CMS-P-0015A Showcards and Reference Cards

Showcards &
Reference Cards
Medicare Current Beneficiary Survey

Version Information
Component: Community
Language: English

MCBS Showcards Guide
Quex Sections
ACQ
CPQ

DIQ

DVH

ENS
HAQ

HFQ

Showcards
AC1
CP1
CP2
CP3
DI1
DI2
DI3
DI4
DI5
DI6
DVH1
DVH2
DVH3
DVH4
ENS1
HA1
HA2
HA3
HA4
HF1
HF2
HF3
HF4
HF5
HF6
HF7
HF8
HF9
HF10
HF11

Current Version
January 8, 2020
May 8, 2019
May 8, 2019
May 8, 2019
July 28, 2014
July 28, 2014
July 28, 2014
July 28, 2014
July 28, 2014
August 1, 2015
January 9, 2019
January 9, 2019
May 8, 2019
January 8, 2020
July 24, 2017
July 28, 2014
July 28, 2014
July 28, 2014
July 19, 2021
August 1, 2015
August 1, 2015
July 2024
July 2024
July 2024
July 2024
July 2024
July 2024
July 2024
July 2024
July 2024

MCBS Showcards Guide
Quex Sections

HHQ

HIQ

IAQ

Showcards
HF12
HF13
HF14
HF15
HH1
HH2
HH3
HH4
HH5
HI1
HI2 – State
HI3 – State
HI4 – State
HI6 – State
HI6
HIT1
HIT2
IA1
IA2
IA3
IA4
IA5
IA6
IA7
IA8
IA9
IA10
IA11
IA12
IA13

Current Version
July 2024
July 2024
July 2024
July 2024
May 6, 2020
July 28, 2014
July 28, 2014
July 28, 2014
May 6, 2020
February 17, 2015 & July 24, 2017

October 11, 2022
October 11, 2022
October 11, 2022
October 11, 2022
November 5, 2019
July 28, 2014
July 28, 2014
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015

MCBS Showcards Guide
Quex Sections

IUQ
KNQ

Showcards
IA14
IA15
IA16
IA17
IA18
IA19
IA20
IA21
IA22
IA23
IA24
IA25
IA26
IA27
IA28
IA29
IA30
IA31
IA32
IA33
IA34
IA35
IA36
IU1
KN1
KN2
KN3
KN4
KN5
KN6

Current Version
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
August 1, 2015
May 3, 2017
May 3, 2017
May 4, 2016
May 4, 2016
January 10, 2018
July 28, 2014
July 28, 2014
January 13, 2016
January 11, 2017
January 11, 2017
January 11, 2017

MCBS Showcards Guide
Quex Sections

MPQ

NAQ
OMQ

PMQ
PVQ

RXQ

SCQ

USQ

Showcards
KN7
KN8
KN9
KN10
MP1
MP2
MP3
MP4
MP5
MP6
NA1
OM1
OM2
OM3
OM4
OM5
PM1
PV1
PV2
PV3
RX1
RX2
RX3
RX4
RX5
SC1
SC2
SC3
SC4
US1

Current Version
January 11, 2017
January 9, 2023
January 11, 2017
January 8, 2020
January 9, 2019
July 28, 2014
July 28, 2014
July 28, 2014
July 28, 2014
July 24, 2017
August 3, 2016
July 28, 2014
July 28, 2014
July 28, 2014
July 28, 2014
July 28, 2014
July 24, 2017
July 20, 2020
July 20, 2020
July 20, 2020
July 28, 2014
July 28, 2014
July 28, 2014
July 28, 2014
May 2, 2018
July 28, 2014
July 22, 2019
July 22, 2019
July 22, 2019
January 8, 2020

MCBS Showcards Guide
Quex Sections

Showcards
US2
US3
US4
US5
US6
US7
US8

Current Version
January 10, 2018
January 11, 2021
January 10, 2018
January 10, 2018
January 10, 2018
January 10, 2018
January 8, 2020

Introduction
This guide contains a comprehensive, up-to-date list of MCBS Showcards and
Reference Cards. Over time, we may make changes to your Showcards and
Reference Cards by updating the content, adding new cards, or eliminating existing
cards.
You can use this guide to ensure that you are using the most up-to-date set of cards.
To check if you are using the most recent versions, look at the date of the “Current
Version” in the table on the following pages and compare it with the date on the
bottom of your Showcards and Reference cards. If you’re missing updated versions
of Showcards or Reference cards, notify your Field Manager, who will arrange to
have them sent to you.
The Showcards are arranged in alphabetical order according to questionnaire
section name. However, some Field Interviewers prefer to arrange the Showcard
sections by the order in which the sections will appear during the interview.

AC1
• Allergy/immunology
• Anesthesiology
• Audiologist
• Cardiology (heart)
• Chiropractor
• Dentist
• Dermatology (skin)
• Endocrinology/metabolism (diabetes, thyroid)
• Family practice
• Gastroenterology
• General practice
• General surgery
• Geriatrics (elderly)
• Gynecology – obstetrics
• Hematology (blood)
• Hospital residence

(continued)
Updated January 8, 2020

AC1
• Internal medicine (internist)
• Nephrology (kidneys)
• Neurology
• Nuclear medicine
• Nurse practitioner
• Oncology (tumors, cancer)
• Ophthalmology (eyes)
• Optometrist
• Orthopedics
• Osteopathy (DO)
• Otorhinolaryngology (ear, nose, throat)
• Pain Management Specialist
• Pathology
• Phys med/rehab
• Physical Therapist
• Physician’s Assistant

(continued)
Updated January 8, 2020

AC1
• Plastic surgery
• Podiatrist
• Proctology
• Psychiatry/psychiatrist
• Psychologist
• Pulmonary (lungs)
• Radiology
• Rheumatology (arthritis)
• Thoracic surgery (chest)
• Urology
• Vascular Surgeon/Specialist

Updated January 8, 2020

CP1
● Never
● Some days
● Most days
● Every day

Updated May 8, 2019

CP2
● A little
● A lot
● Somewhere in between a little

and a lot

Updated May 8, 2019

CP3
● Not at all
● A little
● A lot
● Somewhere in between a little

and a lot

Updated May 8, 2019

DI1
• Mexican, Mexican American, Chicano(a)
• Puerto Rican
• Cuban

Updated July 28, 2014

DI2
• American Indian or Alaska Native
• Asian
• Black or African American
• Native Hawaiian or other Pacific Islander
• White

Updated July 28, 2014

DI3
• Asian Indian
• Chinese
• Filipino
• Japanese
• Korean
• Vietnamese

Updated July 28, 2014

DI4
• Native Hawaiian
• Guamanian or Chamorro
• Samoan

Updated July 28, 2014

DI5
• No schooling completed
• Nursery school to 8th grade
• 9th-12th grade, no diploma
• High school graduate (high school
diploma or the equivalent)
• Vocational/technical/business/trade
school certificate or diploma (beyond the
high school level)
• Some college, but no degree
• Associate degree
• Bachelor's degree
• Master's, professional, or doctorate
degree

Updated July 28, 2014

DI6
Annual Income

Monthly Breakdown

A. Less than $5,000

A. Less than $417

B. $5,000 – less than $10,000

B. $417 – less than $834

C. $10,000 – less than $15,000

C. $834 – less than $1,250

D. $15,000 – less than $20,000

D. $1,250 – less than $1,667

E. $20,000 – less than $25,000

E. $1,667 – less than $2,084

F. $25,000 – less than $30,000

F. $2,084 – less than $2,500

G. $30,000 – less than $40,000

G. $2,500 – less than $3,334

H. $40,000 – less than $50,000

H. $3,334 – less than $4,167

I.

$50,000 – less than $66,000

I.

$4,167 – less than $5,500

J.

$66,000 – less than $109,000

J.

$5,500 – less than $9,084

K. $109,000 or more

K. $9,084 or more
Updated August 1, 2015

DVH1
● General exam, checkup or consultation
● Cleaning, prophylaxis, or polishing
● X-rays, radiographs, or bitewings
● Fluoride treatment
● Sealant (plastic coatings on back teeth)
● Fillings
● Inlays
● Crowns or caps
● Root canal
● Periodontal scaling, root planing, or gum
surgery
● Periodontal recall visit (periodic or
regular)
(Continued)
Updated January 9, 2019

DVH1
● Extraction, tooth pulled
● Implants
● Abscess or infection treatment
● Other oral surgery
● Fixed bridges
● Dentures or removable partial dentures
● Relining or repair of bridges or dentures
● Orthodontia, braces, or retainers
● Bond, whiten, or bleach
● Treatment for TMD or TMJ

Updated January 9, 2019

DVH2
● Eye Or Vision Exam
● Contact Lens Fitting
● Contact Lens Purchase
● Eye Glass Frame Fitting Or Adjustment
● Eye Glass Purchase
● Refractive Surgery (Corrective Vision
Surgery)
● Cataract Surgery
● Glaucoma Surgery
● Corneal Surgery
● Vitreo-Retinal Surgery
● Oculoplastic Surgery
● Eye Muscle Surgery
● Eye Removal
Updated January 9, 2019

DVH3
● Hearing Aid Fitting/Evaluation
● Hearing Aid Purchase/Repair
● Hearing Exam
● Ear Wax Removal
● Ear Ventilation Tubes
● Tympanoplasty (Reconstruction of ear
drum)
● Cochlear Implant Surgery
● Hearing Rehabilitative Services

Updated May 8, 2019

DVH4
In the Canal (ITC)

In the Ear (ITE)

Behind the Ear
(BTE)

Updated January 8, 2020

ENS1
• Iraq or Afghanistan Conflict (2001 –
Present)
• Persian Gulf War (Aug 1990 – March
1991)
• Vietnam Era (Aug 1964 – May 1975)
• Korean Conflict (June 1950 – Jan 1955)
• World War II (Sept 1940 – July 1947)
• Peace time (all other times)

Updated July 24, 2017

HA1
• One-family, detached
• Two-family or duplex
• Apartment or condominium building
• Mobile home, trailer
• Rowhouse, townhouse
• “mother-in-law” apartment

Updated July 28, 2014

HA2
• Retirement community
• Senior citizens housing
• Assisted living facility
• Continuing care community
• Staged living community
• Retirement apartments
• Church-provided housing
• Personal or residential care home

Updated July 28, 2014

HA3
• Prepared meals
• Housekeeping, maid, or cleaning services
• Laundry services
• Help with medications
• Transportation
• Recreational services

Updated July 28, 2014

HA4
• Have a steady place to live
• Have a place to live today, but worried
about losing it in the future
• Do not have a steady place to live

Updated July 19, 2021

HF1
• Much better now than one year ago
• Somewhat better now than one year ago
• About the same
• Somewhat worse now than one year ago
• Much worse now than one year ago

Updated August 1, 2015

HF2
• It will get much better
• It will get somewhat better
• It will not change
• It will get somewhat worse
• It will get much worse

Updated August 1, 2015

HF3
• Never
• Rarely
• Sometimes
• Often
• Always

Updated July 2024

HF4
• Never
• Hardly ever
• Occasionally
• Fairly often
• Very often

Updated July 2024

HF5
• No difficulty at all
• A little difficulty
• Some difficulty
• A lot of difficulty
• Not able to do it

Updated July 2024

HF6
• Bladder
• Blood
• Bone
• Brain
• Breast
• Cervix
• Colon (bowel)
• Esophagus
• Gall Bladder
• Kidney
• Larynx (windpipe)
• Leukocytes (Leukemia)
• Liver
(continued)
Updated July 2024

HF6
• Lung
• Lymph Nodes (Lymphoma)
• Mouth/Tongue/Lip
• Ovary
• Pancreas
• Prostate
• Rectum
• Soft Tissue/Fat
• Stomach
• Testis
• Throat
• Thyroid
• Uterus

Updated July 2024

HF6
• Type 1
• Type 2
• Borderline
• Pre-Diabetes
• Gestational (Pregnancy-related)

Updated July 2024

HF7
• Type 1
• Type 2
• Borderline
• Pre-Diabetes
• Gestational (Pregnancy-Related)
• Some Other Type

Updated July 2024

HF8
• All of the time
• Most of the time
• Some of the time
• A little of the time
• None of the time

Updated July 2024

HF9
• Just about everything you need to know
• Most of what you need to know
• Some of what you need to know
• A little of what you need to know
• Almost none of what you need to know
about managing Diabetes

Updated July 2024

HF10
• Yes
• No

Updated July 2024

HF11
• Calcium (with or without vitamin D)
• Choline
• Coenzyme Q (such as CoQ10)
• Eye health supplement (such as Ocuvite
PreserVision or I-Caps)
• Fiber supplement (such as Metamucil or
Benefiber)
• Folate or folic acid
• Garlic supplement
• Iron

(continued)

Updated July 2024

HF11
• Joint supplement (such as glucosamine,
with or without chondroitin or other
ingredients)
• Magnesium
• Melatonin
• Niacin
• Omega-3 (ALA/DHA/EPA) or fish oil
• Potassium
• Probiotics (in pill, powder, or liquid form)
• Saw palmetto
• Vitamin A
• Vitamin B-12
(continued)

Updated July 2024

HF11
• Vitamin B-complex
• Vitamin C
• Vitamin D (NOT as part of a calcium
supplement)
• Vitamin E
• Zinc
• Other Supplement(s)

Updated July 2024

HF12
HF9
HF8
• Not at all
• Several days
• More than half the days
• Nearly every day

Updated July 2024

HF13
HF10
HF9
HF8
• Not at all difficult
• Somewhat difficult
• Very difficult
• Extremely difficult

Updated July 2024

HF14
• Never
• Rarely
• Sometimes
• Often
• Always

Updated July 2024

HF15
• More than once a week
• About once a week
• 2-3 times a month
• About once a month
• Every 2-3 months
• Once or twice a year
• Not at all

Updated July 2024

HH1
Home Help by Health or Medical
Professionals
• Nurse (visiting nurse, private duty nurse,
etc.)
• Doctor
• Social worker
• Therapist
• Hospice worker
• Home health aides
• Those who provide homemaker services

Updated May 6, 2020

HH2
Medical or Nursing Treatment
• Applying sterile bandages or dressings
• Giving medications
• Taking blood pressure
• Giving shots or injections

Updated July 28, 2014

HH3
Help With Daily Needs
• Using the telephone
• Doing housework
• Preparing meals

Updated July 28, 2014

HH4
• Bathing
• Showering
• Dressing
• Eating
• Walking
• Using the toilet

Updated July 28, 2014

HH5
Personal Care or Help with Daily Needs
from Persons Who Do Not Live with You
• Friends
• Neighbors
• Relatives

Updated May 6, 2020

HI1
Health Insurance Coverage Options
 “Original” Medicare
 “Medicare Advantage” (MA) plan
o with Prescription Drug Plan (MA-PD) or
without
 Medicaid
 TRICARE/TRICARE for Life
 Public Programs (other than Medicaid)
 Medicare Part D Prescription Drug Plan (PDP)
 Private/Supplemental Insurance Plan
o Purchased directly from an insurance
company, or
o Obtained through an employer, union, or
other group, such as AARP

(continued)
Updated February 17, 2015

HI1
ORIGINAL MEDICARE

MEDICARE ADVANTAGE

 You have your choice of doctors and hospitals.
 Generally, you or your supplemental coverage pay
deductibles and coinsurance.
 If you want drug coverage, you must join a standalone Medicare prescription drug plan –a
separate policy just for drugs.
 You can buy a Medigap plan, which can help pay
expenses not covered by Medicare.

 May either require you to see medical providers in
their network or let you choose and pay more of
the costs.
 You usually pay a copay or coinsurance for
covered services.
 If you want drug coverage, you must join a plan that
includes drug coverage. This will give you all of
your coverage in one plan.
 A Medigap plan is not available.

MEDICAID

TRICARE/TRICARE FOR LIFE

 Public health care plan that helps make Medicare
affordable for beneficiaries with low incomes and
modest assets.
 Medicare beneficiaries who are also enrolled in
Medicaid are referred to as “dual eligibles.”
 Will be automatically enrolled in a Medicare
prescription drug plan and be eligible for a lowincome subsidy or “extra help.”

 Covers active-duty service members, retirees, and
their families.
 TRICARE generally pays the fees left outstanding
after Medicare has made their payment.

Updated July 24, 2017

(continued)

HI1
PRIVATE HEALTH INSURANCE

MEDICARE PART D PRESCRIPTION DRUG PLAN

 Includes supplemental or Medigap plans, plans that
are provided by a former or current employer, and
 Separate policies that cover only prescribed
other plans purchased directly through a private
medicines.
company, union, association, or other group.
 Beneficiaries pay a monthly premium and copay or
 Cover the cost of hospital or doctor visits, prescribed
coinsurance for their required prescriptions.
medicines, or dental care.
 Standalone plans are only available to beneficiaries
 Common type: Medicare Supplement Insurance
who are covered by Original Medicare; otherwise
(Medigap), which is available to recipients of
drug coverage is available as part of Medicare
Original Medicare and helps pay some of the health
Advantage plans.
care costs that Original Medicare doesn't cover, like
copayments, coinsurance and deductibles.
PUBLIC PROGRAMS (OTHER THAN MEDICAID)
 Include state, county, or city-based programs such as a pharmacy program, where the local government
provides at least partial coverage for the cost of prescribed medicines.
 Insurance comes from a public source other than Medicare or Medicaid.

