
|
|
|
|
|
|
H0712 |
008 |
0 |
|
Fairfield |
WellCare |
WellCare Choice |
Local HMO |
$0.00 |
$0.00 |
$0 |
Enhanced |
|
· |
EA |
|
H0712 |
001 |
0 |
|
Fairfield |
WellCare |
WellCare Premium |
Local HMO |
$20.00 |
$0.00 |
$0 |
Enhanced |
Generics |
· |
EA |
|
H0712 |
017 |
0 |
|
Hartford |
Aetna Health Inc. |
Aetna Golden Medicare Value Plan |
Local HMO |
$0.00 |
$0.00 |
$0 |
Basic |
|
· |
BA |
|
H5793 |
001 |
0 |
|
Hartford |
Aetna Health Inc. |
Aetna Golden Medicare Standard Plan |
Local HMO |
$43.00 |
$19.40 |
$0 |
Enhanced |
Generics |
· |
EA |
|
H5793 |
002 |
0 |
|
Hartford |
Aetna Health Inc. |
Aetna Golden Medicare Premier Plan |
Local HMO |
$88.00 |
$42.70 |
$0 |
Enhanced |
Generics |
· |
EA |
|
H5793 |
003 |
0 |
|
Hartford |
Anthem Blue Cross and Blue Shield |
MediBlue HMO Essential |
Local HMO * |
$0.00 |
|
|
|
|
|
|
|
H5854 |
004 |
0 |
|
Hartford |
Anthem Blue Cross and Blue Shield |
MediBlue HMO Plus |
Local HMO |
$23.00 |
$19.10 |
$0 |
Enhanced |
Generics |
· |
EA |
|
H5854 |
002 |
0 |
|
Hartford |
Anthem Blue Cross and Blue Shield |
MediBlue HMO Select |
Local HMO |
$90.00 |
$19.10 |
$0 |
Enhanced |
Generics |
· |
EA |
|
H5854 |
003 |
0 |
|
Hartford |
Fresenius Medical Care Health Plan |
Fresenius Medical Care Health Plan |
Demo * |
$0.00 |
|
|
|
|
|
|
ESRDI Demo |
H5909 |
001 |
0 |
|
Hartford |
Health Net |
Health Net Pearl Option 5 |
PFFS * |
$139.00 |
|
|
|
|
|
|
|
H5996 |
008 |
0 |
|
Hartford |
Health Net |
Health Net Pearl Option 6 |
PFFS |
$159.00 |
$21.20 |
$0 |
Basic |
|
· |
BA |
|
H5996 |
009 |
0 |
|
Hartford |
Health Net of Connecticut |
Health Net Green |
Local HMO * |
$0.00 |
|
|
|
|
|
|
|
H0755 |
023 |
0 |
|
Hartford |
Health Net of Connecticut |
Health Net Ruby Option 2 |
Local HMO |
$0.00 |
$0.00 |
$0 |
Basic |
|
· |
BA |
|
H0755 |
022 |
0 |
|
Hartford |
Health Net of Connecticut |
Health Net Ruby Option 3 |
Local HMO |
$45.00 |
$21.20 |
$0 |
Basic |
|
· |
BA |
|
H0755 |
024 |
0 |
|
Hartford |
Health Net of Connecticut |
Health Net Ruby Option 1 |
Local HMO |
$99.00 |
$19.90 |
$0 |
Enhanced |
Generics |
· |
EA |
|
H0755 |
001 |
0 |
|
Hartford |
Health Net of Connecticut |
Health Net Navy |
Local HMO |
$119.00 |
$21.20 |
$0 |
Basic |
|
· |
BA |
|
H0755 |
020 |
0 |
|
Hartford |
Humana Insurance Company |
Humana Gold Choice PFFS H1804-249 |
PFFS |
$89.00 |
$13.10 |
$265 |
Basic |
|
|
DS |
|
H1804 |
249 |
0 |
|
Hartford |
Humana Insurance Company |
Humana Gold Choice PFFS H1804-247 |
PFFS |
$99.00 |
$23.60 |
$0 |
Enhanced |
|
· |
EA |
|
H1804 |
247 |
0 |
|
Hartford |
Humana Insurance Company |
Humana Gold Choice PFFS H1804-248 |
PFFS |
$129.00 |
$23.60 |
$0 |
Enhanced |
|
· |
EA |
|
H1804 |
248 |
0 |
|
Hartford |
Today's Option |
Today's Options Value |
PFFS * |
$15.00 |
|
|
|
|
|
|
|
H3333 |
029 |
0 |
|
Hartford |
Today's Option |
Today's Options Value Plus |
PFFS |
$43.00 |
$27.70 |
$0 |
Basic |
|
· |
BA |
|
H3333 |
025 |
0 |
|
Hartford |
Today's Option |
Today's Options Premier |
PFFS * |
