Medication coverage guide
Fluticasone propionate (Flonase, Flovent and others)
Generic name: Fluticasone Propionate
What it is used for
A corticosteroid used as a nasal spray for allergies and sinus symptoms and as an inhaler for asthma; it lowers inflammation in the nose and airways.
Which part of Medicare may cover it
Part D (nasal spray or inhaler used at home). Part A during a covered inpatient stay. No Part B clinician-administered form in the CMS Part B spending file.
Medicare Advantage
Most Medicare Advantage plans that include drug coverage (MAPD plans) use the same formulary-and-tier system; the plan's own drug list decides coverage and copay — check the plan's formulary.
Medicare Supplement
Medicare Supplement (Medigap) plans sold today do not include prescription drug coverage; drug coverage comes from Part D or an MAPD plan.
Part D formulary figures for 2027
- Plans listing this drug
- 5,495 of 5,495
- Listing share
- 100%
- Most common tier
- Tier 2
- Share of listing plans at that tier
- 53.08%
Full tier distribution
| Tier | Plans |
|---|---|
| Tier 1 | 498 |
| Tier 2 | 2,917 |
| Tier 3 | 1,889 |
| Tier 4 | 191 |
CMS dashboard figures
Program averages from CMS dashboard data — average total spending across Part D (before rebates), NOT a reader's copay.
Fluticasone Propionate*
- Brand name
- Fluticasone Propionate*
- Generic name
- Fluticasone Propionate
- Total claims (2024)
- 12,849,868
- Total program spending (2024)
- 190,826,219.05
- Total beneficiaries (2024)
- 5,158,892
- Rank by beneficiaries (2024)
- 21
- Average spending per claim (2024)
- 14.85044197
- Average spending per beneficiary (2024)
- 36.989768161
- Average spending per dosage unit, weighted (2024)
- 0.6082934121
Fluticasone Propionate HFA
- Brand name
- Fluticasone Propionate HFA
- Generic name
- Fluticasone Propionate
- Total claims (2024)
- 312,596
- Total program spending (2024)
- 93,410,348.58
- Total beneficiaries (2024)
- 131,903
- Rank by beneficiaries (2024)
- 380
- Average spending per claim (2024)
- 298.82131755
- Average spending per beneficiary (2024)
- 708.17455691
- Average spending per dosage unit, weighted (2024)
- 20.698677265
Flovent HFA
- Brand name
- Flovent HFA
- Generic name
- Fluticasone Propionate
- Total claims (2024)
- 27,166
- Total program spending (2024)
- 9,043,531.54
- Total beneficiaries (2024)
- 20,884
- Rank by beneficiaries (2024)
- 783
- Average spending per claim (2024)
- 332.89890083
- Average spending per beneficiary (2024)
- 433.03636947
- Average spending per dosage unit, weighted (2024)
- 25.938763171
Xhance
- Brand name
- Xhance
- Generic name
- Fluticasone Propionate
- Total claims (2024)
- 25,053
- Total program spending (2024)
- 19,948,162.68
- Total beneficiaries (2024)
- 8,766
- Rank by beneficiaries (2024)
- 1,040
- Average spending per claim (2024)
- 796.23848162
- Average spending per beneficiary (2024)
- 2,275.6288706
- Average spending per dosage unit, weighted (2024)
- 37.715894091
Flovent Diskus
- Brand name
- Flovent Diskus
- Generic name
- Fluticasone Propionate
- Total claims (2024)
- 5,772
- Total program spending (2024)
- 1,456,813.4
- Total beneficiaries (2024)
- 4,207
- Rank by beneficiaries (2024)
- 1,258
- Average spending per claim (2024)
- 252.39317394
- Average spending per beneficiary (2024)
- 346.28319468
- Average spending per dosage unit, weighted (2024)
- 3.6820715543
Armonair Digihaler
- Brand name
- Armonair Digihaler
- Generic name
- Fluticasone Propionate
- Total claims (2024)
- 1,052
- Total program spending (2024)
- 335,851.17
- Total beneficiaries (2024)
- 521
- Rank by beneficiaries (2024)
- 2,081
- Average spending per claim (2024)
- 319.2501616
- Average spending per beneficiary (2024)
- 644.62796545
- Average spending per dosage unit, weighted (2024)
- 276.95088771
Part B status
No fluticasone propionate row in the CMS Part B Spending by Drug HCPCS file (RY26, data through 2024) — no J-code basis; coverage path is Part D.