Updated July 24, 2017

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Alaska (AK)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1 Lasso Healthcare Growth (Lasso Healthcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Alaska (AK)
1

Medicaid

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Alaska (AK)
1

AIDS Drug Assistance Program

2

Alaska Rx Card

3 Chronic & Acute Medical Assistance

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Alabama (AL)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Ascension Complete (Ascension Complete)

3

Blue Advantage (Blue Cross and Blue Shield of
Alabama)

4

Cigna (Cigna)

5

Cigna True Choice (Cigna)

6

Clover Health LiveHealthy (Clover Health)

7

Devoted (Devoted Health)

8

Devoted CHOICE Alabama (Devoted Health)

9

Humana Gold Plus (Humana)

10

Humana Honor (Humana)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Alabama (AL)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
11 HumanaChoice (Humana)
12 Lasso Healthcare Growth (Lasso Healthcare)
13 AARP Medicare Advantage (UnitedHealthcare)
14 AARP Medicare Advantage Choice
(UnitedHealthcare)
15 AARP Medicare Advantage Plan (UnitedHealthcare)
16 VIVA Medicare (VIVA Medicare)
17 Wellcare (Wellcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Alabama (AL)
1

Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Alabama (AL)
1 Alabama Coordinated Health Networks
2 Alabama Select Network
3 Mercy Life of Alabama

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Alabama (AL)
1 Alabama AIDS Drug Assistance Program (Ryan
White Program)
2 Alabama Rx Card
3 Senior Rx

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Arkansas (AR)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Aetna Medicare Premier (Aetna Medicare)

3

BlueMedicare (Arkansas Blue Medicare)

4

Cigna Preferred Medicare (Cigna)

5

Cigna True Choice Medicare (Cigna)

6

Essence Advantage (Essence Healthcare)

7

Health Advantage Blue (Health Advantage)

8

Humana Gold Choice (Humana)

9

Humana Gold Plus (Humana)

10

Humana Honor (Humana)

11

HumanaChoice (Humana)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Arkansas (AR)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
12 Lasso Healthcare Growth (Lasso Healthcare)
13 AARP Medicare Advantage (UnitedHealthcare)
14 AARP Medicare Advantage Choice
(UnitedHealthcare)
15 UnitedHealthcare Medicare Advantage Choice Plan
(UnitedHealthcare)
16 Vantage (Vantage Health Plan)
17 Wellcare (Wellcare)
18 Wellcare No Premium Open (Wellcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Arkansas (AR)
1

Arkansas Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Arkansas (AR)
1

Area Agency on Aging of Southeast Arkansas

2

Arkansas Total Care

3

Central Arkansas Development Council

4

Complete Health

5

Delta Dental of Arkansas

6

Empower Healthcare Solutions

7

Managed Care of North America (MCNA) Dental

8

Multiple Primary Care Providers

9

Pace of the Ozarks

10 Southeasttrans
11 Summit Community Care
12 Total Life Healthcare

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Arkansas (AR)
1 Arkansas AIDS Drug Assistance Program (ADAP)
(Ryan White Program)
2 Arkansas Health Care Access Foundation (AHCAF)

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Arizona (AZ)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Alignment Health AVA (Alignment Health Plan)

3

Alignment Health the ONE (Alignment Health
Plan)

4

Amerivantage (Amerigroup)

5

Amerivantage Classic (Amerigroup)

6

Amerivantage Choice (Amerigroup Insurance
Company)

7

Banner Medicare Advantage Plus (Banner
Medicare Advantage Plus)

8

Banner Medicare Advantage Prime (Banner
Medicare Advantage Prime)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Arizona (AZ)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
9

BlueJourney (Blue Cross Blue Shield of Arizona)

10

BluePathway Plan (Blue Cross Blue Shield of
Arizona)

11

Blue Medicare Advantage (Blue Cross Blue
Shield of Arizona Advantage)

12

Cigna (Cigna)

13

Cigna True Choice (Cigna)

14

Devoted (Devoted Health)

15

Devoted CHOICE Arizona (Devoted Health)

16

Honest Care (Gold Kidney of Arizona)

17

Humana (Humana)
(continued)

Created on 10/11/2022

3

HI2
MEDICARE ADVANTAGE PLANS
Arizona (AZ)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
18

Humana Gold Plus (Humana)

19

HumanaChoice (Humana)

20

Imperial (Imperial Insurance Companies, Inc)

21

Lasso Healthcare Growth (Lasso Healthcare)

22

Molina Medicare Choice Care (Molina Healthcare
of Arizona)

23

SCAN (SCAN Desert Health Plan)

24

AARP Medicare Advantage (UnitedHealthcare)

25

AARP Medicare Advantage Plan
(UnitedHealthcare)
(continued)

Created on 10/11/2022

4

HI2
MEDICARE ADVANTAGE PLANS
Arizona (AZ)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
26

Wellcare (Wellcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Arizona (AZ)
1 Arizona Health Care Cost Containment System
(AHCCS)

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Arizona (AZ)
1

Arizona Complete Health- Complete Care Plan
RBHA (SMI)

2

Arizona Complete Health-Complete Care Plan

3

Banner University Family Care

4

Banner University Family Care (MLTSS)

5

Care 1st

6

DCS/CMDP

7

DES/Division of Developmental Disabilities
(MLTSS)

8

Health Choice Arizona

9

Health Choice Arizona RBHA (SMI)

10

Magellan Complete Care

11

Mercy Care
(continued)

Created on 10/11/2022

2

HI4
MEDICAID HMOs
Arizona (AZ)
12

Mercy Care (MLTSS)

13

Mercy Care RBHA (SMI)

14

United Healthcare

15

United Healthcare (MLTSS)

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Arizona (AZ)
1 Arizona AIDS Drug Assistance Program (ADAP)
2 Arizona Rx Card

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
California (CA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Alignment Health (Alignment Health Plan)

3

Anthem MediBlue (Anthem Blue Cross)

4

Anthem MediBlue Access (Anthem Blue Cross
Life and Health Insurance Co.)

5

Anthem MediBlue Prime (Anthem Blue Cross
Partnership Plan)

6

Aspire Health (Aspire Health)

7

Astiva Health (Astiva Health)

8

Blue Shield (Blue Shield of California)

9

Blue Shield AdvantageOptimum Plan (Blue
Shield of California)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
California (CA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
10

Blue Shield Select (Blue Shield of California)

11

Brand New Day (Brand New Day)

12

CCHP Senior (CCHP (Chinese Community
Health Plan))

13

Central Health (Central Health Medicare Plan)

14

Clever Care (Clever Care Health Plan)

15

Essence Advantage (Essence Healthcare)

16

Humana (Humana)

17

Humana Community (Humana)

18

Humana USAA Honor with (Humana)
(continued)

Created on 10/11/2022

3

HI2
MEDICARE ADVANTAGE PLANS
California (CA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
19

HumanaChoice (Humana)

20

UC San Diego Health Humana (Humana)

21

Ibt Voluntary Employee Benefits Trust (Employer
Pdp)

22

Imperial (Imperial Health Plan of California, Inc.)

23

IIHCP (Integrated HealthPlan)

24

Kaiser Permanente (Kaiser Permanente)

25

Molina Medicare Choice Care (Molina Healthcare
of California)

26

Providence Medicare Sycamore + (Providence
Medicare Advantage Plans)

27

SCAN (SCAN Health Plan)
(continued)

Created on 10/11/2022

4

HI2
MEDICARE ADVANTAGE PLANS
California (CA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
28

Scripps (SCAN Health Plan)

29

Sharp Direct Advantage (Sharp Health Plan)

30

AARP Medicare Advantage (UnitedHealthcare)

31

AARP Medicare Advantage Choice
(UnitedHealthcare)

32

Sharp (UnitedHealthcare)

33

UnitedHealthcare (UnitedHealthcare)

34

Wellcare (Wellcare by Health Net)

35

Wellcare No Premium Open (Wellcare by Health
Net)
(continued)

Created on 10/11/2022

5

HI2
MEDICARE ADVANTAGE PLANS
California (CA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
36 Western Health Advantage MyCare (Western Health
Advantage)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
California (CA)
1

Medi-Cal

Created on 10/11/2022

1

HI4
MEDICAID HMOs
California (CA)
1

Access Dental Plan/Los Angeles

2

Access Dental Plan/Sacramento

3

Aetna Better Health of CA/Sacramento

4

Aetna Better Health of CA/San Diego

5

Alameda Alliance for Health

6

AltaMed Senior Buenacare/Los Angeles

7

Anthem Blue Cross Partnership Plan/Alameda

8

Anthem Blue Cross Partnership Plan/Contra
Costa

9

Anthem Blue Cross Partnership Plan/Fresno

10

Anthem Blue Cross Partnership Plan/Kings

11

Anthem Blue Cross Partnership Plan/Madera
(continued)

Created on 10/11/2022

2

HI4
MEDICAID HMOs
California (CA)
12

Anthem Blue Cross Partnership Plan/Region 1

13

Anthem Blue Cross Partnership Plan/Region 2

14

Anthem Blue Cross Partnership Plan/Sacramento

15

Anthem Blue Cross Partnership Plan/San Benito

16

Anthem Blue Cross Partnership Plan/San
Francisco

17

Anthem Blue Cross Partnership Plan/Santa Clara

18

Anthem Blue Cross Partnership Plan/Tulare

19

Bakersfield PACE

20

Blue Shield of California Promise/San Diego
(continued)

Created on 10/11/2022

3

HI4
MEDICAID HMOs
California (CA)
21

Brandman Centers for Senior Care/Los Angeles

22

CalOptima PACE/Orange

23

CalOptima/Orange

24

CalViva Health/Fresno

25

CalViva Health/Kings

26

CalViva Health/Madera

27

California Health & Wellness Plan/Imperial

28

California Health & Wellness Plan/Region 1

29

California Health & Wellness Plan/Region 2

30

CenCal Health/San Luis Obispo

31

CenCal Health/Santa Barbara
(continued)

Created on 10/11/2022

4

HI4
MEDICAID HMOs
California (CA)
32

Center for Elders Independence/Alameda

33

Center for Elders Independence/Contra Costa

34

Central California Alliance for Health/Merced

35

Central California Alliance for Health/Monterey
Santa Cruz

36

Central Valley PACE

37

Coastline PACE

38

Community Health Group Partnership Plan/San
Diego

39

Contra Costa Health Plan

40

Family Health Centers of San Diego

41

Family Mosaic Project/San Francisco

42

Fresno PACE
(continued)

Created on 10/11/2022

5

HI4
MEDICAID HMOs
California (CA)
43

Gary and Mary West PACE of Northern San
Diego

44

Gold Coast Health Plan/Ventura

45

Health Net Dental Plan/Los Angeles

46

Health Net Dental Plan/Sacramento

47

Health Net/Kern

48

Health Net/Los Angeles

49

Health Net/Sacramento

50

Health Net/San Diego

51

Health Net/San Joaquin

52

Health Net/Stanislaus

53

Health Net/Tulare

54

Health Plan of San Joaquin/San Joaquin
(continued)

Created on 10/11/2022

6

HI4
MEDICAID HMOs
California (CA)
55

Health Plan of San Joaquin/Stanislaus

56

Health Plan of San Mateo

57

Inland Empire Health Plan/Riverside

58

Inland Empire Health Plan/San Bernardino

59

InnovAge California PACE- El Dorado

60

InnovAge California PACE- Placer

61

InnovAge California PACE- Sacramento

62

InnovAge California PACE- San Joaquin

63

InnovAge California PACE- Sutter

64

InnovAge California PACE- Yuba

65

InnovAge PACE/Riverside

66

InnovAge PACE/San Bernardino County

67

KP Cal LLC/Amador
(continued)

Created on 10/11/2022

7

HI4
MEDICAID HMOs
California (CA)
68

KP Cal LLC/El Dorado

69

KP Cal LLC/Placer

70

KP Cal LLC/Sacramento

71

KP Cal LLC/San Diego

72

Kern Family Health Care

73

L.A. Care Health Plan/Los Angeles

74

LIBERTY Dental Plan/Los Angeles

75

LIBERTY Dental Plan/Sacramento

76

Molina Healthcare of CA Partner Plan/Imperial

77

Molina Healthcare of CA Partner Plan/Riverside

78

Molina Healthcare of CA Partner
Plan/Sacramento
(continued)

Created on 10/11/2022

8

HI4
MEDICAID HMOs
California (CA)
79

Molina Healthcare of CA Partner Plan/San
Bernardino

80

Molina Healthcare of CA Partner Plan/San Diego

81

On Lok Lifeways/Alameda

82

On Lok Lifeways/San Francisco

83

On Lok Lifeways/Santa Clara

84

Pacific PACE/Los Angeles

85

Partnership Health Plan/Southeast

86

Partnership Health Plan/Southwest

87

Partnership HealthPlan of CA/Northeast

88

Partnership HealthPlan of CA/Northwest

89

Positive Healthcare/Los Angeles
(continued)

Created on 10/11/2022

9

HI4
MEDICAID HMOs
California (CA)
90

Rady Children's Hospital San Diego (RCHSD)

91

Redwood Coast Pace/Humboldt

92

SCAN Health Plan Riverside/San Bernardino

93

SCAN Health Plan/Los Angeles

94

San Diego PACE

95

San Francisco Health Plan

96

Santa Clara Family Health Plan

97

Sequoia PACE

98

St. Paul's PACE/San Diego

99

Stockton PACE/San Joaquin

100

Stockton PACE/Stanislaus

101

Sutter SeniorCare PACE/Sacramento
(continued)

Created on 10/11/2022

10

HI4
MEDICAID HMOs
California (CA)
102 UnitedHealthcare Community Plan/San Diego

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
California (CA)
1

AIDS Drug Assistance Program

2

Operation Access (OA)

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Colorado (CO)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Aetna Medicare Premier (Aetna Medicare)

3

Anthem MediBlue Access (Anthem Blue Cross
and Blue Shield)

4

Anthem MediBlue Plus (Anthem Blue Cross and
Blue Shield)

5

Cigna Preferred (Cigna)

6

Cigna True Choice Savings Medicare (Cigna)

7

Clear Spring Health Essential (Clear Spring
Health)

8

Devoted (Devoted Health)

9

Devoted CHOICE Colorado (Devoted Health)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Colorado (CO)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
10

Elevate Medicare Select (Elevate Medicare
Advantage)

11

Humana (Humana)

12

Humana Gold Choice (Humana)

13

Humana Gold Plus (Humana)

14

HumanaChoice (Humana)

15

Kaiser Permanente Senior Advantage (Kaiser
Permanente)

16

Perennial Advantage Freedom (Perennial
Advantage)

17

Rocky Mountain Health Plans CareAdvantage
(Rocky Mountain Health Plans)
(continued)

Created on 10/11/2022

3

HI2
MEDICARE ADVANTAGE PLANS
Colorado (CO)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
18 AARP Medicare Advantage (UnitedHealthcare)
19 AARP Medicare Advantage Plan (UnitedHealthcare)
20 Erickson Advantage (UnitedHealthcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Colorado (CO)
1

Health First Colorado

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Colorado (CO)
1

Accountable Care Collaborative: Rocky Mountain
Health Plans Prime

2

Denver Health Medicaid Choice (DHMC)

3

InnovAge - Aurora (PACE)

4

InnovAge - Lakewood (PACE)

5

InnovAge - Loveland (PACE)

6

InnovAge - Pueblo (PACE)

7

InnovAge - Thornton (PACE)

8

RAE 1: Rocky Mountain Health Plans

9

RAE 2: Northeast Health Partners

10

RAE 3: Colorado Access

11

RAE 4: Health Colorado, Inc.

12

RAE 5: Colorado Access
(continued)

Created on 10/11/2022

2

HI4
MEDICAID HMOs
Colorado (CO)
13 RAE 6: Colorado Community Health Alliance
14 RAE 7: Colorado Community Health Alliance
15 Rocky Mountain Health Care Services (PACE)
16 TRU Community Care (PACE)
17 Total Longterm Care
18 VOANS (PACE)

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Colorado (CO)
1 Public Health Intervention Program (PHIP)
2 Ryan White State Drug Assistance Program

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Connecticut (CT)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Anthem MediBlue (Anthem Blue Cross and Blue
Shield)

3

Anthem MediBlue Access Select (Anthem Blue
Cross and Blue Shield)

4

CarePartners Access (CarePartners of
Connecticut)

5

CarePartners of CT CareAdvantage
(CarePartners of Connecticut)

6

Cigna Preferred Medicare (Cigna)

7

Cigna True Choice (Cigna)

8

ConnectiCare (ConnectiCare)

9

Humana Honor (Humana)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Connecticut (CT)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
10 HumanaChoice (Humana)
11 Trinity Health Plan Of New England (Trinity Health
Plan Of New England)
12 Trinity Health Plan Of New England Choice (Trinity
Health Plan Of New England)
13 AARP Medicare Advantage Choice
(UnitedHealthcare)
14 UnitedHealthcare Medicare Advantage
(UnitedHealthcare)
15 Wellcare (Wellcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Connecticut (CT)
1

Connecticut Medicaid

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Connecticut (CT)
1 AmeriCares Free Clinics
2 Connecticut AIDS Drug Assistance Program
3 State-Administered General Assistance (SAGA)
Medical Program

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
District of Columbia (DC)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1 Aetna Medicare Premier Plan (Aetna Medicare)
2 Aetna Medicare Standard Plan (Aetna Medicare)
3 Cigna Preferred Medicare (Cigna)
4 Cigna True Choice Medicare (Cigna)
5 Kaiser Permanente Medicare Advantage (Kaiser
Permanente)
6 Lasso Healthcare Growth (Lasso Healthcare)
7 AARP Medicare Advantage (UnitedHealthcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
District of Columbia (DC)
1

DC Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
District of Columbia (DC)
1 AmeriHealth Caritas District of Columbia
2 Amerigroup District of Columbia
3 CareFirst Community Health Plan District of
Columbia
4 Health Services for Children with Special Needs
5 MedStar Family Choice
6 Medical Transportation Management, Inc.

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
District of Columbia (DC)
1 AIDS Drug Assistance Program (ADAP)

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Delaware (DE)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Aetna Medicare Advantra (Aetna Medicare)

3

Cigna Preferred Medicare (Cigna)

4

Cigna True Choice Medicare (Cigna)

5

Freedom Blue PPO (Highmark Inc.)

6

Humana Gold Plus (Humana)

7

Humana Honor (Humana)

8

HumanaChoice (Humana)

9

Lasso Healthcare Growth (Lasso Healthcare)

10

AARP Medicare Advantage (UnitedHealthcare)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Delaware (DE)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
11 AARP Medicare Advantage Choice Plan
(UnitedHealthcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Delaware (DE)
1

Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Delaware (DE)
1 AmeriHealth Caritas of Delaware
2 Highmark Health Options of Delaware
3 LogistiCare Non-Emergency Medical Transportation
4 Saint Francis Life

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Delaware (DE)
1 Delaware AIDS Drug Assistance Program
2 Delaware Prescription Assistance Program

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Florida (FL)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

AvMed Medicare (AvMed Medicare)

3

BayCarePlus (BayCare Health Plans)

4

Capital Health Plan (Capital Health Plan)

5

CareFree (CarePlus Health Plans, Inc.)

