Sarasota Metro 2019 MAPD Plans

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We were inspired to create this guide after seeing a similar (and much more beautifully designed) one that the Tampa Bay Times put out for the 2018 Medicare Advantage plan year. In the table below you will find a comprehensive list of the Medicare Advantage health plans with drug coverage available in the Sarasota Metro area (Sarasota, Manatee and Charlotte Counties) for the 2019 plan year. Look below the chart for some helpful definitions and for information on what might not be included. If you want to learn more about any of these plans, give us a call at 866-868-9294, we’re happy to answer any questions you may have.

table columns can be sorted


Plan Type Premium Part B Rebate Counties Drug Deductible Doctor Copay (Primary, Specialist) Hospital Copay Yearly Cost (Est.) Out-of-Pocket Cap Network Size Drug Costs (Initial Coverage)
Humana Gold Plus (H1036-267-0) HMO $0 $80 Sarasota $0 $0, $40 $175 Days 1-7 $1,800 $3,900 501-1000 Tier 1: $0, Tier 2: $20, Tier 3: $47, Tier 4: $97, Tier 5: 33%
Wellcare Dividend Prime (H1032-198-0) HMO $0 $75 Charlotte, Manatee, Sarasota $0 $0, $35 $200 Days 1-5 $2,040 $3,400 2501-3000 Tier 1: $0, Tier 2: $0, Tier 3: $35, Tier 4: $90, Tier 5: 33%
BlueMedicare Preferred (H2758-002-0) HMO $0 $0 Manatee, Sarasota $0 $0 $30 $120 Days 1-5 $2,470 $3,400 1501-2000 Tier 1: $0, Tier 2: $1, Tier 3: $35, Tier 4: $100, Tier 5: 33%
Humana Gold Plus (H1036-215-0) HMO $0 $0 Sarasota $0 $0, $25 $95 Days 1-7 $2,500 $3,400 501-1000 Tier 1: $0, Tier 2: $10, Tier 3: $47, Tier 4: $97, Tier 5: 33%
Aetna Medicare Select (H1609-025-0) HMO $0 $0 Charlotte, Manatee, Sarasota $0 $0, $30 $125 Days 1-7 $2,530 $3,400 2501-3000 Tier 1: $0, Tier 2: $0, Tier 3: $47, Tier 4: $100, Tier 5: 33%
BlueMedicare Classic (H1035-019-0) HMO $0 $0 Charlotte, Manatee, Sarasota $0 $0, $40 $200 Days 1-7 $2,750 $5,500 20001+ Tier 1: $3, Tier 2: $10, Tier 3: $40, Tier 4: $93, Tier 5: 33%
Wellcare Elite (H1032-199-0) HMO $0 $0 Charlotte, Manatee, Sarasota $0 $0, $20 $125 Days 1-7 $2,750 $5,000 2501-3000 Tier 1: $0, Tier 2: $0, Tier 3: $35, Tier 4: $75, Tier 5: 33%
BlueMedicare Preferred POS (H2758-008-0) HMO-POS $0 $0 Manatee, Sarasota $0 $0, $25 / OON $30, $45 $120 Days 1-5 $2,780 $4,900 In Network / $8,000 OON 1501-2000 Tier 1: $0, Tier 2: $7, Tier 3: $35, Tier 4: $85, Tier 5: 33%
Aetna Medicare Choice (H1609-028-0) HMO-POS $0 $0 Charlotte, Manatee, Sarasota $195 $0, $25 / OON $50 $350 Days 1-4 / OON 50% per stay $2,820 $6,700 In Network / OON $10,000 7501-8000 Tier 1: $0, Tier 2: $0, Tier 3: $47, Tier 4: $100, Tier 5: 29%
Wellcare Dividend (H1032-188-1) HMO $0 $25 Charlotte, Manatee, Sarasota $0 $0, $40 $400 Days 1-4 $2,820 $6,700 6001-6500 Tier 1: $0, Tier 2: $10, Tier 3: $45, Tier 4: 46%, Tier 5: 33%
AARP MedicareComplete Plan 2 (H1045-034-0) HMO $0 $0 Charlotte, Manatee, Sarasota $0 $0, $20 $195 Days 1-8 $2,840 $4,900 20001+ Tier 1: $3, Tier 2: $10, Tier 3: $45, Tier 4: $95, Tier 5: 33%
Optimum Platinum Plan (H5594-019-0) HMO $0 $0 Sarasota $0 $0, $30 $195 Days 1-7 $2,870 $3,400 11001-12000 Tier 1: $0, Tier 2: $0, Tier 3: $35, Tier 4: $85, Tier 5: 33%
Freedom Medicare Plan Rx (H5427-060-0) HMO $0 $0 Sarasota $0 $0, $35 $150 Days 1-7 $2,920 $3,400 13001-14000 Tier 1: $0, Tier 2: $0, Tier 3: $35, Tier 4: $85, Tier 5: 33%