$46.00 |
|
|
|
|
|
|
|
H3333 |
030 |
0 |
|
Hartford |
Today's Option |
Today's Options Premier Plus |
PFFS |
$85.00 |
$39.00 |
$0 |
Enhanced |
Generics |
· |
EA |
|
H3333 |
027 |
0 |
|
Hartford |
WellCare |
WellCare Advance |
Local HMO * |
$0.00 |
|
|
|
|
|
|
|
H0712 |
008 |
0 |
|
Hartford |
WellCare |
WellCare Choice |
Local HMO |
$0.00 |
$0.00 |
$0 |
Enhanced |
|
· |
EA |
|
H0712 |
001 |
0 |
|
Hartford |
WellCare |
WellCare Premium |
Local HMO |
$20.00 |
$0.00 |
$0 |
Enhanced |
Generics |
· |
EA |
|
H0712 |
017 |
0 |
|
Litchfield |
Aetna Medicare |
Aetna Medicare Open Plan |
PFFS |
$80.00 |
$21.80 |
$265 |
Basic |
|
|
DS |
|
H5736 |
002 |
0 |
|
Litchfield |
Fresenius Medical Care Health Plan |
Fresenius Medical Care Health Plan |
Demo * |
$0.00 |
|
|
|
|
|
|
ESRDI Demo |
H5909 |
001 |
0 |
|
Litchfield |
Health Net of Connecticut |
Health Net Green |
Local HMO * |
$0.00 |
|
|
|
|
|
|
|
H0755 |
023 |
0 |
|
Litchfield |
Health Net of Connecticut |
Health Net Ruby Option 2 |
Local HMO |
$0.00 |
$0.00 |
$0 |
Basic |
|
· |
BA |
|
H0755 |
022 |
0 |
|
Litchfield |
Health Net of Connecticut |
Health Net Ruby Option 3 |
Local HMO |
$45.00 |
$21.20 |
$0 |
Basic |
|
· |
BA |
|
H0755 |
024 |
0 |
|
Litchfield |
Health Net of Connecticut |
Health Net Ruby Option 1 |
Local HMO |
$99.00 |
$19.90 |
$0 |
Enhanced |
Generics |
· |
EA |
|
H0755 |
001 |
0 |
|
Litchfield |
Health Net of Connecticut |
Health Net Navy |
Local HMO |
$119.00 |
$21.20 |
$0 |
Basic |
|
· |
BA |
|
H0755 |
020 |
0 |
|
Litchfield |
Humana Insurance Company |
Humana Gold Choice PFFS H1804-249 |
PFFS |
$89.00 |
$13.10 |
$265 |
Basic |
|
|
DS |
|
H1804 |
249 |
0 |
|
Litchfield |
Humana Insurance Company |
Humana Gold Choice PFFS H1804-247 |
PFFS |
$99.00 |
$23.60 |
$0 |
Enhanced |
|
· |
EA |
|
H1804 |
247 |
0 |
|
Litchfield |
Humana Insurance Company |
Humana Gold Choice PFFS H1804-248 |
PFFS |
$129.00 |
$23.60 |
$0 |
Enhanced |
|
· |
EA |
|
H1804 |
248 |
0 |
|
Litchfield |
Today's Option |
Today's Options Premier |
PFFS * |
$0.00 |
|
|
|
|
|
|
|
H3333 |
024 |
0 |
|
Litchfield |
Today's Option |
Today's Options Value |
PFFS * |
$0.00 |
|
|
|
|
|
|
|
H3333 |
023 |
0 |
|
Litchfield |
Today's Option |
Today's Options Value Plus |
PFFS |
$0.00 |
$0.00 |
$0 |
Basic |
|
· |
BA |
|
H3333 |
026 |
0 |
|
Litchfield |
Today's Option |
Today's Options Premier Plus |
PFFS |
$39.00 |
$38.90 |
$0 |
Enhanced |
Generics |
· |
EA |
|
H3333 |
028 |
0 |
|
Middlesex |
Anthem Blue Cross and Blue Shield |
SmartValue Classic |
PFFS * |
$35.00 |
|
|
|
|
|
|
|
H1689 |
003 |
0 |
|
Middlesex |
Anthem Blue Cross and Blue Shield |
SmartValue Plus |
PFFS |
$46.00 |
$18.30 |
$0 |
Enhanced |
|
· |
EA |
|
H1689 |
004 |
0 |
|
Middlesex |
Fresenius Medical Care Health Plan |
Fresenius Medical Care Health Plan |
Demo * |
$0.00 |
|
|
|
|
|
|
ESRDI Demo |
H5909 |
001 |
0 |
|
Middlesex |
Health Net |
Health Net Pearl Option 5 |
PFFS * |
$139.00 |
|
|
|
|
|
|
|
H5996 |
008 |
0 |
|
Middlesex |
Health Net |