6

CareOne (CarePlus Health Plans, Inc.)

7

CareSalute (CarePlus Health Plans, Inc.)

8

Cigna (Cigna)

9

Devoted (Devoted Health)

10

DrMax (Doctors HealthCare Plans, Inc.)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Florida (FL)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
11

DrMax-B (Doctors HealthCare Plans, Inc.)

12

DrValue (Doctors HealthCare Plans, Inc.)

13

DrValue-B (Doctors HealthCare Plans, Inc.)

14

BlueMedicare (Florida Blue)

15

BlueMedicare Choice (Florida Blue)

16

FHCP Medicare (Florida Blue HMO)

17

Freedom (Freedom Health, Inc.)

18

Health First Secure Plan (Health First Health
Plans, Inc.)

19

HealthSun (HealthSun Health Plans, Inc.)

20

Humana (Humana)
(continued)

Created on 10/11/2022

3

HI2
MEDICARE ADVANTAGE PLANS
Florida (FL)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
21

Humana Honor (Humana)

22

HumanaChoice (Humana)

23

HumanaChoice Florida (Humana)

24

Leon (Leon Health Plans)

25

Optimum (Optimum HealthCare, Inc.)

26

Psers Health Options Program (Employer Pdp)
(Psers Hop Program)

27

Simply (Simply Healthcare Plans, Inc.)

28

AARP Medicare Advantage (UnitedHealthcare)

29

AARP Medicare Advantage Choice
(UnitedHealthcare)
(continued)

Created on 10/11/2022

4

HI2
MEDICARE ADVANTAGE PLANS
Florida (FL)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
30 MedicareMax (UnitedHealthcare)
31 Preferred Choice (UnitedHealthcare)
32 UnitedHealthcare The Villages Medicare
(UnitedHealthcare)
33 Wellcare (Wellcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Florida (FL)
1

Florida Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Florida (FL)
1

Aetna Better Health

2

Children's Medical Services Network

3

Clear Health Alliance

4

Community Care Plan

5

DentaQuest

6

Florida Community Care

7

Florida Pace Center

8

Hope Select Care

9

Humana Medical Plan

10

Liberty

11

Lighthouse Health Plan, LLC

12

MCNA Dental

13

Magellan Complete Care, LLC
(continued)

Created on 10/11/2022

2

HI4
MEDICAID HMOs
Florida (FL)
14

Miami Children's Health Plan

15

Molina Healthcare of Florida

16

Morselife Home Care, Inc.

17

NE PACE Partners

18

Prestige Health Choice

19

Simply Healthcare Plans, Inc.

20

Staywell

21

Staywell Health Plan of Florida

22

Staywell Serious Mental Illness

23

Suncoast Neighborly Care, Inc.

24

Sunshine State Health Plan - Child Welfare

25

Sunshine State Health Plan, Inc.
(continued)

Created on 10/11/2022

3

HI4
MEDICAID HMOs
Florida (FL)
26

United Healthcare of Florida

27

Vivida Health

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Florida (FL)
1 AIDS Drug Assistance Program (ADAP)
2 Florida Rx Card
3 Medically Needy Program

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Georgia (GA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Aetna Medicare Advantra Preferred Plan (Aetna
Medicare)

3

Aetna Medicare Premier Plan (Aetna Medicare)

4

Aetna Medicare Select Plan (Aetna Medicare)

5

Anthem MediBlue (Anthem Blue Cross and Blue
Shield)

6

BlueAdvantage Sapphire (BlueCross BlueShield
of Tennessee)

7

Cigna Preferred (Cigna)

8

Cigna Preferred Medicare (Cigna)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Georgia (GA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
9

Cigna True Choice (Cigna)

10

Clear Spring Health Choice Plan (Clear Spring
Health)

11

Clear Spring Health Select Plus (Clear Spring
Health)

12

Clover Health (Clover Health)

13

Essence Advantage (Essence Healthcare)

14

Essence Advantage Choice (Essence Healthcare)

15

Humana (Humana)

16

Humana Gold Choice (Humana)

17

Humana Gold Plus (Humana)
(continued)

Created on 10/11/2022

3

HI2
MEDICARE ADVANTAGE PLANS
Georgia (GA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
18

HumanaChoice (Humana)

19

Kaiser Permanente Senior Advantage (Kaiser
Permanente)

20

Lasso Healthcare Growth (Lasso Healthcare)

21

Sonder Complete Health Medicare Advantage
(Sonder Health Plan, Inc.)

22

AARP Medicare Advantage Choice Rebate
(UnitedHealthcare)

23

AARP Medicare Advantage Plus Plan
(UnitedHealthcare)

24

AARP Medicare Advantage Walgreens
(UnitedHealthcare)
(continued)

Created on 10/11/2022

4

HI2
MEDICARE ADVANTAGE PLANS
Georgia (GA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
25 UnitedHealthcare Medicare Advantage
(UnitedHealthcare)
26 UnitedHealthcare Medicare Advantage Choice Plan
(UnitedHealthcare)
27 UnitedHealthcare Medicare Advantage Walmart Flex
(UnitedHealthcare)
28 Wellcare (Wellcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Georgia (GA)
1

Georgia Medical Assistance

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Georgia (GA)
1

Amerigroup Community Care

2

CareSource Georgia

3

NEMT

4

Peach State Health Plan

5

WellCare of Georgia

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Georgia (GA)
1 Donated Drug Repository Program
2 Georgia AIDS Drug Assistance Program (ADAP)
3 Georgia Drug Card
4 Health Insurance Continuation Program (HICP)

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Hawaii (HI)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Devoted CHOICE (Devoted Health)

2

HMSA Akamai Advantage (HMSA Akamai
Advantage)

3

Humana (Humana)

4

Humana Gold Plus (Humana)

5

HumanaChoice (Humana)

6

Kaiser Permanente Senior Advantage (Kaiser
Permanente)

7

Lasso Healthcare Growth (Lasso Healthcare)

8

AARP Medicare Advantage (UnitedHealthcare)

9

Wellcare 'Ohana No Premium (Wellcare)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Hawaii (HI)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
10 Wellcare 'Ohana (Wellcare by ‘Ohana Health Plan)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Hawaii (HI)
1

Med Quest

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Hawaii (HI)
1 'Ohana Community Care Services (CCS)
2 'Ohana Quest Integration (QI)
3 AlohaCare Quest Integration (QI)
4 HMSA QUEST Integration (QI)
5 Kaiser Foundation Health Plan Quest Integration (QI)
6 UnitedHealthcare CP Quest Integration (QI)

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Hawaii (HI)
1 Hawaii HIV Drug Assistance Program (HDAP)
2 Hawai‘i Insurance Continuation Program (H-COBRA)
3 Hawai‘i Seropositivity & Medical Management
Program (HSPAMM)

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Iowa (IA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Health Alliance Medicare (Health Alliance
Medicare)

3

Health Alliance Medicare Guide HMO (Health
Alliance Medicare)

4

HealthPartners UnityPoint Health (HealthPartners
UnityPoint Health)

5

Humana (Humana)

6

Humana Gold Choice (Humana)

7

Humana Gold Plus (Humana)

8

HumanaChoice (Humana)

9

MediGold MercyOne Medicare Plan (MediGold)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Iowa (IA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
10

MediGold MercyOne Medicare Plan No Premium
Choice (MediGold)

11

Medica Advantage Solution (Medica)

12

Medica Advantage Solution with CHI Health
(Medica)

13

Medica Prime Solution (Medica)

14

Central Iowa Health Senior Plan (Medical
Associates Health Plan, Inc.)

15

Medical Associates (Medical Associates Health
Plan, Inc.)

16

Mercy (Medical Associates Health Plan, Inc.)

17

MercyOne (Medical Associates Health Plan, Inc.)
(continued)

Created on 10/11/2022

3

HI2
MEDICARE ADVANTAGE PLANS
Iowa (IA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
18 Quad Cities Community Health Senior Plan (Medical
Associates Health Plan, Inc.)
19 Gundersen Quartz Med Advantage (Quartz
Medicare Advantage)
20 Align (Sanford Health Plan)
21 AARP Medicare Advantage (UnitedHealthcare)
22 Blue Medicare Advantage (Wellmark Advantage
Health Plan)
23 Blue Medicare Advantage HMO (Wellmark
Advantage Health Plan)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Iowa (IA)
1

Iowa Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Iowa (IA)
1

Amerigroup of Iowa, Inc.

2

Delta Dental of Iowa

3

Iowa Total Care

4

MCNA Dental Plans, Inc.

5

PACE

6

TMS

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Iowa (IA)
1 AIDS/HIV Health Insurance Premium Payment
Program
2 Iowa Drug Card

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Idaho (ID)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Secure Blue Courage (Blue Cross of Idaho)

3

True Blue (Blue Cross of Idaho)

4

Humana (Humana)

5

Humana Gold Plus (Humana)

6

Humana Honor (Humana)

7

HumanaChoice (Humana)

8

Molina Medicare Choice Care (Molina Healthcare
of Utah & Idaho)

9

PacificSource Medicare Explorer (PacificSource
Medicare)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Idaho (ID)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
10 PacificSource Medicare MyCare (PacificSource
Medicare)
11 Regence (Regence BlueShield of Idaho)
12 Saint Alphonsus Health Plan (Saint Alphonsus
Health Plan)
13 Saint Alphonsus Health Plan No Premium Choice
(Saint Alphonsus Health Plan)
14 SelectHealth Medicare (SelectHealth)
15 SelectHealth Medicare Choice (SelectHealth)
16 AARP Medicare Advantage (UnitedHealthcare)
17 AARP Medicare Advantage Choice
(UnitedHealthcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Idaho (ID)
1

Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Idaho (ID)
1 Blue Cross of Idaho
2 Healthy Connections
3 MCNA (Managed Care of North America, Inc.)
4 MTM (Medical Transportation Management)
5 Molina of Idaho
6 United Healthcare/Optum Idaho

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Idaho (ID)
1 Idaho AIDS Drug Assistance Program
2 Idaho Rx Card

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Illinois (IL)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Better Health Premier Plan MMAI (Aetna
Better Health Premier Plan)

2

Aetna Medicare (Aetna Medicare)

3

Ascension Complete Illinois (Ascension
Complete)

4

Blue Medicare Advantage (Blue Cross
Community MMAI)

5

Blue Cross Medicare Advantage (Blue Cross and
Blue Shield of IL, NM)

6

Blue Medicare Advocate Health (Blue Cross and
Blue Shield of Illinois)

7

Cigna (Cigna)

8

Cigna Preferred (Cigna)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Illinois (IL)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
9

Cigna True Choice (Cigna)

10

Clear Spring Health Community Advantage Plan
(Clear Spring Health)

11

Clear Spring Health Essential (Clear Spring
Health)

12

Devoted (Devoted Health)

13

Devoted CHOICE Illinois (Devoted Health)

14

Essence Advantage (Essence Healthcare)

15

Essence Advantage Choice (Essence Healthcare)

16

Health Alliance Medicare (Health Alliance
Medicare)
(continued)

Created on 10/11/2022

3

HI2
MEDICARE ADVANTAGE PLANS
Illinois (IL)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
17

OSF MedAdvantage (Health Alliance Medicare)

18

Simplete (Health Alliance Medicare)

19

HealthPartners UnityPoint Health (HealthPartners
UnityPoint Health)

20

Humana (Humana)

21

Humana Gold Choice (Humana)

22

Humana Gold Plus (Humana)

23

Humana Gold Plus Integrated (Humana)

24

Humana Honor (Humana)

25

HumanaChoice (Humana)
(continued)

Created on 10/11/2022

4

HI2
MEDICARE ADVANTAGE PLANS
Illinois (IL)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
26

Lasso Healthcare Growth (Lasso Healthcare)

27

Live360 Health Plan (Medical Associates Health
Plan, Inc.)

28

Medical Associates (Medical Associates Health
Plan, Inc.)

29

Quad Cities Community Health Senior Plan
(Medical Associates Health Plan, Inc.)

30

Meridian Medicare-Medicaid Plan
(MeridianComplete)

31

Molina Dual Options (Molina Healthcare of
Illinois)

32

Molina Medicare Choice Care (Molina Healthcare
of Illinois)
(continued)

Created on 10/11/2022

5

HI2
MEDICARE ADVANTAGE PLANS
Illinois (IL)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
33 UW Health IL Quartz Med Advantage (Quartz
Medicare Advantage)
34 AARP Medicare Advantage (UnitedHealthcare)
35 SSM Health Plan (WellFirst Health)
36 Wellcare (Wellcare)
37 Zing (Zing Health)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Illinois (IL)
1

Illinois Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Illinois (IL)
1

Blue Cross Blue Shield of Illinois

2

CountyCare

3

IlliniCare Health

4

IlliniCare Health Plan

5

Meridian Health Plan

6

Molina HealthCare of Illinois

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Illinois (IL)
1 AIDS Drug Assistance Program
2 Access to Care
3 DuPage Physician's Medical Assistance Program
(DPMAP)
4 Illinois Rx Card

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Indiana (IN)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Anthem MediBlue (Anthem Blue Cross and Blue
Shield)

3

Anthem MediBlue Access (Anthem Blue Cross
and Blue Shield)

4

Anthem MediBlue Access Basic (Anthem Blue
Cross and Blue Shield)

5

Ascension Complete St. Vincent (Ascension
Complete)

6

Ascension Complete St. Vincent Access
(Ascension Complete)

7

Essence Advantage (Essence Healthcare)

8

Health Alliance Medicare (Health Alliance
Medicare)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Indiana (IN)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
9

Reid Health Alliance Medicare (Health Alliance
Medicare)

10

Simplete (Health Alliance Medicare)

11

Humana (Humana)

12

Humana Gold Choice (Humana)

13

Humana Gold Plus (Humana)

14

HumanaChoice (Humana)

15

IU Health Plans Medicare (Indiana University
Health Plans)

16

Lasso Healthcare Growth (Lasso Healthcare)

17

MDwise Medicare Inspire (MDwise Medicare)
(continued)

Created on 10/11/2022

3

HI2
MEDICARE ADVANTAGE PLANS
Indiana (IN)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
18 MyTruAdvantage Choice (MyTruAdvantage)
19 MyTruAdvantage Select (MyTruAdvantage)
20 MAP Medicare (ProMedica Medicare Plan)
21 ProMedica Medicare Essential (ProMedica Medicare
Plan)
22 AARP Medicare Advantage (UnitedHealthcare)
23 Wellcare (Wellcare by Allwell)
24 Zing (Zing Health)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Indiana (IN)
1

Indiana Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Indiana (IN)
1 Anthem
2 CareSource Indiana, Inc.
3 Franciscan Senior Health and Wellness
4 MDwise
5 Managed Health Services of Indiana
6 Saint Joseph PACE

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Indiana (IN)
1 AIDS Drug Assistance Program
2 HoosierRx
3 Indiana Drug Card
4 Indiana State Health Insurance Assistance Program

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Kansas (KS)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Ascension Complete Via Christi (Ascension
Complete)

3

Ascension Complete Via Christi Access
(Ascension Complete)

4

Blue Medicare Advantage (Blue Cross and Blue
Shield of Kansas)

5

Blue KC (Blue Medicare Advantage)

6

Cigna Preferred Medicare (Cigna)

7

Cigna True Choice (Cigna)

8

Humana Community (Humana)

9

Humana Gold Choice (Humana)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Kansas (KS)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
10

Humana Gold Plus (Humana)

11

Humana Honor (Humana)

12

HumanaChoice (Humana)

13

Lasso Healthcare Growth (Lasso Healthcare)

14

Medica Prime Solution (Medica)

15

AARP Medicare Advantage (UnitedHealthcare)

16

AARP Medicare Advantage Choice Plan
(UnitedHealthcare)

17

Erickson Advantage (UnitedHealthcare)

18

UnitedHealthcare MedicareDirect
(UnitedHealthcare)
(continued)

Created on 10/11/2022

3

HI2
MEDICARE ADVANTAGE PLANS
Kansas (KS)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
19

Wellcare (Wellcare by Allwell)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Kansas (KS)
1

KanCare program

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Kansas (KS)
1 Aetna Better Health of Kansas
2 Bluestem PACE, Inc.
3 Midland Care
4 Sunflower State Health Plan
5 United HealthCare Community Plan of Kansas
6 Via Christi

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Kansas (KS)
1 Kansas AIDS Drug Assistance Program
2 Kansas Drug Card

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Kentucky (KY)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Anthem MediBlue (Anthem Blue Cross and Blue
Shield)

3

Anthem MediBlue Access (Anthem Blue Cross
and Blue Shield)

4

Anthem MediBlue Access Basic (Anthem Blue
Cross and Blue Shield)

5

Anthem MediBlue Plus (Anthem Blue Cross and
Blue Shield)

6

Cigna Preferred (Cigna)

7

Cigna True Choice (Cigna)

8

Essence Advantage (Essence Healthcare)

9

Humana (Humana)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Kentucky (KY)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
10 Humana Community (Humana)
11 Humana Gold Choice (Humana)
12 Humana Gold Plus (Humana)
13 Humana Honor (Humana)
14 HumanaChoice (Humana)
15 Lasso Healthcare Growth (Lasso Healthcare)
16 Passport Medicare Choice Care (Passport
Advantage)
17 AARP Medicare Advantage (UnitedHealthcare)
18 Wellcare (Wellcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Kentucky (KY)
1

Kentucky Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Kentucky (KY)
1 Aetna Better Health of Kentucky
2 Anthem BCBS
3 Humana
4 NEMT Human Services Transportation Delivery
5 Passport Health Plan
6 WellCare of Kentucky

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Kentucky (KY)
1 Health Kentucky Inc
2 Kentucky AIDS Drug Assistance Program
3 Kentucky Prescription Drug Assistance Program
(KADAP)
4 Kentucky Rx Card