Wellcare Value (H1032-133-0) HMO-POS $0 $0 Charlotte, Manatee, Sarasota $0 $0, $35 / OON 35% per visit $199 Days 1-6 / OON 45% per stay $2,950 $6,700 7001-7500 Tier 1: $0, Tier 2: $10, Tier 3: $45, Tier 4: 48%, Tier 5: 33%
Aetna Medicare Premier (H5521-033-0) PPO $0 $0 Charlotte, Manatee, Sarasota $295 $0, $50 / OON $50, $50 $395 Days 1-4 / OON 50% per stay $3,110 $6,700 In Network / OON $10,000 9001-10000 Tier 1: $0, Tier 2: $0, Tier 3: $47, Tier 4: $100, Tier 5: 27%
AARP MedicareComplete Choice (H2406-009-0) PPO $0 $0 Charlotte, Manatee, Sarasota $150 $10, $35 / OOP $45, $70 $295 Days 1-4 / OON 40% per stay $3,120 $5,900 In Network / OON $10,000 20001+ Tier 1: $3, Tier 2: $10, Tier 3: $45, Tier 4: $95, Tier 5: 30%
Wellcare Premier (H5199-004-0) PPO $0 $0 Charlotte, Manatee, Sarasota $150 $5, $35 / OON 40% per visit $350 Days 1-4 / OON 40% per stay $3,120 $5,000 In Network / OON $10,000 2001-2500 Tier 1: $0, Tier 2: $10, Tier 3: $47, Tier 4: $100, Tier 5: 30%
HumanaChoice Florida (H5216-072-0) PPO $0 $0 Charlotte, Manatee, Sarasota $150 $5, $35 / $65, $65 $290 Days 1-5 / OON $495 Days 1-27 $3,180 $4,900 In Network / OON $10,000 20001+ Tier 1: $2, Tier 2: $10, Tier 3: $47, Tier 4: $100, Tier 5: 30%
AARP Medicare Complete (H1045-028-0) HMO $0 $0 Charlotte, Manatee, Sarasota $195 $0, $45 $295 Days 1-6 $3,320 $4,900 20001+ Tier 1: $3, Tier 2: $10, Tier 3: $45, Tier 4: $95, Tier 5: 29%
BlueMedicare Value (H5434-024-0) PPO $0 $0 Manatee, Sarasota $250 $10, $50 / OON 50% per visit $350 Days 1-5 / OON 50% per stay $3,480 $6,700 In Network / OON $10,000 20001+ Tier 1: $0, Tier 2: $10, Tier 3: $47, Tier 4: $100, Tier 5: 28%
AARP MedicareComplete Choice Plan 2 (R7444-003-0) PPO $0 $0 Charlotte, Manatee, Sarasota $395 $15, $50 / OON $45, $70 $395 Days 1-4 / OON 40% per stay $3,480 $6,700 In Network / OON $10,000 20001+ Tier 1: $3, Tier 2: $14, Tier 3: $47, Tier 4: $100, Tier 5: 25%
HumanaChoice (R5826-074-0) PPO $0 $0 Charlotte, Manatee, Sarasota $395 $15, $50 / OON $60, $60 $395 Days 1-4 / OON $495 Days 1-27 $3,530 $6,700 In Network / OON $10,000 20001+ Tier 1: $6, Tier 2: $20, Tier 3: $47, Tier 4: $100, Tier 5: 25%
Aetna Medicare Value HMO $0 $0 Charlotte, Manatee, Sarasota $0 $15, $45 $250 Days 1-5 $3,660 $5,000 2501-3000 Tier 1: $0, Tier 2: $0, Tier 3: $47, Tier 4: $100, Tier 5: 33%
Wellcare Prime (H5199-006-0) PPO $55 $0 Charlotte, Manatee, Sarasota $0 $5, $35 / OON $5, $40-50 $250 Days 1-5 $3,700 $5,000 In Network / OON $10,000 2001-2500 Tier 1: $0, Tier 2: $5, Tier 3: $47, Tier 4: $100, Tier 5: 33%
BlueMedicareChoice (R3332-001-0) PPO $42 $0 Charlotte, Manatee, Sarasota $250 $10, $45 / OON 50% per visit $295 Days 1-5 / OON $495 Days 1-27 $3,880 $6,700 In Network / OON $10,000 20001+ Tier 1: $0, Tier 2: $10, Tier 3: $47, Tier 4: $100, Tier 5: 28%
HumanaChoice (R5826-005-0) PPO $96 $0 Charlotte, Manatee, Sarasota $100 $5, $40 / OON $45, $45 $195 Days 1-7 / OON 40% per stay $4,120 $6,700 In Network / OON $10,000 20001+ Tier 1: $5, Tier 2: $15, Tier 3: $45, Tier 4: $95, Tier 5: 31%
Humana Gold Choice (H8145-061-0) PFFS $117 $0 Charlotte, Manatee, Sarasota $200 $10, $40 / OON $10-40 , $40 $290 Days 1-5 $5,030 $6,700 20001+ Tier 1: $7, Tier 2: $17, Tier 3: $47, Tier 4: $97, Tier 5: 29%

