Plan Name
Type Plan
Total Part
C + D
Monthly
Premium
Annual
Drug
Deduct.
Drug
Benefit
Type
Addl.
Cover
in the
Gap
Contract
ID
Plan ID
In-
network MOOP**
Aetna Medicare Choice (PPO)
Local
PPO
$0.00 $0.00 EA Yes H7301 013 $3,850.00
Aetna Medicare Discover Value Plus (PPO)
Local
PPO
$27.80 $0.00 EA Yes H7301 017 $3,950.00
Aetna Medicare Duly Prime (PPO)
Local
PPO
$0.00 $0.00 EA Yes H5521 314 $3,875.00
Aetna Medicare Eagle (PPO)
Local
PPO *
Drugs not
covered
H5521 286 $4,390.00
Aetna Medicare Elite (PPO)
Local
PPO
$0.00 $0.00 EA Yes H1608 050 $4,500.00
Aetna Medicare Enhanced Select (PPO)
Local
PPO
$169.00 $300.00 EA No H7301 015 $1,400.00
Aetna Medicare Gold Advantage (HMO)
Local
HMO
$0.00 $0.00 EA Yes H2663 005 $2,400.00
Aetna Medicare Option 1 (HMO-POS)
Local
HMO
$19.00 $0.00 EA Yes H2663 006 $6,000.00
Aetna Medicare Option 2 (HMO)
Local
HMO
$28.00 $0.00 EA Yes H2663 002 $4,900.00
Aetna Medicare Premier (HMO-POS)
Local
HMO
$0.00 $0.00 EA Yes H3192 013 $3,500.00
Aetna Medicare Premier (PPO)
Local
PPO
$40.00 $150.00 EA Yes H1608 013 $7,550.00
Aetna Medicare Premier (PPO)
Local
PPO
$13.00 $0.00 EA Yes H7301 009 $4,650.00
Aetna Medicare Premier Advantra (PPO)
Local
PPO
$9.00 $0.00 EA Yes H7301 002 $3,875.00
Aetna Medicare Premier Plus (PPO)
Local
PPO
$0.00 $150.00 EA Yes H1608 051 $6,750.00
Aetna Medicare Premier Plus (PPO)
Local
PPO
$34.00 $0.00 EA Yes H5521 016 $3,400.00
Aetna Medicare Premier Preferred (HMO)
Local
HMO
$0.00 $0.00 EA Yes H2663 017 $3,400.00
Aetna Medicare Prime (HMO-POS)
Local
HMO
$0.00 $0.00 EA Yes H3192 001 $3,950.00
Aetna Medicare SmartFit (PPO)
Local
PPO
$0.00 $0.00 EA Yes H1608 067 $3,900.00
Aetna Medicare SmartFit (PPO)
Local
PPO
$0.00 $250.00 EA Yes H7301 021 $3,875.00
Aetna Medicare SmartSaver Elite (PPO)
Local
PPO
$0.00 $300.00 EA No H7301 016 $6,000.00
Aetna Medicare Value (PPO)
Local
PPO
$0.00 $0.00 EA Yes H5521 086 $3,950.00
2024 Illinois Medicare Advantage, and Cost Plans
(Illinois SHIP)
Data as of September 05, 2023. Includes CY2024 approved contracts/plans. PACE, Special Needs Plans, Part B Only Plans, and
Employer sponsored plans (800 series) are excluded. Plans under sanction are not shown. Medicare/Medicaid plans are shown in a
Notes: Data are subject to change as contracts are finalized. For CY2024, enhanced alternative plans may offer additional cost
sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.