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Louisiana (LA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Aetna Medicare Advantra Plan (Aetna Medicare)

3

Blue Advantage (Blue Cross and Blue Shield of
Louisiana)

4

Humana (Humana)

5

Humana Value Plus (Humana)

6

Humana-Ochsner Network (Humana)

7

HumanaChoice (Humana)

8

Lasso Healthcare Growth (Lasso Healthcare)

9

Ochsner Health Plan (Ochsner Health Plan)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Louisiana (LA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
10 Peoples Health (Peoples Health)
11 Peoples Health Choices (Peoples Health)
12 Vantage (Vantage Health Plan)
13 Wellcare (Wellcare)
14 Wellcare No Premium Medicare (Wellcare by
Allwell)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Louisiana (LA)
1

Healthy Louisiana

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Louisiana (LA)
1

Aetna Better Health of Louisiana

2

AmeriHealth Caritas Louisiana

3

Healthy Blue

4

Louisiana Healthcare Connections

5

MCNA of Louisiana

6

Magellan

7

PACE - Baton Rouge

8

PACE - Greater New Orleans

9

PACE - Lafayette

10

UnitedHealthcare Community Plan

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Louisiana (LA)
1 Louisiana ADAP
2 Louisiana Drug Card
3 Louisiana Health Access Program (LA (HAP)
4 Lousiana SenioRx

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Massachusetts (MA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Aetna Medicare Value Plan (Aetna Medicare)

3

Medicare HMO Blue (Blue Cross Blue Shield of
Massachusetts)

4

Medicare PPO Blue (Blue Cross Blue Shield of
Massachusetts)

5

CCA Medicare (Commonwealth Care Alliance
Massachusetts)

6

CCA One Care (Commonwealth Care Alliance
Massachusetts)

7

Fallon Medicare Plus (Fallon Health)

8

Health New England (Health New England
Medicare Advantage Plans)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Massachusetts (MA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
9

Health New England Medicare Compass (Health
New England Medicare Advantage)

10

Humana Honor (Humana)

11

HumanaChoice (Humana)

12

Lasso Healthcare Growth (Lasso Healthcare)

13

Mass Advantage (Mass Advantage)

14

Mass Advantage Premiere (Mass Advantage)

15

Mass General Brigham Advantage (Mass
General Brigham Health Plan)

16

Mass General Brigham Advantage Secure (Mass
General Brigham Health Plan)
(continued)

Created on 10/11/2022

3

HI2
MEDICARE ADVANTAGE PLANS
Massachusetts (MA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
17

Senior Whole Health Medicare Choice Care
(Molina Healthcare of WI and MA)

18

Tufts Health Unify (Tufts Health Plan)

19

Tufts Medicare Preferred Access (Tufts Health
Plan)

20

Tufts Medicare Preferred HMO (Tufts Health
Plan)

21

AARP Medicare Advantage (UnitedHealthcare)

22

AARP Medicare Advantage Choice
(UnitedHealthcare)

23

AARP Medicare Advantage Plan
(UnitedHealthcare)

24

Erickson Advantage (UnitedHealthcare)
(continued)

Created on 10/11/2022

4

HI2
MEDICARE ADVANTAGE PLANS
Massachusetts (MA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
25 UnitedHealthcare Connected® for One Care
(UnitedHealthcare)
26 Wellcare (Wellcare)
27 Wellcare No Premium (Wellcare)
28 eternalHealth (eternalHealth)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Massachusetts (MA)
1

MassHealth

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Massachusetts (MA)
1

Atrius Health in partnership with Tufts Health
Public Plans (THPP)

2

Baystate Health Care Alliance in partnership with
Health New England

3

Beth Israel Deaconess Care Organization
(BIDCO) in partnership with Tufts Health Public
Plans (THPP)

4

Boston Accountable Care Organization in
partnership with BMC HealthNet Plan

5

Boston Children's Health ACO in partnership with
Tufts Health Public Plans (THPP)

6

Boston Medical Center HealthNet Plan

7

Cambridge Health Alliance (CHA) in partnership
with Tufts Health Public Plans (THPP)

8

Commonwealth Care Alliance

9

Community Care Cooperative
(continued)

Created on 10/11/2022

2

HI4
MEDICAID HMOs
Massachusetts (MA)
10

Elder Service Plan of Cambridge Health Alliance

11

Elder Service Plan of Harbor Health

12

Element Care Inc

13

Fallon Health Summit Eldercare

14

Health Collaborative of the Berkshires in
partnership with Fallon Health

15

Mass General Brigham ACO

16

Massachusetts Behavioral Health Partnership

17

Mercy Life Inc

18

Mercy Medical Center in partnership with BMC
HealthNet Plan

19

Merrimack Valley ACO in partnership with
AllWays Health Partners
(continued)

Created on 10/11/2022

3

HI4
MEDICAID HMOs
Massachusetts (MA)
20

Multiple Primary Care Providers

21

Navicare HMO

22

Neighborhood PACE

23

Reliant Medical Group in partnership with Fallon
Health

24

Senior Whole Health

25

Serenity Care PACE Program

26

Signature Healthcare in partnership with BMC
HealthNet Plan

27

Southcoast Health in partnership with BMC
HealthNet Plan

28

Steward Health Choice

29

Tufts Health Plan

30

United Healthcare
(continued)

Created on 10/11/2022

4

HI4
MEDICAID HMOs
Massachusetts (MA)
31 Upham's Elder Service Plan
32 Wellforce in partnership with Fallon Health

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Massachusetts (MA)
1 Commonwealth Care
2 Healthy Start
3 Massachusetts Drug Card
4 Massachusetts HIV Drug Assistance Program
5 Prescription Advantage

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Maryland (MD)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare Connect Plus (Aetna Medicare)

2

Alterwood Advantage (Alterwood Advantage)

3

CareFirst BlueCross BlueShield Advantage
(CareFirst BCBS Medicare Advantage)

4

Cigna (Cigna)

5

Humana Gold Plus (Humana)

6

Humana Honor (Humana)

7

HumanaChoice (Humana)

8

Johns Hopkins Advantage MD (Johns Hopkins
Advantage MD)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Maryland (MD)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
9

Kaiser Permanente Medicare Advantage (Kaiser
Permanente)

10 Lasso Healthcare Growth (Lasso Healthcare)
11 AARP Medicare Advantage (UnitedHealthcare)
12 Erickson Advantage (UnitedHealthcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Maryland (MD)
1

Maryland Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Maryland (MD)
1

Aetna Better Health

2

Amerigroup Community Care

3

Hopkins Elder Plus

4

Jai Medical Systems

5

Kaiser Permanente

6

Maryland Physician's Care

7

MedStar Family Choice

8

Priority Partners

9

United Healthcare Community Plan

10

University of Maryland Health Partners

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Maryland (MD)
1 Maryland AIDS Drug Assistance Program
2 Maryland Medicaid Pharmacy Program (MPP)
3 Maryland Rx Card
4 Maryland Senior Prescription Drug Assistance
Program
5 Primary Adult Care Program (PAC)

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Maine (ME)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Anthem l MaineHealth Advantage (AMH Health)

2

Anthem l MaineHealth Advantage Access (AMH
Health)

3

Aetna Medicare (Aetna Medicare)

4

Aetna Medicare Value Plan (Aetna Medicare)

5

Humana Gold Plus (Humana)

6

Humana Honor (Humana)

7

HumanaChoice (Humana)

8

Martin's Point Generations Advantage (Martin's
Point Generations Advantage)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Maine (ME)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
9

Martin's Point Generations Advantage Select

10 AARP Medicare Advantage (UnitedHealthcare)
11 AARP Medicare Advantage Choice
(UnitedHealthcare)
12 UnitedHealthcare Northern Light Health Choice
(UnitedHealthcare)
13 UnitedHealthcare Northern Light Health Flex
(UnitedHealthcare)
14 Wellcare (Wellcare)
15 Wellcare Advantage No Premium (Wellcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Maine (ME)
1

MaineCare

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Maine (ME)
1

MidCoast Connector

2

MotivCare

3

Multiple Primary Care Providers

4

Penquis CAP

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Maine (ME)
1 DirigoChoice Health Plan
2 Maine AIDS Drug Assistance Program
3 Maine Low Cost Drugs for the Elderly and Disabled
Program (LCD)
4 Maine Rx Card
5 Maine Rx Plus

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Michigan (MI)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Better Health Premier Plan (Aetna Better
Health Premier Plan)

2

Aetna Medicare (Aetna Medicare)

3

AmeriHealth Caritas VIP Care Plus (AmeriHealth
Caritas VIP Care Plus)

4

Ascension Complete Michigan (Ascension
Complete)

5

Ascension Complete Michigan Access
(Ascension Complete)

6

BCN Advantage (Blue Care Network)

7

Medicare Plus Blue PPO (Blue Cross Blue Shield
of Michigan)

8

CCA Medicare (CCA Health Michigan)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Michigan (MI)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
9

HAP Empowered MI Health Link (HAP
Empowered MI Health Link)

10

HAP (HAP Senior Plus (PPO))

11

Humana (Humana)

12

Humana Gold Choice (Humana)

13

Humana Gold Plus (Humana)

14

Humana Value Plus (Humana)

15

HumanaChoice (Humana)

16

McLaren Medicare Inspire (McLaren Medicare)

17

MeridianComplete (MeridianComplete
(Medicare-Medicaid Plan))
(continued)

Created on 10/11/2022

3

HI2
MEDICARE ADVANTAGE PLANS
Michigan (MI)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
18

Molina Dual Options (Molina Healthcare of
Michigan)

19

Molina Medicare Choice Care (Molina Healthcare
of Michigan)

20

Covenant Advantage (PHP Medicare)

21

PHP Advantage (PHP Medicare)

22

Sparrow Advantage (PHP Medicare)

23

University of Michigan Health Advantage (PHP
Medicare)

24

Paramount Elite (Paramount Elite Medicare
Plans)

25

PriorityMedicare (Priority Health Medicare)
(continued)

Created on 10/11/2022

4

HI2
MEDICARE ADVANTAGE PLANS
Michigan (MI)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
26 AARP Medicare Advantage (UnitedHealthcare)
27 Erickson Advantage (UnitedHealthcare)
28 Upper Peninsula Health Plan MI Health Link (UPHP
MI Health Link)
29 Wellcare (Wellcare)
30 Zing (Zing Health)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Michigan (MI)
1 Michigan Department of Health and Human Service

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Michigan (MI)
1

A & D Home Health Care, Inc.

2

Aetna Better Health of Michigan

3

Area Agency on Aging 1-B

4

Area Agency on Aging of NW Michigan

5

Area Agency on Aging of Western Michigan

6

Ascension Living PACE (formerly Genesys
PACE)

7

Blue Cross Blue Shield of Michigan

8

Blue Cross Complete of Michigan

9

CMH Partnership of Southeast Michigan

10

Care Resources

11

Community PACE

12

Delta Dental of Michigan
(continued)

Created on 10/11/2022

2

HI4
MEDICAID HMOs
Michigan (MI)
13

Detroit Area Agency on Aging

14

Detroit Wayne Mental Health Authority

15

Great Lakes PACE

16

HAP Empowered

17

Huron Valley PACE

18

Lakeshore Regional Entity

19

Life Circles

20

MORC Home Care Inc.

21

Macomb County CMH Services

22

McLaren Health Plan

23

Meridian Health Plan of Michigan

24

Mid-State Health Network

25

Molina Healthcare of Michigan
(continued)

Created on 10/11/2022

3

HI4
MEDICAID HMOs
Michigan (MI)
26

Northcare Network

27

Northern Healthcare Management

28

Northern Michigan Regional Entity

29

Oakland County CMH Authority

30

PACE Central Michigan

31

PACE North

32

PACE of Southeast MI

33

PACE of Southwest MI

34

Priority Health Choice

35

R9 Area Agency on Aging

36

Region 10 PIHP

37

Region 2- Area Agency on Aging

38

Region 3B Area Agency on Aging
(continued)

Created on 10/11/2022

4

HI4
MEDICAID HMOs
Michigan (MI)
39

Region 4 Area Agency on Aging

40

Region 7 Area Agency on Aging

41

Reliance Community Care Partners

42

Senior Care Partners

43

Senior Community Care

44

Senior Resources of West Michigan

45

Senior Services, Inc.

46

Southwest MI Behavioral Health

47

The Information Center

48

The Senior Alliance

49

Thome PACE

50

Total Health Care

51

Tri County Office on Aging
(continued)

Created on 10/11/2022

5

HI4
MEDICAID HMOs
Michigan (MI)
52

UPCAP Area Agency on Aging

53

UnitedHealthcare Community Plan

54

Upper Peninsula Health Plan

55

Valley Area Agency on Aging

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Michigan (MI)
1 Elder Prescription Insurance Program (EPIC)
2 MiRx Card
3 Michigan Drug Assistance Program (MIDAP)
4 Michigan The AIDS Drug Assistance Program (ADAP)

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Minnesota (MN)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Allina Health Aetna Medicare (Allina Health Aetna
Medicare)

2

Blue Cross Medicare Advantage (Blue Cross and
Blue Shield of Minnesota)

3

Platinum Blue (Blue Cross and Blue Shield of
Minnesota)

4

HealthPartners Journey (HealthPartners)

5

Humana (Humana)

6

Humana Gold Choice (Humana)

7

Humana Gold Plus (Humana)

8

HumanaChoice (Humana)

9

Lasso Healthcare Growth (Lasso Healthcare)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Minnesota (MN)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
10 Medica Advantage Solution (Medica)
11 Medica Prime Solution (Medica)
12 Gundersen MN Quartz Med Advantage (Quartz
Medicare Advantage)
13 Align (Sanford Health Plan of Minnesota)
14 Care (UCare)
15 EssentiaCare (UCare)
16 UCare (UCare)
17 UCare Your Choice (UCare)
18 AARP Medicare Advantage (UnitedHealthcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Minnesota (MN)
1

Minnesota Medical Assistance

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Minnesota (MN)
1

Blue Plus

2

Health Partners

3

Hennepin Health

4

Itasca Medical

5

Medica

6

Prime West

7

South Country

8

South Country Alliance

9

South Country Health Alliance

10

UCare

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Minnesota (MN)
1 Minnesota AIDS Drug Assistance Program (ADAP)
2 Minnesota Drug Card
3 Minnesota's General Assistance Medical Care

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Missouri (MO)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Anthem MediBlue (Anthem Blue Cross and Blue
Shield)

3

Anthem MediBlue Plus (Anthem HealthKeepers)

4

Blue KC (Blue Medicare Advantage)

5

Cigna Preferred Medicare (Cigna)

6

Cigna True Choice (Cigna)

7

CoxHealth Medicare Advantage (Cox
HealthPlans)

8

Essence Advantage (Essence Healthcare)

9

Essence Advantage Choice (Essence Healthcare)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Missouri (MO)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
10

Humana (Humana)

11

Humana Community (Humana)

12

Humana Gold Choice (Humana)

13

Humana Gold Plus (Humana)

14

Humana Honor (Humana)

15

HumanaChoice (Humana)

16

Lasso Healthcare Growth (Lasso Healthcare)

17

Medica Prime Solution (Medica)

18

Missouri Department Of Transportatio/ Highway
Patr (Employer Pdp)
(continued)

Created on 10/11/2022

3

HI2
MEDICARE ADVANTAGE PLANS
Missouri (MO)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
19 AARP Medicare Advantage (UnitedHealthcare)
20 UnitedHealthcare Medicare Advantage Choice Plan
(UnitedHealthcare)
21 UnitedHealthcare MedicareDirect (UnitedHealthcare)
22 SSM Health Plan (WellFirst Health)
23 Wellcare (Wellcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Missouri (MO)
1

MO HealthNet

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Missouri (MO)
1

Home State Health Central

2

Home State Health Eastern

3

Home State Health Southwest

4

Home State Health Western

5

Logisticare Solutions

6

Missouri Care Central

7

Missouri Care Eastern

8

Missouri Care Southwest

9

Missouri Care Western

10

UnitedHealthcare Central

11

UnitedHealthcare Eastern

12

UnitedHealthcare Southwest

13

UnitedHealthcare Western

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Missouri (MO)
1 Missouri AIDS Drug Assistance Program
2 Missouri Drug Card
3 Missouri Rx Plan

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Mississippi (MS)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Cigna (Cigna)

3

Cigna True Choice (Cigna)

4

Clover Health LiveHealthy (Clover Health)

5

Humana (Humana)

6

Humana Gold Plus (Humana)

7

HumanaChoice (Humana)

8

Lasso Healthcare Growth (Lasso Healthcare)

9

Blue Advantage Plus (Patrius Health)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Mississippi (MS)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
10 AARP Medicare Advantage (UnitedHealthcare)
11 Vantage (Vantage Health Plan)
12 Wellcare (Wellcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Mississippi (MS)
1

Mississippi Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Mississippi (MS)
1

Magnolia Health

2

Molina Healthcare of Mississippi

3

UnitedHealthcare Community Plan

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Mississippi (MS)
1

AIDS Drug Assistance Program

2

Mississippi Drug Card

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Montana (MT)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Blue Cross Medicare Advantage (Blue Cross and
Blue Shield of Montana)

2

Humana Gold Choice (Humana)

3

Humana Gold Plus (Humana)

4

Humana Honor (Humana)

5

HumanaChoice (Humana)

6

Lasso Healthcare Growth (Lasso Healthcare)

7

PacificSource Medicare Explorer (PacificSource
Medicare)

8

PacificSource Medicare MyCare Choice
(PacificSource Medicare)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Montana (MT)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
9

AARP Medicare Advantage (UnitedHealthcare)

10 UnitedHealthcare MedicareDirect (UnitedHealthcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Montana (MT)
1

Montana Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Montana (MT)
1

Passport to Health

2

Team Care

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Montana (MT)
1 AIDS Drug Assistance Program
2 Big Sky Rx
3 Mental Health Services Plan (MHSP)
4 Montana Rx Card

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
North Carolina (NC)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Alignment Health AVA (Alignment Health Plan)

3

Alignment Health Platinum (Alignment Health
Plan)

4

ApexBold (ApexHealth)

5

ApexEnrich (ApexHealth)

6

Blue Medicare (Blue Cross and Blue Shield of
North Carolina)

7

HealthTeam Advantage Plan (CARE N'' CARE
INSURANCE COMPANY OF NORTH
CAROLINA)

8

Cigna (Cigna)

9

Cigna True Choice (Cigna)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
North Carolina (NC)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
10

Devoted (Devoted Health)

11

Experience Health Medicare Advantage
(Experience Health, Inc.)

