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Chart of 2021 BIN and PCN values for each Medicare Part D prescription drug plan Part 3 of 5 (H3962 through H5928)

Category: Your Formulary (Drug List)
Published: Aug, 01 2020 10:08:23
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The Centers for Medicare & Medicaid Services (CMS) released a compilation of the BIN and PCN values for each 2021 Medicare Part D plan sponsor. Please note, the data below is Part 3 of 5 (H3962 - H5928) with links to Part 1&2 and Parts 4&5.

CMS included the following disclaimer in regards to this data:

"DISCLAIMER: The Centers for Medicare & Medicaid Services (CMS) has made a reasonable effort to ensure that the provided data are a true and accurate representation of the data on file at CMS at the time of disclosure. This information reflects data as reported by the Medicare Part D sponsors and has not been validated. CMS is not responsible for data that is misrepresented, misinterpreted or altered in any way."

The chart below is the third page of the 2021 Medicare Part D pharmacy BIN and PCN list covering prescription drug plans from contracts H3962 through H5928.

Click here for the first page (E0654 - H2235), second page (H2237 - H3959), fourth page (H5928 - H8634) and fifth page (H8634 - S9701).


2021 Medicare Prescription Drug Plan Pharmacy BIN and PCN Numbers
Contract ID Contract Name Plan ID BIN PCN
H3962KEYSTONE HEALTH PLAN CENTRAL, INC.001, 004, 007610455CAPD
H3962KEYSTONE HEALTH PLAN CENTRAL, INC.801, 803, 813, 814, 815, 816, 817, 818610455CAPDG
H3975 all plans004336MEDDADV
H3979GHS HEALTH MAINTENANCE ORGANIZATION, INC.001011552MAPDOK
H3979GHS HEALTH MAINTENANCE ORGANIZATION, INC.801, 803011552MAPDOKG
H4000MEMORIAL HOSPITAL OF LARAMIE COUNTYall plans013170CLAIMCR
H4003MMM HEALTHCARE, LLCall plans004336MEDDADV
H4004MMM HEALTHCARE, LLCall plans004336MEDDADV
H4005TRIPLE S ADVANTAGE, INC.all plans610674abarcaD
H4007HUMANA HEALTH PLANS OF PUERTO RICO, INC.all plans01558103200000
H4036ANTHEM INSURANCE COMPANIES, INC.all plans020115IS
H4053GREENVILLE HEALTH SYSTEMall plans013170None
H4074MERCY LIFE OF ALABAMAall plans022188PSTMEDD
H4091SIMPRA ADVANTAGE, INC.003123456PCNsample
H4091SIMPRA ADVANTAGE, INC.001, 002610602NVTD
H4093PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INCall plans012312PartD
H4094OPTIMUM CHOICE, INC.all plans6100979999
H4105PACE ORGANIZATION OF RHODE ISLANDall plans000000PACE
H4118THE WASHTENAW PACE002018091PRSMEDD
H4118THE WASHTENAW PACE001022188PSTMEDD
H4140DOCTORS HEALTHCARE PLANS, INC.all plans01892707830000
H4141HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.all plans01558103200000
H4142CHEROKEE NATION COMPREHENSIVE CARE AGENCYall plans000000PACE
H4152BLUE CROSS & BLUE SHIELD OF RHODE ISLAND005, 007, 013, 017, 018, 020610455BCRIMA
H4152BLUE CROSS & BLUE SHIELD OF RHODE ISLAND815, 817610455BCRIMAG
H4172NHC ADVANTAGE, LLCall plans610602NVTD
H4198COMMUNITYCARE GOVERNMENT PROGRAMS, INC.all plans015789CTRXMEDD
H4203PALMETTO HEALTH ALLIANCEall plans000000000000
H4213USABLE MUTUAL INSURANCE COMPANYall plans016895PFFSAR
H4227VISTA HEALTH PLAN, INC.all plans01235306110000
H4232 all plans012312PARTD
H4235SENIOR TOTAL LIFE CARE, INC.002018091PRSMEDC
H4235SENIOR TOTAL LIFE CARE, INC.001018091PRSMEDD
