Cigna True Choice Medicare (PPO)
$0.00 $0.00 EA No H7849 057 $3,700.00
Cigna True Choice Medicare (PPO)
$0.00 $0.00 EA No H7849 058 $3,700.00
Cigna True Choice Medicare (PPO)
$0.00 $0.00 EA No H7849 059 $4,600.00
Cigna True Choice Savings Medicare (PPO)
$0.00 $0.00 EA No H7849 076 $5,000.00
Cigna True Choice Savings Medicare (PPO)
$0.00 $0.00 EA No H7849 077 $4,100.00
Cigna True Choice Savings Medicare (PPO)
$0.00 $0.00 EA No H7849 080 $3,700.00
Clear Spring Health Community Advantage
Plan (HMO)
$0.00 $0.00 EA No H3071 002 $2,950.00
Clear Spring Health Essential (HMO)
$0.00 $0.00 EA No H5454 001 $2,900.00
Clear Spring Health Essential (HMO)
$0.00 $0.00 EA No H5454 002 $2,900.00
Devoted CHOICE Illinois (PPO)
$0.00 $0.00 EA Yes H6545 001 $3,200.00
Devoted CORE Illinois (HMO)
$0.00 $0.00 EA Yes H7151 001 $2,500.00
Devoted GIVEBACK Illinois (HMO)
$0.00 $0.00 EA Yes H7151 003 $4,500.00
Essence Advantage (HMO)
$0.00 $0.00 EA Yes H2610 005 $2,300.00
Essence Advantage Choice (PPO)
$0.00 $0.00 EA Yes H6200 001 $3,400.00
Essence Advantage Choice Plus (PPO)
$22.20 $0.00 EA Yes H6200 002 $3,000.00
Essence Advantage Plus (HMO)
$53.80 $0.00 EA Yes H2610 006 $1,900.00
Essence Advantage Select (HMO)
$0.00 $0.00 EA Yes H2610 016 $2,800.00
Health Alliance Medicare HMO 20 Rx (HMO)
$125.00 $0.00 EA Yes H1463 003 $4,000.00
Health Alliance Medicare HMO Basic (HMO)
covered
H1463 008 $6,700.00
Health Alliance Medicare POS 10 Rx (HMO-
POS)
$165.00 $0.00 EA Yes H1463 019 $2,900.00
Health Alliance Medicare POS Basic Rx (HMO-
POS)
$53.00 $0.00 EA Yes H1463 015 $5,400.00
Health Alliance Medicare POS Choice Rx (HMO-
POS)
$0.00 $0.00 EA Yes H1463 044 $3,500.00
Health Alliance Medicare POS Enrich Rx (HMO-
POS)
$165.00 $250.00 EA Yes H1463 042 $0.00
HealthPartners UnityPoint Health Align (PPO)
$0.00 $0.00 EA No H3416 001 $3,900.00
HealthPartners UnityPoint Health Symmetry
(PPO)
$49.00 $0.00 EA Yes H3416 002 $3,300.00
Humana Community Select (HMO)
$0.00 $0.00 EA Yes H1468 018 $2,300.00
Humana Gold Choice H8145-006 (PFFS) PFFS $40.00 $545.00 EA No H8145 006
Humana Gold Choice H8145-122 (PFFS) PFFS $132.00 $0.00 EA Yes H8145 122
Humana Gold Choice H8145-126 (PFFS) PFFS * $15.00
H8145 126
Humana Gold Plus H0028-014 (HMO)
$0.00 $0.00 EA Yes H0028 014 $2,900.00