12

FirstMedicare Direct (FirstMedicare Direct)

13

FirstMedicare Direct PPO Plus (FirstMedicare
Direct)

14

New Hanover Health Advantage (FirstMedicare
Direct)

15

Humana Gold Choice (Humana)

16

Humana Gold Plus (Humana)

17

Humana Honor (Humana)

18

HumanaChoice (Humana)
(continued)

Created on 10/11/2022

3

HI2
MEDICARE ADVANTAGE PLANS
North Carolina (NC)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
19 Lasso Healthcare Growth (Lasso Healthcare)
20 Troy Medicare (Troy Medicare)
21 AARP Medicare Advantage (UnitedHealthcare)
22 AARP Medicare Advantage Choice Flex Plan
(UnitedHealthcare)
23 Erickson Advantage (UnitedHealthcare)
24 Wellcare (Wellcare)
25 Wellcare No Premium (Wellcare)
26 Wellcare No Premium Value (Wellcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
North Carolina (NC)
1

North Carolina Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
North Carolina (NC)
1

Alliance Behavioral Healthcare

2

Cardinal Innovations Healthcare Solutions

3

CarePartners PACE

4

Carolina Seniorcare

5

Eastpointe Human Services

6

Elderhaus, Inc.

7

Life St. Joseph of the Pines, Inc.

8

North Carolina Community Care

9

PACE At Home Inc

10

PACE Of The Southern Piedmont

11

PACE Of The Triad

12

Partners Behavioral Health Management
(continued)

Created on 10/11/2022

2

HI4
MEDICAID HMOs
North Carolina (NC)
13 Piedmont Health Services, Inc.
14 Sandhills Center For MH DD SA
15 Senior Total Life Care, Inc.
16 Staywell
17 Trillium Health Resources
18 VAYA Health
19 Voans Senior Community Care Of North Carolina

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
North Carolina (NC)
1 Med-assist
2 North Carolina Drug Card
3 North Carolina HIV Medication Assistance Program
(NC HMAP)

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
North Dakota (ND)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

HealthPartners Freedom (HealthPartners)

3

Humana (Humana)

4

Humana Gold Choice (Humana)

5

Humana Honor (Humana)

6

HumanaChoice (Humana)

7

Lasso Healthcare Growth (Lasso Healthcare)

8

Medica Prime Solution (Medica)

9

NextBlue (NextBlue of North Dakota)

10

Align (Sanford Health Plan)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
North Dakota (ND)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
11 AARP Medicare Advantage (UnitedHealthcare)
12 UnitedHealthcare Medicare Advantage Assure
(UnitedHealthcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
North Dakota (ND)
1

Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
North Dakota (ND)
1 Multiple Primary Care Providers
2 ND Medicaid Expansion MCO
3 Northland PACE Senior Care Services

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
North Dakota (ND)
1 AIDS Drug Assistance Program
2 North Dakota Rx Card
3 Prescription Connection for North Dakota

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Nebraska (NE)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Blue Cross Blue Shield Nebraska MA (Blue
Cross and Blue Shield of Nebraska)

3

Blue Cross Blue Shield Nebraska MA Core (Blue
Cross and Blue Shield of NE)

4

Humana (Humana)

5

Humana Gold Plus (Humana)

6

HumanaChoice (Humana)

7

Medica Advantage Solution (Medica)

8

Medica Advantage Solution with CHI Health
(Medica)

9

Medica Prime Solution (Medica)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Nebraska (NE)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
10 AARP Medicare Advantage (UnitedHealthcare)
11 UnitedHealthcare MedicareDirect (UnitedHealthcare)
12 Wellcare (Wellcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Nebraska (NE)
1

Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Nebraska (NE)
1 Immanuel Pathways
2 MCNA Nebraska
3 Nebraska Total Care
4 UnitedHealthcare Community Plan of Nebraska
5 WellCare of Nebraska

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Nebraska (NE)
1

AIDS Drug Assistance Program

2

Nebraska Rx Card

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
New Hampshire (NH)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Aetna Medicare Elite Plan (Aetna Medicare)

3

Anthem MediBlue (Anthem Blue Cross and Blue
Shield)

4

Anthem MediBlue Access (Anthem Blue Cross
and Blue Shield)

5

Harvard Pilgrim Stride (Harvard Pilgrim Health
Care of New England, Inc.)

6

Humana (Humana)

7

Humana Honor (Humana)

8

HumanaChoice (Humana)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
New Hampshire (NH)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
9

Lasso Healthcare Growth (Lasso Healthcare)

10

Martin's Point Generations Advantage (Martin's
Point Generations Advantage)

11

Martin's Point Generations Advantage Select

12

AARP Medicare Advantage (UnitedHealthcare)

13

AARP Medicare Advantage Choice
(UnitedHealthcare)

14

AARP Medicare Advantage Plan
(UnitedHealthcare)

15

UnitedHealthcare Medicare Advantage Assure
(UnitedHealthcare)
(continued)

Created on 10/11/2022

3

HI2
MEDICARE ADVANTAGE PLANS
New Hampshire (NH)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
16

WellSense (WellSense Health Plan)

17

Wellcare (Wellcare)

18

Wellcare No Premium (Wellcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
New Hampshire (NH)
1

New Hampshire Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
New Hampshire (NH)
1 AmeriHealth Caritas of New Hampshire
2 New Hampshire Healthy Families
3 Well Sense Health Plan

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
New Hampshire (NH)
1 AIDS Drug Assistance Program
2 New Hampshire Medication Bridge Program
3 New Hampshire Rx Card

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
New Jersey (NJ)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Aetna Medicare Premier (Aetna Medicare)

3

Amerivantage (Amerigroup Community Care)

4

Amerivantage Choice (Amerigroup Insurance
Company)

5

Braven Medicare (Braven Health)

6

Braven Medicare Plus (Braven Health)

7

Cigna (Cigna)

8

Cigna True Choice (Cigna)

9

Clover Health (Clover Health)

10

Health Partners Medicare (Health Partners
Medicare)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
New Jersey (NJ)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
11 Humana Gold Plus (Humana)
12 Humana Honor (Humana)
13 HumanaChoice (Humana)
14 Psers Health Options Program Value (Employer
Pdp) (Psers Hop Program)
15 AARP Medicare Advantage (UnitedHealthcare)
16 AARP Medicare Advantage Choice
(UnitedHealthcare)
17 Erickson Advantage (UnitedHealthcare)
18 Wellcare (Wellcare)
19 Wellcare Premium Enhanced Open (Wellcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
New Jersey (NJ)
1

New Jersey FamilyCare

Created on 10/11/2022

1

HI4
MEDICAID HMOs
New Jersey (NJ)
1

Aetna Better Health NJ

2

Amerigroup New Jersey Inc

3

Amerivantage Dual Coordination (HMO D-SNP)
Amerivantage Dual Secure (HMO POS)

4

Atlanticare LIFE

5

Beacon of LIFE

6

Horizon NJ Health

7

Horizon NJ TotalCare (HMO D-SNP)

8

Inspira LIFE

9

LIFE St. Francis

10

Lutheran Senior Life

11

ModivCare

12

Trinity Health LIFE NJ
(continued)

Created on 10/11/2022

2

HI4
MEDICAID HMOs
New Jersey (NJ)
13 UnitedHealthcare Community Plan
14 UnitedHealthcare Dual Complete ONE ONE (HMO
D-SNP)
15 WellCare of New Jersey
16 Wellcare Liberty (HMO D-SNP)

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
New Jersey (NJ)
1 AIDS Drug Distribution Program
2 Hospital Care Payment Assistance Program
3 NJ WorkAbility
4 New Jersey Drug Card
5 New Jersey Pharmaceutical Assistance for the Aged
and Disabled (PAAD)
6 New Jersey Senior Gold Prescription Discount
Program

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
New Mexico (NM)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Amerivantage (Amerigroup Community Care of
New Mexico)

3

Blue Cross Medicare Advantage Basic (Blue
Cross and Blue Shield of IL, NM)

4

Blue Cross Medicare Advantage (Blue Cross and
Blue Shield of NM, TX)

5

CHRISTUS Health Plan (CHRISTUS Health Plan
Generations)

6

Cigna Preferred Savings Medicare (Cigna)

7

Cigna True Choice Savings Medicare (Cigna)

8

Humana (Humana)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
New Mexico (NM)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
9

Humana Gold Choice (Humana)

10 Humana Gold Plus (Humana)
11 HumanaChoice (Humana)
12 Lasso Healthcare Growth (Lasso Healthcare)
13 Molina Medicare Choice Care (Molina Healthcare of
New Mexico, Inc.)
14 Presbyterian (Presbyterian Health Plan)
15 Presbyterian MediCare PPO Plan (Presbyterian
Insurance Company, Inc.)
16 AARP Medicare Advantage (UnitedHealthcare)
17 Wellcare (Wellcare by Allwell)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
New Mexico (NM)
1

Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
New Mexico (NM)
1 Blue Cross Blue Shield of NM
2 Innovage New Mexico PACE dba Total Community
Care
3 Presbyterian Health Plan
4 Western Sky Community Care, Inc.

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
New Mexico (NM)
1 New Mexico AIDS/HIV Drugs Assistance Program
2 New Mexico Drug Card

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Nevada (NV)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Saint Mary's ATRIO (ATRIO Health Plans)

2

Aetna Medicare (Aetna Medicare)

3

Alignment Health (Alignment Health Plan)

4

Anthem MediBlue (Anthem Blue Cross and Blue
Shield)

5

Humana Gold Plus (Humana)

6

Humana Honor (Humana)

7

HumanaChoice (Humana)

8

Imperial (Imperial Insurance Companies, Inc)

9

Lasso Healthcare Growth (Lasso Healthcare)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Nevada (NV)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
10

Molina Medicare Choice Care (Molina Healthcare
of Nevada)

11

Prominence Plus (Prominence Health Plan)

12

SCAN (SCAN Health Plan)

13

SelectHealth Medicare (SelectHealth)

14

SelectHealth Medicare Essential (SelectHealth)

15

Renown Preferred Plan by Senior Care Plus
(Senior Care Plus)

16

Senior Care Plus (Senior Care Plus)

17

AARP Medicare Advantage (UnitedHealthcare)
(continued)

Created on 10/11/2022

3

HI2
MEDICARE ADVANTAGE PLANS
Nevada (NV)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
18 UnitedHealthcare Medicare Advantage Focus
(UnitedHealthcare)
19 Wellcare (Wellcare by Allwell)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Nevada (NV)
1

Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Nevada (NV)
1 Anthem Blue Cross Blue Shield of Nevada (ANT)
2 Health Plan of Nevada (HPN)
3 Liberty Dental Plan of Nevada
4 Medical Transportation Management (MTM)
5 Silver Summit Health Plan (SSH)

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Nevada (NV)
1 Nevada AIDS Drug Assistance Program (ADAP)
2 Nevada Disability Rx
3 Nevada Drug Card
4 Nevada Medical Assistance Program
5 Nevada Senior Rx

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
New York (NY)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Aetna Medicare Value Plan (Aetna Medicare)

3

CDPHP (CDPHP Medicare Advantage)

4

Elderplan (Elderplan)

5

EmblemHealth VIP (EmblemHealth Medicare
HMO)

6

Empire MediBlue (Empire BlueCross BlueShield)

7

Empire MediBlue HealthPlus (Empire BlueCross
BlueShield)

8

Medicare (Excellus Health Plan, Inc)

9

Univera (Excellus Health Plan, Inc)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
New York (NY)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
10

Univera SeniorChoice Access (Excellus Health
Plan, Inc)

11

Healthfirst (Healthfirst Medicare Plan)

12

Healthfirst Signature (Healthfirst Medicare Plan)

13

Highmark Blue (Highmark BCBS of WNY and
Highmark BS of NENY)

14

Humana Gold Plus (Humana)

15

Humana Honor (Humana)

16

HumanaChoice (Humana)

17

Independent Health's Encompass (Independent
Health)

18

MVP Medicare (MVP HEALTH CARE)
(continued)

Created on 10/11/2022

3

HI2
MEDICARE ADVANTAGE PLANS
New York (NY)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
19 UVM Health Advantage (MVP HEALTH CARE)
20 AARP Medicare Advantage (UnitedHealthcare)
21 UnitedHealthcare Medicare Advantage
(UnitedHealthcare)
22 Wellcare (Wellcare)
23 Wellcare Fidelis (Wellcare by Fidelis Care)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
New York (NY)
1

New York Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
New York (NY)
1

Aetna Better Health

2

Affinity Health Plan

3

Agewell New York

4

Amidacare Special Needs

5

Archcare Community Life

6

Archcare Senior Life

7

Capital District Physician's Health Plan

8

Catholic Health Life

9

Centerlight (CCM)

10

Centers Plan

11

Centers Plan for Healthy Living

12

Complete Senior Care

13

Eddy Senior Care
(continued)

Created on 10/11/2022

2

HI4
MEDICAID HMOs
New York (NY)
14

Elderplan

15

Elderserve

16

Elderwood

17

Excellus

18

Extended MLTC

19

Fallon Health Weinberg

20

Fidelis Care

21

Fidelis Legacy Plan

22

HIP Combined

23

HIP GNY

24

Hamaspik Choice MLTC

25

Health Advantage/Elant Choice

26

Health Now
(continued)

Created on 10/11/2022

3

HI4
MEDICAID HMOs
New York (NY)
27

HealthFirst

28

HealthPlus

29

HealthPlus Advantage Plus

30

Icircle Care MLTC

31

Independent Health Association

32

Independent Health/Hudson Valley & WNY

33

Independent Living for Seniors

34

Integra MLTC

35

Kalos Health Plan

36

MVP Health Plan

37

MetroPlus

38

MetroPlus Health Plan Special Needs

39

Molina Healthcare of New York, Inc
(continued)

Created on 10/11/2022

4

HI4
MEDICAID HMOs
New York (NY)
40

Montefiore HMO MLTC

41

PACE CNY

42

Prime Health Choice

43

Senior Health Partners

44

Senior Network Health

45

Senior Whole Health

46

Total Senior Care

47

United HealthCare

48

VNA Homecare Options

49

VNS Choice

50

VNS Choice Plus

51

VNS Choice Special Needs

52

Village Care
(continued)

Created on 10/11/2022

5

HI4
MEDICAID HMOs
New York (NY)
53

WellCare

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
New York (NY)
1 AIDS Drug Assistance Program
2 New York Elderly Pharmaceutical Insurance
Coverage (EPIC)
3 New York Rx Card

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Ohio (OH)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Better Health of Ohio, MyCare Ohio (Aetna
Better Health of OH, MyCare OH)

2

Aetna Medicare (Aetna Medicare)

3

Aetna Medicare Advantra Silver (Aetna Medicare)

4

Aetna Medicare Premier Plus (Aetna Medicare)

5

Aetna Medicare Value (Aetna Medicare)

6

Anthem MediBlue (Anthem Blue Cross and Blue
Shield)

7

Anthem MediBlue Access (Anthem Blue Cross
and Blue Shield)

8

Buckeye Health Plan - MyCare Ohio (Buckeye
Health Plan - MyCare Ohio)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Ohio (OH)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
9

CareSource MyCare Ohio (CareSource MyCare
Ohio)

10

Cigna Preferred (Cigna)

11

Cigna True Choice (Cigna)

12

Devoted (Devoted Health)

13

Devoted CHOICE Ohio (Devoted Health)

14

Essence Advantage (Essence Healthcare)

15

Essence Advantage Choice (Essence Healthcare)

16

Reid Health Alliance Medicare HMO (Health
Alliance Medicare)

17

Humana (Humana)
(continued)

Created on 10/11/2022

3

HI2
MEDICARE ADVANTAGE PLANS
Ohio (OH)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
18

Humana Gold Choice (Humana)

19

Humana Value Plus (Humana)

20

HumanaChoice (Humana)

21

Lasso Healthcare Growth (Lasso Healthcare)

22

MediGold Mount Carmel (MediGold)

23

MedMutual Advantage (Medical Mutual of Ohio)

24

Molina Dual Options MyCare Ohio (Molina
Healthcare of Ohio)

25

Molina Medicare Choice Care (Molina Healthcare
of Ohio)
(continued)

Created on 10/11/2022

4

HI2
MEDICARE ADVANTAGE PLANS
Ohio (OH)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
26

MAP Medicare (Paramount Elite Medicare Plans)

27

PARAMOUNT ELITE (Paramount Elite Medicare
Plans)

28

Paramount Elite Preferred PPO (Paramount Elite
Medicare Plans)

29

Perennial Advantage Freedom (Perennial
Advantage)

30

PrimeTime Health Plan (PrimeTime Health Plan)

31

SummaCare Medicare (SummaCare Medicare
Advantage Plans)

32

The Health Plan SecureCare - Option (The
Health Plan)
(continued)

Created on 10/11/2022

5

HI2
MEDICARE ADVANTAGE PLANS
Ohio (OH)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
33 The Health Plan SecureChoice - Option II (The
Health Plan)
34 UPMC for Life HMO (UPMC for Life)
35 AARP Medicare Advantage (UnitedHealthcare)
36 UnitedHealthcare Connected for MyCareOhio
(UnitedHealthcare Community Plan)
37 Wellcare (Wellcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Ohio (OH)
1

Ohio Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Ohio (OH)
1 Aetna Better Health of Ohio
2 Buckeye Health Plan
3 CareSource
4 McGregor PACE
5 Molina Healthcare of Ohio, Inc.
6 Paramount Advantage
7 UnitedHealthcare Community Plan of Ohio, Inc.