H4236SPARTAN PLAN PA, INC.005123456PCNsample
H4236SPARTAN PLAN PA, INC.001, 002, 003, 006610602NVTD
H4237 all plans004336MEDDAV
H4256 002018091PRSMEDC
H4256 001018091PRSMEDD
H4279UPMC FOR YOU, INCall plans003858A4
H4304 all plans004336MEDDADV
H4305TOTAL LIFE HEALTHCAREall plans016110PACE
H4326PACE @ HOME, INC.all plans022188PSTMEDD
H4338 all plans012312PARTD
H4343 all plans004336MEDDADV
H4346HMO COLORADO, INC.all plans020115IS
H4393CATHOLIC MANAGED LONG TERM CARE, INC.all plans004336MEDDADV
H4402ALEXIAN BROTHERS COMMUNITY SERVICESall plans022188PSTMEDD
H4407HEALTHSPRING LIFE & HEALTH INSURANCE COMPANYall plans017010CIMCARE
H4461CARITEN HEALTH PLAN INC.all plans01558103200000
H4490MISSOURI MEDICARE SELECT, LLCall plans012312PARTD
H4497MEDICAL MUTUAL OF OHIOall plans003858MD
H4506SELECTCARE OF TEXAS, INC.all plans004336MEDDADV
H4513HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.059, 060, 061017010CIHSCARE
H4513HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.026, 027, 028, 029, 030, 034, 035, 036, 037, 038, 039, 040, 042, 043, 046, 047, 048, 049, 050, 051, 052, 053, 054, 055, 056, 057, 804, 815, 817, 819, 820, 821017010CIMCARE
H4514UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.all plans6100979999
H4517AMARILLO MULTISVC CTR FR THE AGING INCall plans018091PRSMEDD
H4518BIENVIVIR SENIOR HEALTH SERVICESall plans000000000000
H4523AETNA HEALTH INC. (TX)all plans610502MEDDAET
H4527PHYSICIANS HEALTH CHOICE OF TEXAS, LLCall plans6100979999
H4544 all plans6100979999
H4590UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.010, 012, 020, 022, 025, 033, 041, 042, 043, 044, 803, 8046100979999
H4590UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.0376109979999
H4604UNITEDHEALTHCARE OF UTAH, INC.all plans6100979999
H4605REGENCE BLUECROSS BLUESHIELD OF UTAH002, 004, 007, 008, 0096106232100000
H4605REGENCE BLUECROSS BLUESHIELD OF UTAH802, 803, 8046106232100001
H4623HUMANA REGIONAL HEALTH PLAN, INC.all plans01558103200000
H4624 all plans610602NVTD
H4675 001016499HMOBH
H4675 802, 803016499HMOPOSBHG
H4676TROY HEALTH, INC.all plans019587PRX11802
H4699 all plans004336MEDDADV
H4709BRIGHT HEALTH INSURANCE COMPANY OF FLORIDA001, 011, 012, 013, 014, 015, 016, 017, 018, 019, 020, 021, 022, 023, 024, 025004336MEDDADV
H4709BRIGHT HEALTH INSURANCE COMPANY OF FLORIDA003012312PARTD
H4711COVENTRY HEALTH CARE OF NEBRASKA, INC.all plans610502MEDDAET
H4714PACE OF THE SOUTHERN PIEDMONT, INC.all plans022188PSTMEDD
H4754PACIFICSOURCE COMMUNITY HEALTH PLANSall plans004336MEDDADV
H4778SPARTAN PLAN IL, INC.005123456PCNsample
H4778SPARTAN PLAN IL, INC.001, 002, 003, 006610602NVTD
H4829 all plans6100979999
H4835AETNA BETTER HEALTH OF OKLAHOMA, INC.all plans610502MEDDAET
H4847WELLCARE OF SOUTH CAROLINA, INC.all plans004336MEDDADV
H4853BRIGHT HEALTH COMPANY OF ARIZONA008, 009, 010, 011, 012, 013, 014004336MEDDADV
H4853BRIGHT HEALTH COMPANY OF ARIZONA001, 002012312PARTD
H4868WELLCARE OF NEW YORK, INC.all plans004336MEDDADV
H4875PRIORITY HEALTHall plans003858MD
H4882HEALTHPARTNERS, INC.all plans015574ASPROD1
H4909ANTHEM INSURANCE COMPANIES, INC.all plans020115IS
H4922AGEWELL NEW YORK, LLCall plans012312PARTD
H4931BANNER - UNIVERSITY CARE ADVANTAGE001, 006, 007, 008, 013, 014, 015015574ASPROD1
H4931BANNER - UNIVERSITY CARE ADVANTAGE016015574ASRPOD1