Definitions

HMO: Health Maintenance Organization. In these types of Medicare Advantage plans, you must receive healthcare through the plan network. If you seek treatment for anything other than emergency care out-of-network, you pay the full cost. You may need referrals to see specialists from your primary care physician, though some carriers do not require this.

PPO: Preferred Provider Organization. In these types of Medicare Advantage plans, you may seek treatment within your plans network or with out-of-network physicians. You usually pay a higher co-pay to see out-of-network physicians and the plan’s out-of-pocket maximum may be higher with out-of-network physicians, as well. Referrals are not needed to see a specialist.

Premium: This is the plan premium in addition to the $134 standard Medicare Part B premium. While most Medicare Advantage plans do not have an additional premium, a select few do.

Part B Rebate: Also known as a Part B Reduction, this is a portion of the $134 standard Medicare Part B premium that is reduced by enrolling in that plan. It is usually seen as an increase in your social security payments, as that is where most people have their Part B premium taken from.

Drug Deductible: This is the deductible that some plans require before they begin paying for prescription drugs. Some plans waive the deductible for prescription drugs in Tiers 1 and 2.

Doctor Co-Pay: The fee you will pay to see your primary care physician or a specialist.

Hospital Co-Pay: This is the fee you will pay when admitted into the hospital. The co-pay is charged during each individual hospital stay you may have during the year. For example, if you are in the hospital for 10 days in a plan where the hospital copay is $200 for days 1-5, you will be responsible for $1000. If you are admitted again for two days a few weeks after you are released, you would pay $400 for the additional stay.

Yearly Cost (Est.): This is the amount that CMS (Centers for Medicare and Medicaid Services) estimates the total cost associated with the plan and services you use during the calendar year. This figure does NOT include your prescription drug costs.

Out-of-Pocket Cap: This is the most money you will contribute towards your treatment during a plan year. This figure does NOT include your prescription drug costs.

Network Size: This is the number of physicians (primary care and specialists) that are contracted to provide service through the plan.

Drug Costs (Initial Coverage): Co-pays and co-insurance for different drug tiers within the plan during the initial coverage phase. Once both the plan and insured contribute $3,820 (in 2019) towards prescription drugs, the insured then enters the coverage gap (donut hole) and pays a higher co-insurance until payments reach $5,100. At this point, the insured enters the catastrophic coverage phase, and the plan contributes 95% of further drug costs.

What’s Not In This Chart?

Plenty. This chart serves to give a general overview of the Medicare Advantage plans with prescription drug coverage (MAPD) in the Tampa Bay Area. Special Needs Plans for Dual Eligibles (have both Medicare and Medicaid) and those with chronic illnesses are not included.

There are many co-pays that go beyond a visit to the doctor. This includes things like lab fees, urgent care, emergency care, ambulances, surgical benefits, etc.

Many plans also provide you with extras that Original Medicare does not provide, such as transportation, over-the-counter allowances, gym memberships (Silver Sneakers), dental/vision/hearing benefits, some even provide in-home cleaning and meals.


Medicare Advantage plans can be a great option for many Medicare beneficiaries who are looking to receive extra benefits that Original Medicare may not offer and don’t mind seeing physicians within a structured network. However, it is best to look at all of your options including Original Medicare with a Supplement (Medigap) or on its own.

Data Source: Centers for medicare and medicaid services (cms)


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