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Ohio (OH)
1 Healthy Families
2 Ohio Drug Card
3 Ohio HIV Drug Assistance Program (OHDAP)
4 Ohio's Best Rx

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Oklahoma (OK)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Aetna Medicare Premier Plan (Aetna Medicare)

3

Blue Cross Medicare Advantage (Blue Cross and
Blue Shield of OK, TX)

4

Blue Cross Medicare Advantage Basic (Blue
Cross and Blue Shield of Oklahoma)

5

Cigna Preferred Savings Medicare (Cigna)

6

Cigna True Choice Medicare (Cigna)

7

Options Gold (CommunityCare Options (PPO))

8

Senior Health Plan (CommunityCare Senior
Health Plan (HMO))
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Oklahoma (OK)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
9

Generations (GlobalHealth)

10

Humana (Humana)

11

Humana Gold Choice (Humana)

12

Humana Gold Plus (Humana)

13

Humana Honor (Humana)

14

HumanaChoice (Humana)

15

Integris Health Partners+ (Integris Health
Partners+ (HMO))

16

Lasso Healthcare Growth (Lasso Healthcare)

17

Medica Prime Solution (Medica)
(continued)

Created on 10/11/2022

3

HI2
MEDICARE ADVANTAGE PLANS
Oklahoma (OK)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
18 AARP Medicare Advantage (UnitedHealthcare)
19 Wellcare (Wellcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Oklahoma (OK)
1

SoonerCare

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Oklahoma (OK)
1

Cherokee Elder Care (CEC)

2

Life PACE

3

SoonerCare Choice

4

SoonerRide

5

Valir PACE

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Oklahoma (OK)
1 Oklahoma AIDS Drug Assistance Program
2 Oklahoma Drug Card
3 Rx for Oklahoma

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Oregon (OR)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

ATRIO (ATRIO Health Plans)

2

Aetna Medicare (Aetna Medicare)

3

AllCare Advantage (AllCare Advantage)

4

Cigna Preferred Medicare (Cigna)

5

Cigna True Choice Savings Medicare (Cigna)

6

Devoted CHOICE (Devoted Health)

7

Devoted CORE Oregon (Devoted Health)

8

Humana (Humana)

9

Humana Gold Plus (Humana)

10

HumanaChoice (Humana)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Oregon (OR)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
11

Kaiser Permanente Senior Advantage (Kaiser
Permanente)

12

Lasso Healthcare Growth (Lasso Healthcare)

13

Moda Health (Moda Health Plan, Inc.)

14

PacificSource Medicare (PacificSource Medicare)

15

PacificSource Medicare Explorer (PacificSource
Medicare)

16

Providence Medicare (Providence Medicare
Advantage Plans)

17

Regence (Regence BlueCross BlueShield of
Oregon)
(continued)

Created on 10/11/2022

3

HI2
MEDICARE ADVANTAGE PLANS
Oregon (OR)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
18 Samaritan Advantage (Samaritan Advantage Health
Plan)
19 Summit Health (Summit Health Plan, Inc.)
20 AARP Medicare Advantage (UnitedHealthcare)
21 AARP Medicare Advantage Plan (UnitedHealthcare)
22 Wellcare (Wellcare by Health Net)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Oregon (OR)
1

Oregon Health Plan

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Oregon (OR)
1

Advanced Health

2

Advantage Dental Services

3

AllCare Health Plan

4

Capitol Dental Care, Inc.

5

CareOregon Dental

6

Cascade Health Alliance

7

Columbia Pacific

8

Eastern Oregon CCO

9

Family Dental Care

10

Greater Oregon Behavioral Health, Inc.

11

HealthShare of Oregon

12

InterCommunity Health Network

13

Jackson Care Connect
(continued)

Created on 10/11/2022

2

HI4
MEDICAID HMOs
Oregon (OR)
14

Managed Dental Care of Oregon

15

ODS Community Health Inc.

16

PacificSource Community Solutions - Central
Oregon

17

PacificSource Community Solutions - Columbia
Gorge

18

PacificSource Community Solutions - Lane
(CCO)

19

PacificSource Community Solutions - Marion
Polk (CCO)

20

PrimaryHealth of Josephine County

21

Providence Elder Place

22

Trillium Community Health Plan

23

Umpqua Health Alliance

24

Willamette Valley Community Health
(continued)

Created on 10/11/2022

3

HI4
MEDICAID HMOs
Oregon (OR)
25

Yamhill Community Care

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Oregon (OR)
1 CAREAssist: Oregon's AIDS Drug Assistance
Program (ADAP)
2 Oregon Prescription Drug Program (OPDP)
3 Oregon Rx Card
4 Oregon Senior Prescription Drug Assistance Program
(SPDAP)

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Pennsylvania (PA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

BlueJourney (Capital Blue Cross)

3

Capital Blue Cross (Capital Blue Cross)

4

Capital Blue Cross | WellSpan Health Inspire
(Capital Blue Cross)

5

Cigna (Cigna)

6

Cigna True Choice (Cigna)

7

Clover Health Choice (Clover Health)

8

Devoted (Devoted Health)

9

Devoted CHOICE Pennsylvania (Devoted Health)

10

Geisinger Gold (Geisinger Gold)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Pennsylvania (PA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
11

Geisinger Gold Preferred (Geisinger Gold)

12

Health Partners Medicare (Health Partners
Medicare)

13

Community Blue Medicare (Highmark Inc.)

14

Community Blue Medicare HMO (Highmark Inc.)

15

Complete Blue PPO (Highmark Inc.)

16

Freedom Blue PPO (Highmark Inc.)

17

Security Blue HMO-POS (Highmark Inc.)

18

Together Blue Medicare HMO Signature
(Highmark Inc.)

19

Humana (Humana)
(continued)

Created on 10/11/2022

3

HI2
MEDICARE ADVANTAGE PLANS
Pennsylvania (PA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
20

Humana Gold Choice (Humana)

21

Humana Gold Plus (Humana)

22

Humana USAA Honor with (Humana)

23

HumanaChoice (Humana)

24

Keystone 65 (Independence Blue Cross)

25

Personal Choice 65 (Independence Blue Cross)

26

Lasso Healthcare Growth (Lasso Healthcare)

27

Psers Health Options Program Value (Employer
Pdp) (Psers Hop Program)

28

UPMC for Life HMO (UPMC for Life)
(continued)

Created on 10/11/2022

4

HI2
MEDICARE ADVANTAGE PLANS
Pennsylvania (PA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
29 UPMC for Life PPO (UPMC for Life)
30 AARP Medicare Advantage (UnitedHealthcare)
31 AARP Medicare Advantage Choice
(UnitedHealthcare)
32 Erickson Advantage (UnitedHealthcare)
33 Wellcare (Wellcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Pennsylvania (PA)
1 Pennsylvania Medical Assistance (MA) (Medicaid)

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Pennsylvania (PA)
1

Adult Community Autism Program

2

Aetna Better Health

3

Albright LIFE H-9068

4

Allegheny County HealthChoices

5

AmeriHealth Caritas

6

AmeriHealth Caritas/AmeriHealth Caritas
Northeast

7

Beaver County HealthChoices

8

Behavioral Health Services of Somerset and
Bedford Counties

9

Berks County HealthChoices

10

Blair County HealthChoices

11

Bucks County HealthChoices

12

Cambria County HealthChoices
(continued)

Created on 10/11/2022

2

HI4
MEDICAID HMOs
Pennsylvania (PA)
13

Capital Area Behavioral Health Collaborative

14

Carbon-Monroe-Pike Joinder Board

15

Chester County HealthChoices

16

Community Care Behavioral Health Organization

17

Community LIFE H- 3917

18

Delaware County HealthChoices

19

Erie County HealthChoices

20

Fayette County HealthChoices

21

Gateway Health

22

Geisinger Health Plan

23

Greene County (Commonwealth)

24

Health Partners Plan
(continued)

Created on 10/11/2022

3

HI4
MEDICAID HMOs
Pennsylvania (PA)
25

Innovage LIFE H-9830

26

Keystone First

27

LIFE Geisinger H-2064

28

LIFE NWPA H-4999

29

LIFE Pittsburgh H-3918

30

LIFE St. Mary H-6551

31

Lehigh County HealthChoices

32

LogistiCare

33

Lycoming-Clinton Joinder Board

34

Mercy LIFE H-3919

35

Mercy LIFE West Philadelphia H-3908

36

Montgomery County HealthChoices

37

Northampton County HealthChoices
(continued)

Created on 10/11/2022

4

HI4
MEDICAID HMOs
Pennsylvania (PA)
38

Northeast Behavioral Health Care Consortium

39

Northwest Behavioral Health Partnership

40

Pennsylvania Health and Wellness

41

Philadelphia County HealthChoices

42

Senior LIFE Altoona H- 5902

43

Senior LIFE Greensburg H-2937

44

Senior LIFE Johnstown H-3925

45

Senior LIFE Lehigh H- 5978

46

Senior LIFE Washington H-2992

47

Senior LIFE York H- 0819

48

Southwest Behavioral Health Management

49

SpiriTrust LIFE H-2537
(continued)

Created on 10/11/2022

5

HI4
MEDICAID HMOs
Pennsylvania (PA)
50 Tuscarora Managed Care Alliance
51 UPMC Community HealthChoices
52 UPMC for You
53 United Healthcare Community Plan, Inc
54 VieCare Armstrong H- 6118
55 VieCare Beaver H- 7660
56 VieCare Butler H-3060
57 York/Adams HealthChoices Joinder Governing
Board

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Pennsylvania (PA)
1 AIDS Drug Assistance Program
2 Chronic Renal Disease Program (CRDP)
3 Pennsylvania Drug Card
4 Pennsylvania PACE Needs Enhancement Tier
(PACENET)
5 Pennsylvania Pharmaceutical Assistance Contract for
the Elderly (PACE)
6 Special Pharmaceutical Benefits Program – Mental
Health (SPBP-MH)

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Puerto Rico (PR)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Humana Gold Plus (Humana)

2

HumanaChoice Value (Humana)

3

MCS Classicare (MCS Classicare)

4

MMM (PMC Medicare Choice)

5

PMC Max (PMC Medicare Choice)

6

AhorroMax (Triple S Advantage)

7

Basic (Triple S Advantage)

8

Brillante (Triple S Advantage)

9

Enlace Plus (Triple S Advantage)

10

Magno (Triple S Advantage)

11

Real (Triple S Advantage)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Puerto Rico (PR)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
12

Optimo Xtra (Triple-S Advantage)

13

Óptimo (Triple-S Advantage)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Puerto Rico (PR)
1

Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Puerto Rico (PR)
1 Government Health Plan First Medical
2 Government Health Plan MMM Multi Health Inc
3 Government Health Plan Molina Health Care PR
4 Government Health Plan Triple S
5 Government Health Plan de Salud Menonita
6 Medicare Platino - Humana Health Plan of PR
7 Medicare Platino - MCS Advantage Inc
8 Medicare Platino - MMM Health Care Inc
9 Medicare Platino - Triple S Advantage

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Puerto Rico (PR)
1 Puerto Rico AIDS Drug Assistance Program

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Rhode Island (RI)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Aetna Medicare Explorer Plan (Aetna Medicare)

3

BlueCHiP for Medicare (Blue Cross & Blue Shield
of Rhode Island)

4

HealthMate for Medicare (Blue Cross & Blue
Shield of Rhode Island)

5

CCA Medicare (CCA Health Rhode Island)

6

Humana Honor (Humana)

7

HumanaChoice (Humana)

8

Lasso Healthcare Growth (Lasso Healthcare)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Rhode Island (RI)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
9

Neighborhood INTEGRITY (NEIGHBORHOOD
HEALTH PLAN OF RHODE ISLAND)

10 AARP Medicare Advantage (UnitedHealthcare)
11 AARP Medicare Advantage Choice
(UnitedHealthcare)
12 AARP Medicare Advantage Choice Plan
(UnitedHealthcare)
13 Wellcare (Wellcare)
14 Wellcare No Premium (Wellcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Rhode Island (RI)
1

Rhode Island Medical Assistance

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Rhode Island (RI)
1 Medical Transportation Management, Inc.
2 Neighborhood Health Plan of Rhode Island
3 PACE Organization of Rhode Island
4 Tufts Health Public Plans
5 United HealthCare of Rhode Island Community Plan
6 UnitedHealthcare Dental of Rhode Island

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Rhode Island (RI)
1 RI AIDS Drug Assistance Program
2 Rhode Island Pharmaceutical Assistance to the
Elderly (RIPAE)
3 Rhode Island Rx Card
4 Rhody Health Partners
5 Rite Care

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
South Carolina (SC)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

ApexBold (ApexHealth)

3

BlueCross (Blue Cross Blue Shield of South
Carolina)

4

BlueCross Secure (Blue Cross Blue Shield of
South Carolina)

5

Cigna (Cigna)

6

Cigna True Choice Medicare (Cigna)

7

Clear Spring Health Gold Plus (Clear Spring
Health)

8

Clear Spring Health Select Plan (Clear Spring
Health)

9

Clover Health (Clover Health)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
South Carolina (SC)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
10

Devoted CHOICE (Devoted Health)

11

Devoted CORE Upstate (Devoted Health)

12

First Choice VIP Care Plus (FIRST CHOICE VIP
CARE PLUS)

13

Humana Gold Choice (Humana)

14

Humana Gold Plus (Humana)

15

Humana Honor (Humana)

16

HumanaChoice (Humana)

17

Lasso Healthcare Growth (Lasso Healthcare)

18

Molina Dual Options (Molina Healthcare of South
Carolina)
(continued)

Created on 10/11/2022

3

HI2
MEDICARE ADVANTAGE PLANS
South Carolina (SC)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
19 Molina Medicare Choice Care (Molina Healthcare of
South Carolina)
20 AARP Medicare Advantage (UnitedHealthcare)
21 AARP Medicare Advantage Choice
(UnitedHealthcare)
22 UnitedHealthcare Medicare Advantage
(UnitedHealthcare)
23 Wellcare (Wellcare)
24 Wellcare Prime by Absolute Total Care (Wellcare
Prime by Absolute Total Care)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
South Carolina (SC)
1

Healthy Connections

Created on 10/11/2022

1

HI4
MEDICAID HMOs
South Carolina (SC)
1

Absolute Total Care, Inc.

2

BlueChoice Healthplan Medicaid

3

Greenville Senior Care

4

Modivcare formerly Logisticare

5

Molina Healthcare of South Carolina

6

Palmetto Senior Care

7

Select Health of South Carolina

8

South Carolina Solutions

9

The Methodist Oaks

10

WellCare of South Carolina

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
South Carolina (SC)
1 AIDS Drug Assistance Plan
2 Gap Assistance Pharmacy Program for Seniors
(GAPS)
3 South Carolina Drug Card

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
South Dakota (SD)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

HealthPartners Freedom (HealthPartners)

3

Humana (Humana)

4

Humana Gold Choice (Humana)

5

Humana Gold Plus (Humana)

6

Humana Honor (Humana)

7

HumanaChoice (Humana)

8

Lasso Healthcare Growth (Lasso Healthcare)

9

Medica Prime Solution (Medica)

10

Align (Sanford Health Plan)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
South Dakota (SD)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
11 AARP Medicare Advantage (UnitedHealthcare)
12 Blue Medicare Advantage (Wellmark Advantage
Health Plan)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
South Dakota (SD)
1

Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
South Dakota (SD)
1

Multiple Primary Care Providers

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
South Dakota (SD)
1 AIDS Drug Assistance Program ( ADAP )
2 South Dakota Rx Card

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Tennessee (TN)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Aetna Medicare Value Plus Plan (Aetna
Medicare)

3

Amerivantage Classic (Amerigroup)

4

Amerivantage (Amerigroup Insurance Company)

5

Ascension Complete Saint Thomas (Ascension
Complete)

6

Ascension Complete Saint Thomas Access
(Ascension Complete)

7

BlueAdvantage (BlueCross BlueShield of
Tennessee)

8

Cigna (Cigna)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Tennessee (TN)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
9

Cigna True Choice Medicare (Cigna)

10

Clover Health Choice (Clover Health)

11

Devoted (Devoted Health)

12

Devoted CHOICE Tennessee (Devoted Health)

13

Farm Bureau Advantage (Farm Bureau Health
Plans)

14

Humana (Humana)

15

Humana Honor (Humana)

16

HumanaChoice (Humana)

17

AARP Medicare Advantage (UnitedHealthcare)
(continued)

Created on 10/11/2022

3

HI2
MEDICARE ADVANTAGE PLANS
Tennessee (TN)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
18 AARP Medicare Advantage Walgreens
(UnitedHealthcare)
19 UnitedHealthcare Medicare Advantage Choice
(UnitedHealthcare)
20 Wellcare (Wellcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Tennessee (TN)
1

TennCare

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Tennessee (TN)
1 Alexian Brothers Community Services
2 Amerigroup
3 DentaQuest USA Insurance Company
4 OptumRx
5 UnitedHealthcare Community Plan
6 Volunteer State Health Plan (BlueCare)
7 Volunteer State Health Plan (TennCare Select)

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Tennessee (TN)
1 Project Access Nashville
2 TennCare
3 Tennessee Drug Card
4 Tennessee HIV Drug Assistance Program

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Texas (TX)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Alignment Health AVA (Alignment Health Plan)

3

Alignment Health the ONE (Alignment Health
Plan)

4

Amerivantage (Amerigroup)

5

Amerivantage Classic (Amerigroup)

6

Amerivantage Choice (Amerigroup Insurance
Company)

7

Ascension Complete (Ascension Complete)

8

BSW SeniorCare Advantage (Baylor
Scott & White Health Plan)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Texas (TX)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
9

Covenant Health Advantage (Baylor
Scott & White Health Plan)

10

Blue Cross Medicare Advantage (Blue Cross and
Blue Shield of OK, TX)

11

Blue Cross Medicare Advantage Basic (Blue
Cross and Blue Shield of Texas)

12

CHRISTUS Health Plan (CHRISTUS Health Plan
Generations)

13

Care N' Care Choice (Care N' Care Insurance
Company)

14

Care N' Care Classic (Care N' Care Insurance
Company)

15

Southwestern Health Select (Care N' Care
Insurance Company)
(continued)

Created on 10/11/2022

3

HI2
MEDICARE ADVANTAGE PLANS
Texas (TX)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
16

Cigna (Cigna)

17

Cigna True Choice (Cigna)

18

Clover Health Choice (Clover Health)

19

Community First Medicare Advantage Alamo
Plan (Community First Health Plans)

20

Devoted (Devoted Health)

21

Devoted CHOICE (Devoted Health)

22

Texas LoneStar (GlobalHealth)

23

Humana (Humana)

24

Humana Gold Choice (Humana)

25

Humana Gold Plus (Humana)
(continued)

Created on 10/11/2022

4

HI2
MEDICARE ADVANTAGE PLANS
Texas (TX)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
26

HumanaChoice (Humana)

27

Imperial (Imperial Insurance Companies, Inc)

28

KelseyCare Advantage (KelseyCare Advantage)

29

Lasso Healthcare Growth (Lasso Healthcare)

30

Memorial Hermann (Memorial Hermann Health
Plan)

31

Molina Medicare Choice Care (Molina Healthcare
of Texas, Inc.)