H4937CALIFORNIA PHYSICIANS' SERVICEall plans00433677993322
H4961ALIGNMENT HEALTH PLAN005, 006, 802610445AHPPARTD
H4961ALIGNMENT HEALTH PLAN001, 002, 003, 004, 801610455AHPPARTD
H4982AETNA BETTER HEALTH OF CALIFORNIA INC.all plans610502MEDDAET
H4999THE LUTHERAN HOME FOR THE AGEDall plans016110PACE
H5007PROVIDENCE HEALTH SYSTEMall plans000000000000
H5008UNITEDHEALTHCARE INSURANCE COMPANYall plans6100979999
H5009REGENCE BLUESHIELD002, 008, 0096106232100000
H5009REGENCE BLUESHIELD802, 803, 8046106232100001
H5010ASURIS NORTHWEST HEALTHall plans6106232110000
H5015TEXAS INDEPENDENCE HEALTH PLAN, INC.all plans012312PartD
H5037MOUNTAIN EMPIRE OLDER CITIZENS, INC.all plans013170CLAIMCR
H5042CDPHP UNIVERSAL BENEFITS, INC.all plans004336MEDDADV
H5050KAISER FOUNDATION HEALTH PLAN OF WASHINGTONall plans610011CTRXMEDD
H5085 all plans013170000000
H5087WELLCARE OF CALIFORNIA, INC.all plans004336MEDDADV
H5106HIGHMARK SENIOR SOLUTIONS COMPANYall plans610014MEDDPRIME
H5117LOUISIANA HEALTHCARE CONNECTIONS, INC.all plans004336MEDDADV
H5124FRANCISCAN ACO, INC.all plans000000000000
H5126OSCAR INSURANCE COMPANYall plans004336MEDDADV
H5140BLUE CROSS AND BLUE SHIELD OF ARIZONA, INC.all plans015574ASPROD1
H5141CLOVER INSURANCE COMPANYall plans004336MEDDADV
H5167ROCKY MOUNTAIN HEALTH CARE SERVICESall plans018091PRSMEDD
H5172COMMUNITY HEALTH GROUPall plans015574asprod1
H5178HUMANA HEALTH PLAN, INC.all plans01558103200000
H5190SUNSHINE STATE HEALTH PLAN, INC.all plans004336MEDDADV
H5199WELLCARE HEALTH INSURANCE OF ARIZONA, INC.all plans004336MEDDADV
H5209CARE WISCONSIN HEALTH PLAN, INC.all plans012312PARTD
H5211SECURITY HEALTH PLAN OF WISCONSIN, INC.all plans015574ASPROD1
H5212COMMUNITY CARE, INC.002018091PRSMEDD
H5212COMMUNITY CARE, INC.001022188PSTMEDD
H5213TOTAL COMMUNITY CARE, L.L.C.all plans022188PSTMEDD
H5215NETWORK HEALTH INSURANCE CORPORATIONall plans003858MD
H5216HUMANA INSURANCE COMPANY139001558103200000
H5216HUMANA INSURANCE COMPANY001, 006, 009, 011, 013, 014, 017, 018, 019, 020, 021, 022, 023, 024, 027, 028, 029, 032, 033, 034, 036, 037, 039, 040, 041, 042, 043, 044, 045, 047, 048, 050, 051, 052, 053, 054, 055, 057, 058, 061, 062, 063, 064, 065, 066, 067, 068, 070, 071, 072, 073, 074, 075, 076, 078, 080, 081, 083, 085, 088, 089, 091, 092, 093, 096, 097, 098, 099, 100, 103, 106, 107, 109, 111, 112, 114, 115, 117, 119, 120, 122, 124, 125, 128, 129, 131, 132, 133, 136, 137, 138, 141, 142, 143, 144, 145, 148, 149, 154, 155, 156, 158, 159, 160, 161, 163, 164, 165, 166, 167, 168, 169, 170, 171, 172, 173, 175, 176, 177, 179, 180, 181, 182, 184, 185, 186, 188, 189, 192, 193, 194, 195, 196, 197, 198, 199, 202, 203, 204, 205, 206, 207, 208, 209, 210, 211, 212, 214, 215, 219, 220, 222, 223, 224, 226, 227, 228, 229, 230, 231, 232, 233, 237, 238, 239, 240, 241, 242, 243, 244, 245, 246, 247, 248, 249, 250, 251, 252, 253, 254, 255, 805, 808, 811, 813, 81501558103200000
H5216HUMANA INSURANCE COMPANY035555555555555555555
H5232PARAMOUNT CARE, INC.all plans004336MEDDADV
H5253UNITEDHEALTHCARE OF WISCONSIN, INC.004, 007, 011, 024, 030, 033, 034, 035, 036, 037, 038, 039, 041, 042, 043, 047, 048, 049, 050, 051, 052, 054, 059, 060, 061, 064, 067, 072, 073, 077, 079, 080, 081, 082, 083, 084, 087, 088, 089, 090, 091, 097, 099, 100, 102, 103, 104, 105, 107, 108, 109, 110, 111, 112, 801, 805, 810, 811, 813, 814, 816, 817, 818, 820, 821, 823, 8246100979999
