Company Name Plan Name Benefit Type $0
Premium
with
Full Low
Income
Subsidy?
Monthly
Drug
Premium
Annual
Drug
Deductible
Type of
Extra
Coverage
Differed in
the Gap
Contract
ID
Plan ID

Aetna Medicare

1-800-213-4599
aetnamedicare.com

Aetna Medicare Rx Essentials Basic   $32.90 $220 No Gap Coverage S5810 038
Aetna Medicare Rx Plus Enhanced   $66.00 $0 Some Generics S5810 140
Aetna Medicare Rx Premier Enhanced   $130.20 $0 Many Generics S5810 174
AmeriHealth Rx
1-800-898-3492
amerihealth65.com
AmeriHealth NJ Rx Option 1 Basic   $32.20 $295 No Gap Coverage S4496 001
AmeriHealth NJ Rx Option 2 Enhanced   $40.20 $0 No Gap Coverage S4496 003
Bravo Health
1-800-723-9209
Bravo Rx Basic   $39.20 $295 No Gap Coverage S5998 003

CIGNA Medicare Rx

1-800-735-1459
cignamedicarerx.com

CIGNA Medicare Rx Plan One Basic   $34.90 $295 No Gap Coverage S5617 018
CIGNA Medicare Rx Plan Two Enhanced   $43.80 $0 No Gap Coverage S5617 020
CIGNA Medicare Rx Plan Three Enhanced   $88.50 $0 Some Generics S5617 174

Coventry AdvantraRx

1-800-882-3822
advantrarx.com

AdvantraRx Value Enhanced   $24.60 $0 No Gap Coverage S5674 014
AdvantraRx Premier Basic   $40.80 $0 No Gap Coverage S5674 015
AdvantraRx Premier Plus Enhanced   $56.80 $0 Many Generics S5674 017

EnvisionRx Plus
1-866-250-2005
envisionrxplus.com

EnvisionRxPlus Silver Basic   $33.20 $295 No Gap Coverage S7694 004
EnvisionRxPlus Gold Enhanced   $69.00 $0 No Gap Coverage S7694 038
First Health Part D
1-800-588-3322
firsthealthpartd.com
First Health Part D-Secure Enhanced   $16.70 $175 No Gap Coverage S5768 086
First Health Part D-Premier Basic YES $29.10 $0 No Gap Coverage S5768 007
Fox Insurance
1-888-369-7979
foxrxcare.com
Fox Value Plan Basic YES $24.60 $295 No Gap Coverage S5557 023
Fox Grand Plan Enhanced   $41.60 $285 Some Generics S5557 013
Health Net
1-800-606-3604
heathnet.com
Health Net Orange Option 1 Basic   $32.90 $295 No Gap Coverage S5678 005
Health Net Orange Option 2 Enhanced   $52.10 $0 No Gap Coverage S5678 011
HealthSpring
1-800-331-6293
healthspring.com
HealthSpring Prescription Drug Plan -Reg 4 *Will Not work with PAAD Beneficiaries Basic YES $26.60 $295 No Gap Coverage S5932 005
Horizon Blue Cross
Blue Shield of NJ
1-800-224-1234
horizonblue.com
Horizon Medicare Blue Rx Standard Basic   $42.30 $295 No Gap Coverage S5993 001
Horizon Medicare Blue Rx Plus Enhanced   $72.90 $0 Many Generics S5993 003

Humana Insurance

1-800-706-0872
humana-medicare.com

Humana PDP Enhanced Enhanced   $33.70 $0 No Gap Coverage S5884 003
Humana PDP Standard Basic   $38.90 $295 No Gap Coverage S5884 062
Humana PDP Complete Enhanced   $98.90 $0 Many Generics S5884 032

Medco Medicare
Prescription Plan

1-800-758-3605
medcomedicare.com

Medco Medicare Prescription Plan - Value Basic YES $27.70 $295 No Gap Coverage S5660 106
Medco Medicare Prescription Plan - Choice Enhanced   $41.60 $0 No Gap Coverage S5660 035
Medco Medicare Prescription Plan - Access Enhanced   $71.40 $0 All Generics S5660 174

Pennsylvania Life
Insurance

1-800-978-9500
rxpathway.com

Prescriba Rx Gold
(formerly Prescription Pathways)
Enhanced   $42.70 $0 No Gap Coverage S5597 036
Prescriba Rx Bronze Basic   $44.70 $295 No Gap Coverage S5597 238
Prescriba Rx Platinum Enhanced   $74.90 $0 All Generics S5597 201

RxAmerica

1-800-429-6686
meds4medicare.com

Advantage Freedom Plan by RxAmerica Enhanced   $28.60 $0 No Gap Coverage S5644 049
Advantage Star Plan by RxAmerica Basic YES $30.50 $295 No Gap Coverage S5644 005
Sierra Health & Life
1-866-789-0565
sierrarx.com
SierraRx Basic Basic   $72.70 $295 No Gap Coverage S5917 009

SilverScript Insur.

1-866-552-6106
silverscript.com

SilverScript Value Basic YES $29.40 $295 No Gap Coverage S5601 008
SilverScript Plus Enhanced   $50.10 $50 Many Generics S5601 009
SilverScript Complete Enhanced   $74.30 $0 Many Generics S5601 075
Sterling Life Insur.
1-888-909-1713
sterlingplans.com
Sterling Rx Basic   $38.70 $295 No Gap Coverage S4802 001

UniCare

1-866-892-5335
medicarerxrewards.com

MedicareRx Rewards Standard Basic   $31.20 $295 No Gap Coverage S5960 110
MedicareRx Rewards Value Basic   $41.50 $130 No Gap Coverage S5960 004
United American Insurance Co.
1-866-299-3406
UA Medicare Part D Rx - Silver Plan Basic   $41.50 $160 No Gap Coverage S5755 042
UA Medicare Part D Prescription Drug Cov Enhanced   $45.90 $0 No Gap Coverage S5755 007

UnitedHealthcare
1-800-745-0922
aarpmedicarerx.com

1-888-867-5564

AARP MedicareRx Saver Basic YES $26.10 $295 No Gap Coverage S5921 286
AARP MedicareRx Preferred Basic   $36.90 $0 No Gap Coverage S5820 003
UnitedHealth Rx Basic Enhanced   $41.40 $0 No Gap Coverage S5921 288
AARP MedicareRx Enhanced Enhanced   $73.30 $0 Many Generics S5921 293

Universal American
(formerly Memberhealth)

1-866-684-5353
communityccrx.com

Community CCRx Basic Basic   $43.90 $295 No Gap Coverage S5803 073
Community CCRx Choice Enhanced   $56.40 $0 No Gap Coverage S5803 141
Community CCRx Gold Enhanced   $76.50 $0 All Generics S5803 221

WellCare

1-888-423-5252
wellcarepdp.com

WellCare Classic Basic   $33.60 $295 No Gap Coverage S5967 141
WellCare Signature Enhanced   $37.20 $0 No Gap Coverage S5967 038