32

Prominence Plus (Prominence Health Plan)

33

SCAN (SCAN Health Plan)
(continued)

Created on 10/11/2022

5

HI2
MEDICARE ADVANTAGE PLANS
Texas (TX)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
34 AARP Medicare Advantage (UnitedHealthcare)
35 AARP Medicare Advantage Choice
(UnitedHealthcare)
36 Erickson Advantage (UnitedHealthcare)
37 UnitedHealthcare Medicare Advantage Choice
(UnitedHealthcare)
38 Wellcare No Premium (Wellcare)
39 Wellcare TexanPlus (Wellcare)
40 Wellcare (Wellcare by Allwell)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Texas (TX)
1

Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Texas (TX)
1

Aetna Better Health of Texas, Inc.

2

American Medical Response

3

Amerigroup Insurance Company

4

Amerigroup Texas, Inc.

5

Bienvivir Senior Health Services (El Paso)

6

Children's Medical Center Health Plan

7

Community First Health Plans, Inc.

8

Community Health Choice Texas, Inc.

9

Cook Children's Health Plan

10

DentaQuest USA Insurance Company, Inc.

11

Driscoll Children's Health Plan

12

Driscoll Children's Health Plan
(continued)

Created on 10/11/2022

2

HI4
MEDICAID HMOs
Texas (TX)
13

El Paso Health Plans, Inc., dba El Paso Health

14

Health Care Service Corp. (dba Blue Cross Blue
Shield)

15

Health Care Service Corporation DBA Blue Cross
and Blue Shield of Texas (BCBSTX)

16

HealthSpring Life & Health Insurance Co., Inc.

17

LogistiCare

18

MCNA Insurance Company

19

Medical Transportation Management

20

Molina Healthcare of Texas, Inc.

21

Parkland Community Health Plan, Inc.

22

Project Amistad

23

SHA. LLC, dba FirstCare Health Plans
(continued)

Created on 10/11/2022

3

HI4
MEDICAID HMOs
Texas (TX)
24 Scott & White Health Plan
25 Seton Health Plan, Inc., dba Dell Childrens Health
Plan
26 Silver Star Health Network (Lubbock)
27 Superior Health Plan, Inc.
28 Texas Children's Health Plan, Inc.
29 The Basics at Jan Werner (Amarillo)
30 UnitedHealthcare Insurance Company, dba United
Healthcare
31 UnitedHealthcare Insurance Company, dba United
Healthcare Community Plan

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Texas (TX)
1 AIDS Drug Assistance Program (ADAP)
2 Texas Drug Card
3 Texas Kidney Health Care Program

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Utah (UT)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Aetna Medicare Advantra (Aetna Medicare)

3

Cigna Preferred Savings Medicare (Cigna)

4

Cigna True Choice Savings Medicare (Cigna)

5

Humana Gold Plus (Humana)

6

Humana Honor (Humana)

7

HumanaChoice (Humana)

8

Lasso Healthcare Growth (Lasso Healthcare)

9

Molina Medicare Choice Care (Molina Healthcare
of Utah & Idaho)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Utah (UT)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
10 Regence (Regence BlueCross BlueShield of Utah)
11 SelectHealth Medicare (SelectHealth)
12 SelectHealth Medicare Choice (SelectHealth)
13 AARP Medicare Advantage (UnitedHealthcare)
14 AARP Medicare Advantage Choice
(UnitedHealthcare)
15 AARP Medicare Advantage Choice Plan
(UnitedHealthcare)
16 Advantage U Signature (University of Utah Health
Insurance Plans)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Utah (UT)
1

Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Utah (UT)
1

Bear River Mental Health

2

Central Utah Counseling Center

3

Davis Behavioral Health

4

Four Corners Community Behavioral Health

5

HOME

6

Health Choice

7

Health Choice Integrated

8

Healthy U

9

Healthy U Behavioral Health

10

Healthy U Integrated

11

Logisticare Solutions

12

MCNA Dental

13

Molina
(continued)

Created on 10/11/2022

2

HI4
MEDICAID HMOs
Utah (UT)
14 Molina Integrated
15 Northeastern Counseling Center
16 Premier Access
17 Salt Lake County Division of Behavioral Health
Services
18 SelectHealth
19 SelectHealth Integrated
20 Southwest Behavioral Health Center
21 Valley Behavioral Health
22 Wasatch Behavioral Health
23 Weber Human Services

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Utah (UT)
1 Utah AIDS Drug Assistance Program
2 Utah Drug Card

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Virginia (VA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Align Freedom (Align Senior Care)

3

Anthem MediBlue (Anthem Blue Cross and Blue
Shield)

4

Cigna Preferred (Cigna)

5

Cigna True Choice (Cigna)

6

Clear Spring Health Essential (Clear Spring
Health)

7

Humana (Humana)

8

Humana Gold Choice (Humana)

9

Humana Gold Plus (Humana)

10

Humana Honor (Humana)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Virginia (VA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
11

HumanaChoice (Humana)

12

Kaiser Permanente Medicare Advantage (Kaiser
Permanente)

13

Mary Washington Medicare Advantage (Mary
Washington Medicare Advantage)

14

Riverside Medicare Advantage Complete (Mary
Washington Medicare Advantage)

15

Molina Medicare Choice Care (Molina Healthcare
of Virginia)

16

Optima Medicare (Optima Medicare)

17

AARP Medicare Advantage (UnitedHealthcare)

18

Erickson Advantage (UnitedHealthcare)
(continued)

Created on 10/11/2022

3

HI2
MEDICARE ADVANTAGE PLANS
Virginia (VA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
19 UnitedHealthcare Medicare Advantage Choice
(UnitedHealthcare)
20 UnitedHealthcare Medicare Advantage Choice Flex
(UnitedHealthcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Virginia (VA)
1

Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Virginia (VA)
1

Aetna Better Health

2

Aetna Better Health of Virginia

3

AllCare for Seniors

4

Anthem HealthKeepers Plus

5

Anthem Healthkeepers

6

Centra PACE

7

InnovAge Virginia PACE Charlottesville, LLC

8

InnovAge Virginia PACE Roanoke Valley, LLC

9

Magellan Complete Care

10

Mountain Empire PACE

11

Optima Family Care

12

Optima Health Community Care
(continued)

Created on 10/11/2022

2

HI4
MEDICAID HMOs
Virginia (VA)
13

Sentara Senior Community Care

14

United Healthcare

15

Virginia Premier

16

Virginia Premier Elite Plus

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Virginia (VA)
1 Virginia AIDS Drug Assistance Program
2 Virginia Drug Card
3 Virginia State Pharmacy Assistance Programs
(SPAP)

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Vermont (VT)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Humana Honor (Humana)

2

HumanaChoice (Humana)

3

MVP Medicare (MVP HEALTH CARE)

4

UVM Health Advantage (MVP HEALTH CARE)

5

AARP Medicare Advantage (UnitedHealthcare)

6

AARP Medicare Advantage Choice
(UnitedHealthcare)

7

AARP Medicare Advantage Plan
(UnitedHealthcare)

8

UnitedHealthcare Medicare Advantage Assure
(UnitedHealthcare)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Vermont (VT)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
9

Vermont Blue Advantage (Vermont Blue Advantage)

10 Vermont Blue Advantage Unity HMO (Vermont Blue
Advantage)
11 Wellcare (Wellcare)
12 Wellcare No Premium (Wellcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Vermont (VT)
1

Vermont Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Vermont (VT)
1 Department of Vermont Health Access

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Vermont (VT)
1 Catamount Health
2 Healthy Vermonters
3 Vermont AIDS Drug Assistance Program
4 Vermont Rx Card
5 Vermont Vpharm

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Washington (WA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Amerivantage Classic (AMERIGROUP)

2

Aetna Medicare (Aetna Medicare)

3

Aetna Medicare Value (Aetna Medicare)

4

Asuris (Asuris Northwest Health)

5

Cigna Preferred Medicare (Cigna)

6

Cigna True Choice Savings Medicare (Cigna)

7

Community Health Plan of WA MA (Community
Health Plan of WA Medicare Advantage)

8

Health Alliance NW (Health Alliance Northwest)

9

Humana (Humana)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Washington (WA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
10

Humana Gold Plus (Humana)

11

Humana Honor (Humana)

12

HumanaChoice (Humana)

13

Kaiser Permanente Medicare Advantage (Kaiser
Permanente)

14

Kaiser Permanente Senior Advantage (Kaiser
Permanente)

15

Molina Medicare Choice Care (Molina Healthcare
of Washington, Inc.)

16

PacificSource Medicare Explorer (PacificSource
Medicare)

17

PacificSource Medicare MyCare (PacificSource
Medicare)
(continued)

Created on 10/11/2022

3

HI2
MEDICARE ADVANTAGE PLANS
Washington (WA)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
18 Premera Blue Cross Medicare Advantage (Premera
Blue Cross Medicare Advantage)
19 Providence Medicare (Providence Medicare
Advantage Plans)
20 Regence (Regence BlueShield Of Idaho)
21 AARP Medicare Advantage (UnitedHealthcare)
22 Wellcare (Wellcare by Health Net)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Washington (WA)
1

Apple Health (Medicaid)

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Washington (WA)
1

Amerigroup

2

Community Health Plan

3

Coordinated Care of Washington

4

Molina Health Care

5

Multiple Primary Care Providers

6

Multiple Sites

7

Multiple Transportation Brokers

8

PACE

9

United Health Care

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Washington (WA)
1 Early Intervention Program (EIP)
2 Washington Drug Card
3 Washington State Health Insurance Pool (WSHIP)

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Wisconsin (WI)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Anthem MediBlue (Anthem Blue Cross and Blue
Shield)

3

Anthem MediBlue Plus (Anthem Blue Cross and
Blue Shield)

4

Elite (Aspirus Health Plan)

5

Essential (Aspirus Health Plan)

6

Dean Advantage (Dean Advantage, Prevea360
Medicare Advantage)

7

Prevea360 (Dean Advantage, Prevea360
Medicare Advantage)

8

DeanCare Gold (Dean Health Plan, Inc.)

9

HealthPartners Freedom (HealthPartners)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Wisconsin (WI)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
10

HealthPartners Robin (HealthPartners)

11

Humana (Humana)

12

Humana Gold Choice (Humana)

13

Humana Gold Plus (Humana)

14

Humana Honor (Humana)

15

HumanaChoice (Humana)

16

Medica Prime Solution (Medica)

17

Medical Associates (Medical Associates Clinic
Health Plan of Wisconsi)

18

Molina Medicare Choice Care (Molina Healthcare
of Wisconsin and Massachusetts)
(continued)

Created on 10/11/2022

3

HI2
MEDICARE ADVANTAGE PLANS
Wisconsin (WI)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
19

Network (Network Health Medicare Advantage
Plans)

20

NetworkPrime (Network Health Medicare
Advantage Plans)

21

Aurora Health Quartz Med Advantage (Quartz
Medicare Advantage)

22

Gundersen Quartz Med Advantage (Quartz
Medicare Advantage)

23

UW Health Quartz Med Advantage (Quartz
Medicare Advantage)

24

Ascend (Security Health Plan of Wisconsin, Inc.)

25

Essence (Security Health Plan of Wisconsin,
Inc.)
(continued)

Created on 10/11/2022

4

HI2
MEDICARE ADVANTAGE PLANS
Wisconsin (WI)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
26 Esteem (Security Health Plan of Wisconsin, Inc.)
27 Spirit (Security Health Plan of Wisconsin, Inc.)
28 EssentiaCare (UCare)
29 AARP Medicare Advantage (UnitedHealthcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Wisconsin (WI)
1

BadgerCare Plus

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Wisconsin (WI)
1

Anthem Blue Cross Blue Shield

2

Care Wisconsin Health Plan - Trilogy Health Ins

3

Children Come First

4

Children's Community Health Plan

5

Children's Hospital of Wisconsin

6

Community Care Health Plan

7

Community Care, Inc.

8

Dean Health Plan

9

Group Health Cooperative of Eau Claire

10

Group Health Cooperative of South Central

11

Inclusa, Inc.

12

Independent Care (iCare)
(continued)

Created on 10/11/2022

2

HI4
MEDICAID HMOs
Wisconsin (WI)
13 Lakeland Care, Inc.
14 MHS of Wisconsin
15 Managed Health Services
16 MercyCare Insurance Company
17 Molina Health Plan
18 My Choice Family Care - Care Wisconsin
19 My Choice Wisconsin Health Plan
20 Network Health Plan
21 Quartz
22 Security Health Plan of Wisconsin
23 UnitedHealthcare Community Plan
24 Wrap Around Milwaukee

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Wisconsin (WI)
1 Wisconsin AIDS/HIV Drug Assistance Program
2 Wisconsin Chronic Disease Program
3 Wisconsin Drug Card
4 Wisconsin SeniorCare

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
West Virginia (WV)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Aetna Medicare Advantra (Aetna Medicare)

3

Freedom Blue PPO (Highmark Inc.)

4

Humana Gold Choice (Humana)

5

Humana Gold Plus (Humana)

6

Humana Honor (Humana)

7

HumanaChoice (Humana)

8

Lasso Healthcare Growth (Lasso Healthcare)

9

The Health Plan SecureCare (The Health Plan)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
West Virginia (WV)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
10 The Health Plan SecureChoice (The Health Plan)
11 United Mine Workers Of America Hlth & Retirement
12 AARP Medicare Advantage (UnitedHealthcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
West Virginia (WV)
1

West Virginia Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
West Virginia (WV)
1

Aetna Better Health of WV

2

The Health Plan of WV

3

Unicare of WV

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
West Virginia (WV)
1 Golden Mountaineer Discount Card
2 West Virginia AIDS Drug Assistance Program
3 West Virginia Rx Card

Created on 10/11/2022

1

HI2
MEDICARE ADVANTAGE PLANS
Wyoming (WY)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
1

Aetna Medicare (Aetna Medicare)

2

Aetna Medicare Advantra Select (Aetna
Medicare)

3

Humana Gold Choice (Humana)

4

Humana Honor (Humana)

5

HumanaChoice (Humana)

6

Lasso Healthcare Growth (Lasso Healthcare)

7

Medica Prime Solution (Medica)

8

AARP Medicare Advantage Choice Plan
(UnitedHealthcare)

9

UnitedHealthcare Medicare Advantage Patriot
(UnitedHealthcare)
(continued)

Created on 10/11/2022

2

HI2
MEDICARE ADVANTAGE PLANS
Wyoming (WY)
(Medicare Managed Care, such as Medicare HMO,
Medicare PPO, or Medicare PFFS Plan)
10 UnitedHealthcare MedicareDirect (UnitedHealthcare)

Created on 10/11/2022

1

HI3
MEDICAID PROGRAM NAMES
Wyoming (WY)
1

Medicaid

Created on 10/11/2022

1

HI4
MEDICAID HMOs
Wyoming (WY)
1 Cheyenne Regional Medical Center PACE

Created on 10/11/2022

1

HI6
PUBLIC ASSISTANCE PLANS
Wyoming (WY)
1 AIDS Drug Assistance Program
2 Wyoming Prescription Drug Assistance Program
(PDAP)
3 Wyoming Rx Card

HIT1
TRICARE Plan Names
A. TRICARE for Life
B. TRICARE Plus
C. TRICARE Prime
D. TRICARE Extra
E. TRICARE Standard
F. TRICARE Pharmacy / TRICARE Senior
Pharmacy
G. TRICARE Dental Program
H. TRICARE Retiree Dental Program
I. TRICARE Reserve Select (TRS)
J. TRICARE US Family Health Plan
(continued)
Updated July 28, 2014

HIT1
Beneficiary Information Card
for TRICARE For Life
FRONT OF CARD
TRICARE For Life
To Provider: File claims in the usual manner to Medicare.
To Patient : Services that are a benefit of both Medicare and
TRICARE :No deductible or cost share is required.
Medicare only benefit :Medicare deductible and
cost share required.
TRICARE only benefit:TRICARE deductible and
cost share required.
For benefit questions call 1-888-DoD-LIFE

(1-888-363-5433)

www.tricare.osd.mil

For more information call 1-800-977-6753

www.hnfs.net

BACK OF CARD
TRICARE Senior Pharmacy
Military Treatment Facility: No Co-pay
National Mail Order Pharmacy: $3 generic;$9 brand name
(90 day supply)

TRICARE Network Pharmacy: $3 generic;$9 brand name
(30 day supply)

TRICARE Non-network Pharmacy: $9 or 20%of cost (30 day supply)
$150/person or $300/family
annual deductible applies.
For pharmacy questions call 1-877-DoD-MEDS

(1-877-363-6337)

(Co-pays subject to change)
5007334 (9/01 T85)

Updated July 28, 2014

HIT2
Places to Obtain Medicines in Tricare
Plan
 TRICARE Mail Order Pharmacy (TMOP)
 TRICARE Retail Pharmacy Network
Pharmacy (TRRx)
 Military Treatment Facility Pharmacy
(MTF)
 Non-network retail pharmacy