H5253UNITEDHEALTHCARE OF WISCONSIN, INC.062, 0639100979999
H5262QUARTZ HEALTH PLAN CORPORATIONall plans015574ASPROD1
H5273CAREPARTNERS OF CONNECTICUT, INC.all plans004336MEDDADV
H5280MOLINA HEALTHCARE OF OHIO, INC.all plans004336MEDDADV
H5294SUPERIOR HEALTH PLAN, INC.all plans004336MEDDADV
H5296 all plans610445AHPPARTD
H5302AETNA HEALTH INC. (GA)all plans610502MEDDAET
H5322CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.all plans6100979999
H5325COVENTRY HEALTH CARE OF KANSAS, INC.all plans610502MEDDAET
H5337AETNA BETTER HEALTH, INC. (OH)all plans610502MEDDAET
H5355IEHP HEALTH ACCESSall plans01235304110000
H5373 all plans004336MEDDADV
H5374 all plans610602NVTD
H5377HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.all plans01558103200000
H5386SHARP HEALTH PLANall plans004336MEDDADV
H5398CENTENE VENTURE COMPANY KANSASall plans004336MEDDADV
H5403ON LOK SENIOR HEALTH SERVICESall plans022188PSTMEDD
H5405CENTER FOR ELDERS INDEPENDENCEall plans022188PSTMEDD
H5406SUTTER HEALTH SACRAMENTO SIERRA REGIONall plans018091PRSMEDD
H5410HEALTHSPRING OF FLORIDA036017010CIHSCARE
H5410HEALTHSPRING OF FLORIDA001, 013, 018, 024, 025, 026, 027, 028, 029, 030, 031, 032, 033, 034, 035, 807, 808017010CIMCARE
H5420MEDICA HEALTHCARE PLANS, INC.all plans6100979999
H5422BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIAall plans020115IS
H5425SCAN HEALTH PLAN803, 804003858A4
H5425SCAN HEALTH PLAN001, 004, 005, 006, 007, 008, 009, 010, 019, 020, 028, 029, 030, 031, 033, 034, 040, 045, 052, 053, 054, 055, 064, 065, 066, 067, 068, 069, 070, 071, 072, 073, 074003858MD
H5427FREEDOM HEALTH, INC.059, 060, 070, 072, 077, 078, 082, 083, 087, 088, 089, 091, 092, 093, 094, 096, 098, 099020115IS
H5427FREEDOM HEALTH, INC.102, 103610011FRH
H5430ONECARE BY CARE1ST HEALTH PLAN ARIZONA INC.all plans004336MEDDADV
H5431HEALTHSUN HEALTH PLANS, INC.all plans020115IS
H5433ORANGE COUNTY HEALTH AUTHORITYall plans015574ASPROD1
H5434BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.002, 023, 024, 025, 026, 030, 031, 032, 033, 034, 035, 036, 037012833MedDPrime
H5434BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.801, 802012833MedDPrimeG
H5435UNITEDHEALTHCARE INSURANCE COMPANYall plans6100979999
H5439HEALTH NET LIFE INSURANCE COMPANYall plans004336MEDDADV
H5447 all plans610602NVT
H5454CLEAR SPRING HEALTH OF ILLINOIS, INC.all plans012312PARTD
H5463 all plans004336MEDDADV
H5471SIMPLY HEALTHCARE PLANS, INC.all plans020115IS
H5475MERIDIAN HEALTH PLAN OF MICHIGAN, INC.033, 034, 035, 036, 037004336MEDDAV
H5475MERIDIAN HEALTH PLAN OF MICHIGAN, INC.001, 003, 004, 005, 006, 008, 009, 010, 011, 012, 013, 015, 016, 019, 020, 021, 022, 023, 024, 026, 027, 028, 029, 030, 031, 032610241HPMMCR
H5493LIFE AT ST. FRANCIS HEALTHCARE, INC.all plans022188PSTMEDD
H5496IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.all plans012312PARTD
H5521AETNA LIFE INSURANCE COMPANYall plans610502MEDDAET
H5522HEALTHASSURANCE PENNSYLVANIA, INC.all plans610502MEDDAET
H5525HUMANA BENEFIT PLAN OF ILLINOIS, INC.all plans01558103200000
H5526HEALTHNOW NEW YORK INC.all plans610014MEDDPRIME
H5528GROUP HEALTH INCORPORATEDall plans0133440020080229
H5533UPMC HEALTH NETWORK, INC.all plans003858A4