Package notes
Dashboard rank 21 by beneficiaries 2024 (5,158,892 for the primary row); the same dashboard generic also carries inhaler rows (Fluticasone Propionate HFA, Flovent HFA, Flovent Diskus, Xhance, Armonair Digihaler), all carried in this package. Single-ingredient fluticasone propionate only: fluticasone combination inhalers (fluticasone-salmeterol, a separate package; fluticasone-vilanterol; fluticasone-umeclidinium-vilanterol) are different dashboard generics excluded by the combination rule, and fluticasone furoate is a different ingredient, not carried here.
Company rollup
Every organization below has at least one plan in the supplied plan-coverage file that lists this medication.
| Organization | Plans listing the drug | Tier range | Tier distribution |
|---|---|---|---|
| ABSOLUTE TOTAL CARE, INC. | 1 | Tier 1 | Tier 1: 1 |
| AETNA BETTER HEALTH INC. (CT) | 4 | Tier 2 | Tier 2: 4 |
| AETNA BETTER HEALTH INC. (GA) | 27 | Tier 2 | Tier 2: 27 |
| AETNA BETTER HEALTH INC. (NJ) | 1 | Tier 2 | Tier 2: 1 |
| AETNA BETTER HEALTH OF CALIFORNIA INC. | 8 | Tier 2 | Tier 2: 8 |
| AETNA BETTER HEALTH OF MICHIGAN INC. | 3 | Tier 2 | Tier 2: 3 |
| AETNA BETTER HEALTH OF OKLAHOMA INC. | 1 | Tier 2 | Tier 2: 1 |
| AETNA BETTER HEALTH OF TEXAS INC. | 6 | Tier 2 | Tier 2: 6 |
| AETNA BETTER HEALTH OF WASHINGTON, INC. | 2 | Tier 2 | Tier 2: 2 |
| AETNA BETTER HEALTH PREMIER PLAN MMAI INC. | 1 | Tier 2 | Tier 2: 1 |
| AETNA BETTER HEALTH, INC. (LA) | 16 | Tier 2 | Tier 2: 16 |
| AETNA HEALTH AND LIFE INSURANCE COMPANY | 20 | Tier 2 | Tier 2: 20 |
| AETNA HEALTH INC. (CT) | 6 | Tier 2 | Tier 2: 6 |
| AETNA HEALTH INC. (FL) | 49 | Tier 2 | Tier 2: 49 |
| AETNA HEALTH INC. (GA) | 7 | Tier 2 | Tier 2: 7 |
| AETNA HEALTH INC. (LA) | 1 | Tier 2 | Tier 2: 1 |
| AETNA HEALTH INC. (ME) | 5 | Tier 2 | Tier 2: 5 |
| AETNA HEALTH INC. (NJ) | 5 | Tier 2 | Tier 2: 5 |
| AETNA HEALTH INC. (NY) | 18 | Tier 2 | Tier 2: 18 |
| AETNA HEALTH INC. (PA) | 49 | Tier 2 | Tier 2: 49 |
| AETNA HEALTH INC. (TX) | 29 | Tier 2 | Tier 2: 29 |
| AETNA HEALTH OF CALIFORNIA INC. | 17 | Tier 2 | Tier 2: 17 |
| AETNA HEALTH OF IOWA INC. | 8 | Tier 2 | Tier 2: 8 |
| AETNA HEALTH OF MICHIGAN INC. | 12 | Tier 2 | Tier 2: 12 |