Updated July 28, 2014

HI6
• Prescribed medicines
• Visits to a doctor or other health
professional
• Lab work
• Inpatient hospital care
• Nursing home or long term care
• Dental care
• Optical or vision care
• Hearing care
• Behavioral health care (e.g., counseling,
psychotherapy, mental health and
substance use disorder services)
• Other services

Updated January 9, 2023

IA1
Monthly Mortgage Payments
A. Less than $250
B. $250 – less than $500
C. $500 – less than $1,000
D. $1,000 – less than $3,000
E. $3,000 – less than $5,000
F. $5,000 or more

Updated August 1, 2015

IA2
Present Value of
Home/Apartment/Condo
A. Less than $50,000
B. $50,000 – less than $75,000
C. $75,000 – less than $100,000
D. $100,000 – less than $200,000
E. $200,000 – less than $300,000
F. $300,000 – less than $500,000
G. $500,000 – less than $750,000

H. $750,000 or more

Updated August 1, 2015

IA3
Monthly Rent
A. Less than $250
B. $250 – less than $500
C. $500 – less than $1,000
D. $1,000 – less than $3,000
E. $3,000 – less than $5,000
F. $5,000 or more

Updated August 1, 2015

IA4
Retirement Plans
• 401(k)
• 403(b)
• IRA
• Keogh

Updated August 1, 2015

IA5

Combined Monthly Social
Security or Railroad Retirement
Amount
A. Less than $1,300
B. $1,300 – less than $1,700
C. $1,700 – less than $2,200
D. $2,200 – less than $2,600
E. $2,600 or more

Updated August 1, 2015

IA6

Individual Monthly Social
Security or Railroad
Retirement Amount
A. Less than $700
B. $700 – less than $1,000
C. $1,000 – less than $1,300
D. $1,300 – less than $1,600
E. $1,600 or more

Updated August 1, 2015

IA7

Combined Monthly
Supplemental Security
Income Amount
A. Less than $300
B. $300 – less than $700
C. $700 – less than $1,000
D. $1,000 or more

Updated August 1, 2015

IA8

Individual Monthly
Supplemental Security
Income Amount
A. Less than $100
B. $100 – less than $200
C. $200 – less than $400
D. $400 – less than $700
E. $700 or more

Updated August 1, 2015

IA9

Combined Monthly Veterans
Administration Income
Amount
A. Less than $1,000
B. $1,000 – less than $1,400
C. $1,400 – less than $1,800
D. $1,800 – less than $2,200
E. $2,200 or more

Updated August 1, 2015

IA10

Individual Monthly Veterans
Administration Income
Amount
A. Less than $500
B. $500 – less than $700
C. $700 – less than $900
D. $900 – less than $1,100
E. $1,100 or more

Updated August 1, 2015

IA11
Combined Monthly Pension
Payment
A. Less than $600
B. $600 – less than $1,300
C. $1,300 – less than $2,100
D. $2,100 – less than $5,900
E. $5,900 or more

Updated August 1, 2015

IA12
Individual Monthly Pension
Payment
A. Less than $400
B. $400 – less than $900
C. $900 – less than $1,600
D. $1,600 – less than $3,800
E. $3,800 or more

Updated August 1, 2015

IA13
Combined Total Retirement
Accounts
A. Less than $34,000
B. $34,000 – less than $82,000
C. $82,000 – less than $175,000
D. $175,000 – less than $413,000
E. $413,000 or more

Updated August 1, 2015

IA14
Individual Total Retirement
Accounts
A. Less than $20,000
B. $20,000 – less than $47,000
C. $47,000 – less than $92,000
D. $92,000 – less than $218,000
E. $218,000 or more

Updated August 1, 2015

IA15

Combined Monthly Amount
Received from Retirement
Account
A. Less than $200
B. $200 – less than $500
C. $500 – less than $1,000
D. $1,000 – less than $2,500
E. $2,500 or more

Updated August 1, 2015

IA16

Individual Monthly Amount
Received from Retirement
Account
A. Less than $100
B. $100 – less than $300
C. $300 – less than $700
D. $700 – less than $1,700
E. $1,700 or more

Updated August 1, 2015

IA17

Combined Amount Received
from Retirement Account Last
Year
A. Less than $2,400
B. $2,400 – less than $6,000
C. $6,000 – less than $12,000
D. $12,000 – less than $30,000
E. $30,000 or more

Updated August 1, 2015

IA18

Individual Amount Received
from Retirement Account Last
Year
A. Less than $1,200
B. $1,200 – less than $3,600
C. $3,600 – less than $8,400
D. $8,400 – less than $20,400
E. $20,400 or more

Updated August 1, 2015

IA19

Combined Mutual
Funds/Stocks/Bonds Not Part
of Retirement Account
A. Less than $9,000
B. $9,000 – less than $18,000
C. $18,000 – less than $93,000
D. $93,000 – less than $350,000
E. $350,000 or more

Updated August 1, 2015

IA20

IAQ35C- Mutual
Funds/Stocks/Bonds Not Part
of Retirement Account
A. Less than $600
B. $600 – less than $5,000
C. $5,000 – less than $16,000
D. $16,000 – less than $62,000
E. $62,000 or more

Updated August 1, 2015

IA21

IAC26A- Mutual
Funds/Stocks/Bonds Not Part
of Retirement Account
A. Less than $8,000
B. $8,000 – less than $62,000
C. $62,000 – less than $192,000
D. $192,000 – less than $213,000
E. $213,000 or more

Updated August 1, 2015

IA22

IAQ36C- Mutual
Funds/Stocks/Bonds Not Part
of Retirement Account
A. Less than $300
B. $300 – less than $2,500
C. $2,500 – less than $8,000
D. $8,000 – less than $37,000
E. $37,000 or more

Updated August 1, 2015

IA23
IAQ38B – All Accounts Last
Month
A. Less than $11,000
B. $11,000 – less than $25,000
C. $25,000 – less than $50,000
D. $50,000 – less than $108,000
E. $108,000 or more

Updated August 1, 2015

IA24
IAQ38C – All Accounts Last
Month
A. Less than $2,000
B. $2,000 – less than $7,000
C. $7,000 – less than $17,000
D. $17,000 – less than $57,000
E. $57,000 or more

Updated August 1, 2015

IA25
IAQ39B/IAQ40B – All Accounts
Last Month
A. Less than $8,000
B. $8,000 – less than $13,000
C. $13,000 – less than $28,000
D. $28,000 – less than $54,000
E. $54,000 or more

Updated August 1, 2015

IA26
IAQ39C/IAQ40C – All Accounts
Last Month
A. Less than $500
B. $500 – less than $1,900
C. $1,900 – less than $5,000
D. $5,000 – less than $20,000
E. $20,000 or more

Updated August 1, 2015

IA27
IAQ41 – Combined Interest and
Dividends Last Year
A. Less than $200
B. $200 – less than $1,000
C. $1,000 – less than $4,000
D. $4,000 – less than $16,000
E. $16,000 or more

Updated August 1, 2015

IA28
IAQ42B/IAQ43B – Individual
Interest and Dividend Income
A. Less than $400
B. $400 – less than $1,000
C. $1,000 – less than $2,000
D. $2,000 – less than $11,000
E. $11,000 or more

Updated August 1, 2015

IA29
IAQ44A – Value of Business,
Farm, or Real Estate
A. Less than $30,000
B. $30,000 – less than $101,000
C. $101,000 – less than $247,000
D. $247,000 – less than $703,000
E. $703,000 or more

Updated August 1, 2015

IA30
IAQ45B/IAQ46A – Value of
Business, Farm, or Real Estate
A. Less than $18,000
B. $18,000 – less than $68,000
C. $68,000 – less than $122,000
D. $122,000 – less than $293,000
E. $293,000 or more

Updated August 1, 2015

IA31
IAQ47B – Income from
Businesses or Property
A. Less than $3,600
B. $3,600 – less than $12,000
C. $12,000 – less than $25,000
D. $25,000 – less than $64,000
E. $64,000 or more

Updated August 1, 2015

IA32
IAQ48B/IAQ49B – Income from
Businesses or Property
A. Less than $3,600
B. $3,600 – less than $7,200
C. $7,200 – less than $14,000
D. $14,000 – less than $38,000
E. $38,000 or more

Updated August 1, 2015

IA33
IAQ51A – Total Combined
Income
A. Less than $5,000
B. $5,000 - less than $10,000
C. $10,000 - less than $15,000
D. $15,000 - less than $20,000
E. $20,000 - less than $25,000
F. $25,000 - less than $30,000
G. $30,000 - less than $40,000
H. $40,000 - less than $50,000
I.

$50,000 - less than $66,000

J. $66,000 - less than $109,000
K. $109,000 or more

Updated May 3, 2017

IA34
IAQ51B – Total Income
A. Less than $5,000
B. $5,000 - less than $10,000
C. $10,000 - less than $15,000
D. $15,000 - less than $20,000
E. $20,000 - less than $25,000
F. $25,000 - less than $30,000
G. $30,000 - less than $40,000
H. $40,000 - less than $50,000
I. $50,000 - less than $66,000
J. $66,000 - less than $109,000
K. $109,000 or more

Updated May 3, 2017

IA35
Lump Sum Payments
A. Insurance Settlement
B. Pension Settlement
C. Inheritance (or Trust)
D. Gift
E. Lawsuit

Updated May 4, 2016

IA36
Present Value of Vehicles
A. Less than $2,500
B. $2,500 – less than $5,000
C. $5,000 – less than $7,500
D. $7,500 – less than $10,000
E. $10,000 – less than $20,000
F. $20,000 or more

Updated May 4, 2016

IU1
Long Term Care Places
●

Skilled nursing homes

●

Intermediate care facilities

●

Board and care homes

●

Nursing home units in hospitals

●

Facilities for the intellectually disabled

●

Psychiatric facilities

●

Group homes

Updated January 10, 2018

KN1
● Very easy
● Somewhat easy
● Somewhat difficult
● Very difficult

Updated July 28, 2014

KN2
● Just about everything you need to know
● Most of what you need to know
● Some of what you need to know
● A little of what you need to know
● Almost none of what you need to know

Updated July 28, 2014

KN3
● Very interested
● Somewhat interested
● Not very interested
● Not at all interested

Updated January 13, 2016

KN4
● Very easy
● Somewhat easy
● Somewhat difficult
● Very difficult

Updated January 11, 2017

KN5
● At least once every year
● Once every few years
● Rarely
● Never
● Only once when first signed up for drug
plan
● Only once when first signed up for
Medicare
● Just signed up for Medicare

Updated January 11, 2017

KN6
● Completely agree
● Somewhat agree
● Somewhat disagree
● Completely disagree

Updated January 11, 2017

KN7
● Very satisfied
● Satisfied
● Dissatisfied
● Very Dissatisfied

Updated January 11, 2017

KN8

Updated January 9, 2023

KN9

● Very easy
● Somewhat easy
● Somewhat difficult
● Very difficult

Updated January 11, 2017

KN10
• Medicare Parts A and B (Original
Medicare)
• Medicare Part C, Medicare Advantage
(MA) Plans
• Medicare Part D, Medicare Prescription
Drug Plans (MPDPs)
• Medigap Plans

Updated January 8, 2020

MP1
Health Practitioners Who Are Not
Medical Doctors
● Acupuncturist
● Chiropractor
● Podiatrist (foot doctor)
● Homeopath
● Naturopath
● Any other kind of health provider who is
not a medical doctor

Updated January 9, 2019

MP2
Mental Health Professionals
• Psychiatrist
• Psychologist
• Clinical social worker
• Licensed professional counselor

Updated July 28, 2014

MP3
Therapists
• Physical therapist
• Speech therapist
• (Intravenous) I.V. therapist
• Massage therapist
• Occupational therapist
• Respiratory therapist

Updated July 28, 2014

MP4
Other Medical Persons
• Nurse
• Nurse practitioner
• Paramedic (not including ambulance
services)
• Physician's assistant

Updated July 28, 2014

MP5
Other Types of Medical Places
• Health clinic
• Neighborhood health center
• Rural health clinic
• Infirmary
• Mental health clinic
• Urgent care center
• Any other place

Updated July 28, 2014

MP6
• Didn't think the problem was serious
• Thought it would cost too much
• Trouble finding or getting to the doctor
• Time, schedule, or personal conflicts
• Thought doctor couldn’t do much about
the problem
• Was afraid of finding out what was wrong
• Doctor would not accept my insurance

Updated July 24, 2017

NA1
• 12 oz. beer
• 5 oz. glass of wine
• One and a half ounces of liquor

Updated August 3, 2016

OM1
Orthopedic Items
• Crutches
• Canes
• Wheelchairs
• Walkers
• Corrective shoes or inserts
• Support stockings
• Braces or supports

Updated July 28, 2014

OM2
Diabetic Equipment or Supplies
• Syringes
• Test paper
• Test strips
• Blood monitoring kits

Updated July 28, 2014

OM3
Prostheses
• Artificial leg or arm
• Mastectomy prosthesis
• Artificial or glass eye

Updated July 28, 2014

OM4
Other Medical Equipment and Supplies
• Portable commode or raised toilet seat
• Portable tub seat
• Special chair or cushion
• Hospital bed
• Ostomy supplies
• Incontinence supplies (such as depends,
serenity or other brands of disposable
undergarments, pads, or briefs)
• Bandages, dressings, tape supplies
• Pulmonary equipment (nebulizer, CPAP, etc.)

• Blood pressure equipment (such as cuffs or
monitors)

Updated July 28, 2014

OM5
Alterations Inside or Outside Home or
Car
• Ramps
• Handrails (other than tub handrails)
• Elevator or incline chair
• Tub seats
• Tub handrails
• Any car alteration

Updated July 28, 2014

PM1
• Thought it would cost too much
• Didn’t think medicine would help
condition
• Was afraid of medicine
reactions/contraindications
• Don’t like to take medicine
• Didn’t think medicine was necessary
• Not covered by insurance/not on plan
formulary
• Trouble obtaining medicine
• Obtained/used samples
• Used another medicine as a substitution

Updated July 24, 2017

PV1
• Less than 6 months ago
• 6 months to less than 1 year ago
• 1 year to less than 2 years ago
• 2 years ago to less than 5 years ago
• 5 or more years ago
• Never had blood pressure taken

Updated July 20, 2020

PV2
• Less than 6 months ago
• 6 months to less than 1 year ago
• 1 year to less than 2 years ago
• 2 years ago to less than 5 years ago
• 5 or more years ago
• Never had cholesterol checked

Updated July 20, 2020

PV3
●

It’s unlikely you’ve been exposed to HIV

●

You were afraid to find out if you were
HIV positive (that you had HIV)

●

Dr. did not prescribe or recommend it

●

You didn’t want to think about HIV or
about being HIV positive

●

You were worried your name would be
reported to the government if you tested
positive

●

You didn’t know where to get tested

●

You don’t like needles

●

You were afraid of losing job, insurance,
housing, friends, family, if people knew
you were positive for aids infection

●

Some other reason

●

No particular reason
Updated July 20, 2020

RX1
• Very easy
• Somewhat easy
• Somewhat difficult
• Very difficult

Updated July 28, 2014

RX2
• Just about everything you need to know
• Most of what you need to know
• Some of what you need to know
• A little of what you need to know
• Almost none of what you need to know

Updated July 28, 2014

RX3
• Very satisfied
• Satisfied
• Dissatisfied
• Very dissatisfied

Updated July 28, 2014

RX4
• Extremely confident
• Very confident
• Moderately confident
• Slightly confident
• Not confident

Updated July 28, 2014

RX5

● Often
● Sometimes
● Never

Updated May 2, 2018

SC1
• Very satisfied
• Satisfied
• Dissatisfied
• Very dissatisfied

Updated July 28, 2014

SC2

• Very Confident
• Confident
• Somewhat Confident
• Not At All Confident

Updated July 22, 2019

SC3

• Very Likely
• Likely
• Unlikely
• Very Unlikely

Updated July 22, 2019

SC4

• Always
• Usually
• Sometimes
• Never

Updated July 22, 2019

US1
• Allergy/immunology
• Anesthesiology
• Audiologist
• Cardiology (heart)
• Chiropractor
• Dentist
• Dermatology (skin)
• Endocrinology/metabolism (diabetes, thyroid)
• Family practice
• Gastroenterology
• General practice
• General surgery
• Geriatrics (elderly)
• Gynecology - obstetrics
• Hematology (blood)
• Hospital residence
(Continued)
Updated January 8, 2020

US1
• Internal medicine (internist)
• Nephrology (kidneys)
• Neurology
• Nuclear Medicine
• Nurse Practitioner
• Oncology (tumors, cancer)
• Ophthalmology (eyes)
• Optometrist
• Orthopedics
• Osteopathy (DO)
• Otorhinolaryngology (ear, nose, throat)
• Pain Management Specialist
• Pathology
• Phys med/rehab
• Physical Therapist
• Physician’s Assistant
(Continued)
Updated January 8, 2020

US1
• Plastic Surgery
• Podiatrist
• Proctology
• Psychiatry/psychiatrist
• Psychologist
• Pulmonary (lungs)
• Radiology
• Rheumatology (arthritis)

• Thoracic Surgery (chest)
• Urology
• Vascular Surgeon/Specialist

Updated January 8, 2020

US2
• Very Well
• Well
• Not Well
• Not at All

Updated January 10, 2018

US3
• Professional Interpreter
• Staff Person At Medical Provider’s
Office
• Family Member
• Friend
• Someone Else
• Does Best That Can In English
• No one helps; no trouble
communicating in English

Updated January 11, 2021

US4
• Never
• Sometimes
• Usually
• Always

Updated January 10, 2018

US5
• Yes, Definitely
• Yes, Somewhat
• No

Updated January 10, 2018

US6
• Strongly Agree
• Agree
• Disagree
• Strongly Disagree

Updated January 10, 2018

US7
0 Hard to Manage
1
2
3
4
5
6
7
8
9
10 Easy to Manage

Updated January 10, 2018

US8
• Much more than it should be

• Somewhat more than it should be
• About what it should be
• Somewhat less than it should be
• Much less than it should be
• No opinion

Updated January 8, 2020