H5549VNS CHOICEall plans015574ASPROD1
H5576VANTAGE HEALTH PLAN, INC.all plans610602NVTD
H5577MCS ADVANTAGE, INC.all plans012312PARTD
H5580MERCY CAREall plans610591MEDDADV
H5587HEALTH CHOICE ARIZONA, INC.all plans004336MEDDADV
H5590BRIDGEWAY HEALTH SOLUTIONSall plans004336MEDDADV
H5591MARTIN'S POINT GENERATIONS ADVANTAGE, INC.all plans004336MEDDADV
H5593AETNA HEALTH OF IOWA INC.all plans610502MEDDAET
H5594OPTIMUM HEALTHCARE, INC.001, 002, 016, 017, 019, 022, 026, 028, 029, 030, 032, 034, 035020115IS
H5594OPTIMUM HEALTHCARE, INC.031610011OPH
H5599 all plans004336MEDDADV
H5608DENVER HEALTH MEDICAL PLAN, INC.all plans015574ASPROD1
H5610CARE RESOURCESall plans022188PSTMEDD
H5619ARCADIAN HEALTH PLAN, INC.109001558103200000
H5619ARCADIAN HEALTH PLAN, INC.001, 003, 012, 013, 015, 016, 021, 023, 026, 029, 032, 037, 038, 039, 040, 041, 042, 044, 045, 046, 047, 049, 050, 051, 052, 053, 054, 055, 056, 057, 059, 060, 061, 062, 063, 064, 065, 066, 067, 069, 071, 073, 075, 076, 077, 078, 079, 080, 081, 082, 083, 084, 086, 087, 088, 089, 090, 091, 093, 094, 095, 097, 099, 100, 101, 102, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 123, 124, 125, 126, 128, 129, 130, 131, 132, 133, 134, 135, 136, 137, 802, 80501558103200000
H5619ARCADIAN HEALTH PLAN, INC.12201558204200000
H5628MOLINA HEALTHCARE OF UTAH, INC.all plans004336MEDDADV
H5629COMMUNITY ELDERCARE OF SAN DIEGOall plans016110PACE
H5644NETWORK HEALTH INSURANCE CORPORATIONall plans003858MD
H5649CENTRAL HEALTH PLAN OF CALIFORNIA, INC.all plans015574ASPROD1
H5652SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.all plans6100979999
H5656SELECTCARE HEALTH PLANS, INC.all plans004336MEDDADV
H5703SOUTH COUNTRY HEALTH ALLIANCEall plans0123536190000
H5742SHA, LLCall plans610602NVTD
H5746AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.all plans020115IS
H5774TRIPLE S ADVANTAGE, INC.all plans610674abarcaD
H5779MERIDIAN HEALTH PLAN OF ILLINOIS, INC.all plans610241MHPILSNP
H5793AETNA HEALTH INC. (CT)all plans610502MEDDAET
H5810MOLINA HEALTHCARE OF CALIFORNIAall plans004336MEDDADV
H5822MIDLAND CARE CONNECTIONall plans000000000000
H5823MOLINA HEALTHCARE OF WASHINGTON, INC.all plans004336MEDDADV
H5826COMMUNITY HEALTH PLAN OF WASHINGTONall plans003858MD
H5828 all plans020115IS
H5841BRIGHT HEALTH INSURANCE COMPANY001, 007, 008, 009, 010004336MEDDADV
H5841BRIGHT HEALTH INSURANCE COMPANY002, 003, 004, 005012312PARTD
H5843 all plans015574ASPROD1
H5852AIDS HEALTHCARE FOUNDATIONall plans015574ASPROD1
H5854ANTHEM HEALTH PLANS, INC.all plans020115IS
H5859HEALTH PLAN OF CAREOREGON, INC.all plans610011CORMCARE
H5883BLUE CARE NETWORK OF MICHIGANall plans610014Meddprime
H5902SENIOR LIFE ALTOONA, INC.all plans013519N/A
H5926MOLINA HEALTHCARE OF MICHIGAN, INC.all plans004336MEDDADV
H5928BLUE SHIELD OF CALIFORNIA PROMISE HEALTH PLAN001, 004, 005, 009, 010, 016, 037, 044, 050, 051, 052, 05300433677993322




The above chart is the third page of the 2021 Medicare Part D pharmacy BIN and PCN list (H3962 - H5928).

Click here for the first page (E0654 - H2235), second page (H2237 - H3959), fourth page (H5928 - H8634) and fifth page (H8634 - S9701).


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  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.
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