*
Indicates plan does not offer Part D drug coverage. **
MOOP is defined as: Maximum Out-of-Pocket (MOOP) limit on enrollee
spending that includes costs for all in-network Part A and Part B Services. N/A is defined as Not Applicable
EA = Enhanced BA = Basic Reference: CMS.gov - https://www.cms.gov/medicare/coverage/prescription-drug-coverage
Aetna Medicare Value (PPO)
Local
PPO
$0.00 $0.00 EA Yes H7301 007 $4,650.00
Aetna Medicare Value Advantra (PPO)
Local
PPO
$0.00 $0.00 EA Yes H7301 006 $4,000.00
Aetna Medicare Value Plus (PPO)
Local
PPO
$22.00 $400.00 EA Yes H7301 014 $4,550.00
Blue Cross Medicare Advantage Basic (HMO)
Local
HMO
$0.00 $0.00 EA Yes H3822 012 $4,900.00
Blue Cross Medicare Advantage Basic (HMO)
Local
HMO
$0.00 $0.00 EA Yes H3822 001 $2,500.00
Blue Cross Medicare Advantage Basic Plus
(HMO-POS)
Local
HMO
$0.00 $0.00 EA Yes H3822 007 $4,500.00
Blue Cross Medicare Advantage Choice Plus
(PPO)
Local
PPO
$77.00 $0.00 EA Yes H8634 003 $4,500.00
Blue Cross Medicare Advantage Choice
Premier (PPO)
Local
PPO
$135.00 $0.00 EA Yes H8634 004 $3,855.00
Blue Cross Medicare Advantage Classic (PPO)
Local
PPO
$0.00 $0.00 EA Yes H8634 017 $5,900.00
Blue Cross Medicare Advantage Classic (PPO)
Local
PPO
$0.00 $200.00 EA No H8634 008 $4,900.00
Blue Cross Medicare Advantage Dental
Premier (PPO)
Local
PPO
$0.00 $545.00 EA No H8634 021 $7,550.00
Blue Cross Medicare Advantage Elite (PPO)
Local
PPO
$0.00 $250.00 EA Yes H8634 016 $3,900.00
Blue Cross Medicare Advantage Essential
(PPO)
Local
PPO
$0.00 $0.00 EA Yes H8634 012 $5,900.00
Blue Cross Medicare Advantage Flex (PPO)
Local
PPO
$202.00 $545.00 EA No H8634 014 $0.00
Blue Cross Medicare Advantage Health Choice
(PPO)
Local
PPO
$0.00 $545.00 EA No H8634 018 $6,900.00
Blue Cross Medicare Advantage Premier Plus
(HMO-POS)
Local
HMO
$76.00 $0.00 EA Yes H3822 008 $3,500.00
Blue Cross Medicare Advantage Protect (PPO)
Local
PPO *
Drugs not
covered
H8634 019 $6,350.00
Blue Cross Medicare Advantage Saver Plus
(PPO)
Local
PPO
$0.00 $545.00 EA No H8634 020 $6,900.00
Blue Cross Medicare Advantage Secure (HMO)
Local
HMO
$0.00 $0.00 EA Yes H8547 001 $2,500.00
Blue Cross Medicare Advantage Value (HMO)
Local
HMO
$0.00 $0.00 EA Yes H3822 014 $2,900.00
Cigna Preferred Medicare (HMO)
Local
HMO
$0.00 $0.00 EA No H4513 085 $2,500.00
Cigna Preferred Medicare (HMO)
Local
HMO
$0.00 $0.00 EA No H7389 004 $3,450.00
Cigna Preferred Medicare (HMO)
Local
HMO
$0.00 $0.00 EA No H7389 003 $2,600.00
Cigna Preferred Savings Medicare (HMO)
Local
HMO
$0.00 $0.00 EA No H4513 086 $4,500.00
Cigna Premier Medicare (HMO-POS)
Local
HMO
$0.00 $0.00 EA No H4513 084 $4,200.00
Cigna True Choice Courage Medicare (PPO)
Local
PPO *
Drugs not
covered
H7849 073 $5,000.00
Cigna True Choice Courage Medicare (PPO)
Local
PPO *
Drugs not
covered
H7849 074 $4,100.00
Cigna True Choice Courage Medicare (PPO)
Local
PPO *
Drugs not
covered
H7849 078 $5,900.00
Cigna True Choice Medicare (PPO)
Local
PPO
$0.00 $0.00 EA No H7849 002 $3,200.00