Health Net Pearl Option 6 |
PFFS |
$159.00 |
$21.20 |
$0 |
Basic |
|
· |
BA |
|
H5996 |
009 |
0 |
|
Middlesex |
Health Net of Connecticut |
Health Net Green |
Local HMO * |
$0.00 |
|
|
|
|
|
|
|
H0755 |
023 |
0 |
|
Middlesex |
Health Net of Connecticut |
Health Net Ruby Option 2 |
Local HMO |
$0.00 |
$0.00 |
$0 |
Basic |
|
· |
BA |
|
H0755 |
022 |
0 |
|
Middlesex |
Health Net of Connecticut |
Health Net Ruby Option 3 |
Local HMO |
$45.00 |
$21.20 |
$0 |
Basic |
|
· |
BA |
|
H0755 |
024 |
0 |
|
Middlesex |
Health Net of Connecticut |
Health Net Ruby Option 1 |
Local HMO |
$99.00 |
$19.90 |
$0 |
Enhanced |
Generics |
· |
EA |
|
H0755 |
001 |
0 |
|
Middlesex |
Health Net of Connecticut |
Health Net Navy |
Local HMO |
$119.00 |
$21.20 |
$0 |
Basic |
|
· |
BA |
|
H0755 |
020 |
0 |
|
Middlesex |
Humana Insurance Company |
Humana Gold Choice PFFS H1804-249 |
PFFS |
$89.00 |
$13.10 |
$265 |
Basic |
|
|
DS |
|
H1804 |
249 |
0 |
|
Middlesex |
Humana Insurance Company |
Humana Gold Choice PFFS H1804-247 |
PFFS |
$99.00 |
$23.60 |
$0 |
Enhanced |
|
· |
EA |
|
H1804 |
247 |
0 |
|
Middlesex |
Humana Insurance Company |
Humana Gold Choice PFFS H1804-248 |
PFFS |
$129.00 |
$23.60 |
$0 |
Enhanced |
|
· |
EA |
|
H1804 |
248 |
0 |
|
Middlesex |
SecureHorizons MedicareDirect |
SecureHorizons MedicareDirect Plan 10 |
PFFS * |
$0.00 |
|
|
|
|
|
|
|
H5435 |
010 |
0 |
|
Middlesex |
SecureHorizons MedicareDirect |
SecureHorizons MedicareDirect Rx Plan 55 |
PFFS |
$10.30 |
$10.30 |
$265 |
Basic |
|
|
DS |
|
H5435 |
014 |
0 |
|
Middlesex |
Today's Option |
Today's Options Premier |
PFFS * |
$0.00 |
|
|
|
|
|
|
|
H3333 |
024 |
0 |
|
Middlesex |
Today's Option |
Today's Options Value |
PFFS * |
$0.00 |
|
|
|
|
|
|
|
H3333 |
023 |
0 |
|
Middlesex |
Today's Option |
Today's Options Value Plus |
PFFS |
$0.00 |
$0.00 |
$0 |
Basic |
|
· |
BA |
|
H3333 |
026 |
0 |
|
Middlesex |
Today's Option |
Today's Options Premier Plus |
PFFS |
$39.00 |
$38.90 |
$0 |
Enhanced |
Generics |
· |
EA |
|
H3333 |
028 |
0 |
|
Middlesex |
UniCare |
Save Well - Plan II |
MSA * |
$0.00 |
|
|
|
|
|
|
|
H7289 |
002 |
0 |
|
Middlesex |
Unicare Life & Health Ins. Company |
SecurityChoice Plus |
PFFS |
$11.00 |
$11.00 |
$0 |
Enhanced |
|
· |
EA |
|
H0540 |
028 |
0 |
|
New Haven |
Aetna Health Inc. |
Aetna Golden Medicare Value Plan |
Local HMO |
$0.00 |
$0.00 |
$0 |
Basic |
|
· |
BA |
|
H5793 |
001 |
0 |
|
New Haven |
Aetna Health Inc. |
Aetna Golden Medicare Standard Plan |
Local HMO |
$43.00 |
$19.40 |
$0 |
Enhanced |
Generics |
· |
EA |
|
H5793 |
002 |
0 |
|
New Haven |
Aetna Health Inc. |
Aetna Golden Medicare Premier Plan |
Local HMO |
$88.00 |
$42.70 |
$0 |
Enhanced |
Generics |
· |
EA |
|
H5793 |
003 |
0 |
|
New Haven |
Anthem Blue Cross and Blue Shield |
MediBlue HMO Essential |
Local HMO * |
$0.00 |
|
|
|
|
|
|
|
H5854 |
004 |
0 |
|
New Haven |
Anthem Blue Cross and Blue Shield |
MediBlue HMO Plus |
Local HMO |
$23.00 |
$19.10 |
$0 |
Enhanced |
Generics |
· |
EA |
|