Cigna True Choice Medicare (PPO)
Local
PPO
$0.00 $0.00 EA No H7849 057 $3,700.00
Cigna True Choice Medicare (PPO)
Local
PPO
$0.00 $0.00 EA No H7849 058 $3,700.00
Cigna True Choice Medicare (PPO)
Local
PPO
$0.00 $0.00 EA No H7849 059 $4,600.00
Cigna True Choice Savings Medicare (PPO)
Local
PPO
$0.00 $0.00 EA No H7849 076 $5,000.00
Cigna True Choice Savings Medicare (PPO)
Local
PPO
$0.00 $0.00 EA No H7849 077 $4,100.00
Cigna True Choice Savings Medicare (PPO)
Local
PPO
$0.00 $0.00 EA No H7849 080 $3,700.00
Clear Spring Health Community Advantage
Plan (HMO)
Local
HMO
$0.00 $0.00 EA No H3071 002 $2,950.00
Clear Spring Health Essential (HMO)
Local
HMO
$0.00 $0.00 EA No H5454 001 $2,900.00
Clear Spring Health Essential (HMO)
Local
HMO
$0.00 $0.00 EA No H5454 002 $2,900.00
Devoted CHOICE Illinois (PPO)
Local
PPO
$0.00 $0.00 EA Yes H6545 001 $3,200.00
Devoted CORE Illinois (HMO)
Local
HMO
$0.00 $0.00 EA Yes H7151 001 $2,500.00
Devoted GIVEBACK Illinois (HMO)
Local
HMO
$0.00 $0.00 EA Yes H7151 003 $4,500.00
Essence Advantage (HMO)
Local
HMO
$0.00 $0.00 EA Yes H2610 005 $2,300.00
Essence Advantage Choice (PPO)
Local
PPO
$0.00 $0.00 EA Yes H6200 001 $3,400.00
Essence Advantage Choice Plus (PPO)
Local
PPO
$22.20 $0.00 EA Yes H6200 002 $3,000.00
Essence Advantage Plus (HMO)
Local
HMO
$53.80 $0.00 EA Yes H2610 006 $1,900.00
Essence Advantage Select (HMO)
Local
HMO
$0.00 $0.00 EA Yes H2610 016 $2,800.00
Health Alliance Medicare HMO 20 Rx (HMO)
Local
HMO
$125.00 $0.00 EA Yes H1463 003 $4,000.00
Health Alliance Medicare HMO Basic (HMO)
Local
HMO *
Drugs not
covered
H1463 008 $6,700.00
Health Alliance Medicare POS 10 Rx (HMO-
POS)
Local
HMO
$165.00 $0.00 EA Yes H1463 019 $2,900.00
Health Alliance Medicare POS Basic Rx (HMO-
POS)
Local
HMO
$53.00 $0.00 EA Yes H1463 015 $5,400.00
Health Alliance Medicare POS Choice Rx (HMO-
POS)
Local
HMO
$0.00 $0.00 EA Yes H1463 044 $3,500.00
Health Alliance Medicare POS Enrich Rx (HMO-
POS)
Local
HMO
$165.00 $250.00 EA Yes H1463 042 $0.00
HealthPartners UnityPoint Health Align (PPO)
Local
PPO
$0.00 $0.00 EA No H3416 001 $3,900.00
HealthPartners UnityPoint Health Symmetry
(PPO)
Local
PPO
$49.00 $0.00 EA Yes H3416 002 $3,300.00
Humana Community Select (HMO)
Local
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
Drugs not
covered
H8145 126
Humana Gold Plus H0028-014 (HMO)
Local
HMO
$0.00 $0.00 EA Yes H0028 014 $2,900.00
Humana Gold Plus H1468-007 (HMO)
Local
HMO
$0.00 $0.00 EA Yes H1468 007 $3,000.00
Humana Gold Plus H1468-013 (HMO)
Local
HMO
$0.00 $0.00 EA Yes H1468 013 $2,300.00
Humana Gold Plus H1468-014 (HMO)
Local
HMO
$49.00 $0.00 EA No H1468 014 $3,850.00
Humana USAA Honor (PPO)
Local
PPO *
Drugs not
covered
H5216 355 $5,500.00
Humana USAA Honor (PPO)
Local
PPO *
Drugs not
covered
H5216 140 $4,500.00
Humana USAA Honor (PPO)
Local
PPO *
$0.00
Drugs not
covered
H5216 329 $6,700.00
Humana USAA Honor (PPO)
Local
PPO *
Drugs not
covered
H5216 258 $5,500.00
Humana USAA Honor (Regional PPO)
Regional
PPO *
Drugs not
covered
R5361 001 $5,500.00
HumanaChoice H5216-013 (PPO)
Local
PPO
$100.00 $0.00 EA No H5216 013 $5,700.00
HumanaChoice H5216-032 (PPO)
Local
PPO
$61.00 $200.00 EA No H5216 032 $6,700.00
HumanaChoice H5216-215 (PPO)
Local
PPO
$0.00 $0.00 EA Yes H5216 215 $5,000.00
HumanaChoice H5216-251 (PPO)
Local
PPO
$0.00 $0.00 EA Yes H5216 251 $3,700.00
HumanaChoice H5216-283 (PPO)
Local
PPO
$30.00 $0.00 EA Yes H5216 283 $3,100.00
HumanaChoice H5216-318 (PPO)
Local
PPO
$0.00 $0.00 EA Yes H5216 318 $3,700.00
HumanaChoice H5216-357 (PPO)
Local
PPO
$138.00 $545.00 EA Yes H5216 357 $1,000.00
HumanaChoice H5216-399 (PPO)
Local
PPO
$30.00 $0.00 EA Yes H5216 399 $3,900.00
HumanaChoice H5525-004 (PPO)
Local
PPO
$100.00 $300.00 EA No H5525 004 $6,300.00
HumanaChoice H5525-068 (PPO)
Local
PPO
$0.00 $250.00 EA Yes H5525 068 $4,200.00
HumanaChoice H5525-069 (PPO)
Local
PPO
$138.00 $545.00 EA Yes H5525 069 $1,000.00
HumanaChoice R5361-002 (Regional PPO)
Regional
PPO
$97.00 $545.00 BA No R5361 002 $6,700.00
Medical Associates Community Plan (Cost) Cost * $152.00
Drugs not
covered
H1651 005
Medical Associates Freedom Plan (Cost) Cost * $193.00
Drugs not
covered
H1651 009
Medical Associates Live360 Health Plan (Cost) Cost * $150.00
Drugs not
covered
H1651 025
Medical Associates Quad Cities Community
Health Senior Plan (Cost)
Cost * $150.00
Drugs not
covered
H1651 017
Medical Associates SmartPlan (Cost) Cost * $128.00
Drugs not
covered
H1651 003
Molina Medicare Choice Care (HMO)
Local
HMO
$0.00 $125.00 EA No H2715 001 $8,300.00
Quartz MA - UW Health IL Quartz Med
Advantage Core D (w/Rx) (HMO)
Local
HMO
$0.00 $300.00 EA Yes H5262 019 $5,500.00
Quartz MA - UW Health IL Quartz Med
Advantage Elite (HMO)
Local
HMO *
$30.00
Drugs not
covered
H5262 027 $3,250.00
Quartz MA - UW Health IL Quartz Med
Advantage Elite D(w/Rx) (HMO)
Local
HMO
$68.00 $200.00 EA Yes H5262 026 $3,250.00
Quartz MA - UW Health IL Quartz Med
Advantage Value (HMO)
Local
HMO *
Drugs not
covered
H5262 020 $4,500.00
Quartz MA - UW Health IL Quartz Med
Advantage Value D(w/Rx) (HMO)
Local
HMO
$32.00 $250.00 EA Yes H5262 018 $4,500.00
United Health Care - AARP Medicare
Advantage from UHC IA-0001 (HMO-POS)
Local
HMO
$0.00 $0.00 EA Yes H5253 107 $3,800.00
United Health Care - AARP Medicare
Advantage from UHC IA-0002 (HMO-POS)
Local
HMO
$39.00 $0.00 EA Yes H5253 108 $3,400.00
United Health Care - AARP Medicare
Advantage from UHC IA-0002 (HMO-POS)
Local
HMO
$29.00 $0.00 EA Yes H5253 108 $3,800.00
United Health Care - AARP Medicare
Advantage from UHC IA-0003 (PPO)
Local
PPO
$0.00 $0.00 EA Yes H8768 017 $3,800.00
United Health Care - AARP Medicare
Advantage from UHC IA-0004 (PPO)
Local
PPO
$0.00 $0.00 EA Yes H8768 032 $3,800.00
United Health Care - AARP Medicare
Advantage from UHC IL-0001 (HMO-POS)
Local
HMO
$29.00 $0.00 EA Yes H2802 025 $3,200.00
United Health Care - AARP Medicare
Advantage from UHC IL-0002 (HMO-POS)
Local
HMO
$0.00 $0.00 EA Yes H2802 054 $2,900.00
United Health Care - AARP Medicare
Advantage from UHC IL-0003 (PPO)
Local
PPO
$49.00 $0.00 EA Yes H8768 003 $3,400.00
United Health Care - AARP Medicare
Advantage from UHC IL-0004 (PPO)
Local
PPO
$34.00 $0.00 EA Yes H8768 005 $3,800.00
United Health Care - AARP Medicare
Advantage from UHC IL-001P (HMO-POS)
Local
HMO
$0.00 $0.00 EA Yes H2802 024 $2,500.00
United Health Care - AARP Medicare
Advantage from UHC ST-0001 (PPO)
Local
PPO
$34.00 $0.00 EA Yes H2406 043 $3,800.00
United Health Care - AARP Medicare
Advantage from UHC ST-0003 (HMO-POS)
Local
HMO
$0.00 $0.00 EA Yes H2802 028 $2,900.00
United Health Care - AARP Medicare
Advantage from UHC ST-0004 (HMO-POS)
Local
HMO
$0.00 $0.00 EA Yes H2802 052 $3,400.00
United Health Care - AARP Medicare
Advantage Patriot No Rx IA-MA01 (PPO)
Local
PPO *
Drugs not
covered
H8768 018 $7,500.00
United Health Care - AARP Medicare
Advantage Patriot No Rx IL-MA01 (PPO)
Local
PPO *
Drugs not
covered
H8768 019 $5,900.00
United Health Care - AARP Medicare
Advantage Patriot No Rx MO-MA01 (HMO-
POS)
Local
HMO *
Drugs not
covered
H2802 050 $3,700.00
United Health Care - AARP Medicare
Advantage Walgreens from UHC IL-0005
(PPO)
Local
PPO
$0.00
Drugs not
covered
EA Yes H8768 010 $5,700.00
United Health Care - AARP Medicare
Advantage Walgreens from UHC IL-0006
(PPO)
Local
PPO
$0.00 $0.00 EA Yes H8768 011 $5,900.00
United Health Care - AARP Medicare
Advantage Walgreens from UHC ST-0002
(PPO)
Local
PPO
$0.00 $0.00 EA Yes H2406 069 $3,800.00
Wellcare Assist Compass (HMO)
Local
HMO
$19.50 $545.00 EA No H1416 023 $2,900.00
Wellcare Complete - Giveback (HMO)
Local
HMO
$0.00 $500.00 EA No H7399 001 $5,000.00
Wellcare Giveback Open (PPO)
Local
PPO
$0.00 $545.00 EA Yes H6713 002 $5,000.00
Wellcare No Premium (HMO-POS)
Local
HMO
$0.00 $0.00 EA No H1416 009 $2,700.00
Wellcare No Premium Essential (HMO)
Local
HMO
$0.00 $0.00 EA No H5779 002 $2,900.00
Wellcare No Premium Essential Value (HMO)
Local
HMO
$0.00 $0.00 EA No H5779 009 $2,900.00
Wellcare No Premium Exclusive (HMO)
Local
HMO
$0.00 $0.00 EA Yes H5779 007 $2,900.00
Wellcare No Premium Open (PPO)
Local
PPO
$0.00 $0.00 EA Yes H6713 001 $3,200.00
Wellcare No Premium Value (HMO-POS)
Local
HMO
$0.00 $0.00 EA No H1416 082 $2,900.00
WellFirst Health Medica Advantage Salute
(HMO-POS)
Local
HMO *
Drugs not
covered
H8019 003 $5,500.00
WellFirst Health Medica Advantage with SSM
Value (HMO-POS)
Local
HMO
$0.00 $0.00 EA Yes H8019 002 $4,500.00
WellFirst Health OSF with Medica Advantage
Preferred (HMO-POS)
Local
HMO
$160.00 $200.00 EA Yes H8019 008 $0.00
WellFirst Health OSF with Medica Advantage
Select (HMO-POS)
Local
HMO
$0.00 $0.00 EA Yes H8019 007 $3,900.00
WellFirst Health OSF with Medica Advantage
Value (HMO)
Local
HMO
$0.00 $0.00 EA Yes H8019 006 $3,500.00
Zing Choice IL (HMO)
Local
HMO
$0.00 $0.00 EA Yes H4624 001 $3,850.00
Zing Elite Select IL (HMO)
Local
HMO
$0.00 $0.00 EA Yes H7330 004 $2,900
Zing Select Care IL (HMO)
Local
HMO
$0.00 $0.00 EA Yes H7330 001 $3,850