| AETNA HEALTH OF OHIO INC. | 24 | Tier 2 | Tier 2: 24 |
| AETNA HEALTH OF UTAH INC. | 2 | Tier 2 | Tier 2: 2 |
| AETNA LIFE INSURANCE COMPANY | 181 | Tier 2 | Tier 2: 181 |
| AIDS HEALTHCARE FOUNDATION | 1 | Tier 1 | Tier 1: 1 |
| ALAMEDA ALLIANCE FOR HEALTH | 1 | Tier 1 | Tier 1: 1 |
| ALIGN SENIOR CARE CALIFORNIA INC. | 3 | Tier 1 | Tier 1: 3 |
| ALIGN SENIOR CARE FLORIDA, INC. | 2 | Tier 1 | Tier 1: 2 |
| ALIGN SENIOR CARE IOWA INSURANCE COMPANY | 2 | Tier 1 | Tier 1: 2 |
| ALIGN SENIOR CARE MI, LLC | 2 | Tier 1 | Tier 1: 2 |
| ALIGNMENT HEALTH ADVANTAGE PLAN INC | 4 | Tier 2 | Tier 2: 4 |
| ALIGNMENT HEALTH ADVANTAGE PLAN INC. | 5 | Tier 2 | Tier 2: 5 |
| ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC | 10 | Tier 2 | Tier 2: 10 |
| ALIGNMENT HEALTH PLAN | 37 | Tier 2 | Tier 2: 37 |
| ALIGNMENT HEALTH PLAN OF ARIZONA, INC. | 7 | Tier 2 | Tier 2: 7 |
| ALIGNMENT HEALTH PLAN OF NEVADA, INC. | 4 | Tier 2 | Tier 2: 4 |
| ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | 10 | Tier 2 | Tier 2: 10 |
| ALLCARE HEALTH PLAN, INC. | 1 | Tier 1 | Tier 1: 1 |
| ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | 5 | Tier 2 | Tier 2: 5 |
| ALLINA HEALTH AND AETNA INSURANCE COMPANY | 7 | Tier 2 | Tier 2: 7 |
| ALOHACARE | 1 | Tier 2 | Tier 2: 1 |
| ALTERWOOD ADVANTAGE, INC. | 6 | Tier 2 | Tier 2: 6 |
| AMERICAN HEALTH PLAN OF FL, INC. | 1 | Tier 1 | Tier 1: 1 |
| AMERICAN HEALTH PLAN OF INDIANA INC | 3 | Tier 1 | Tier 1: 3 |
| AMERICAN HEALTH PLAN OF IOWA INC | 3 | Tier 1 | Tier 1: 3 |
| AMERICAN HEALTH PLAN OF MISSOURI, INC. | 2 | Tier 1 | Tier 1: 2 |
| AMERICAN HEALTH PLAN OF MS, INC. | 1 | Tier 1 | Tier 1: 1 |
| AMERICAN HEALTH PLAN OF PENNSYLVANIA INC | 1 | Tier 1 | Tier 1: 1 |
| AMERICAN HEALTH PLAN OF UT, INC. | 2 | Tier 1 | Tier 1: 2 |
| AMERICAN HEALTH PLAN, INC. | 1 | Tier 1 | Tier 1: 1 |
| AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY | 6 | Tier 1 | Tier 1: 6 |
| AMERIHEALTH CARITAS FLORIDA, INC. | 2 | Tier 2 | Tier 2: 2 |
| AMERIHEALTH CARITAS LOUISIANA, INC. | 1 | Tier 2 | Tier 2: 1 |
| AMERIHEALTH CARITAS NORTH CAROLINA, INC. | 1 | Tier 2 | Tier 2: 1 |
| AMERIHEALTH HMO, INC | 1 | Tier 2 | Tier 2: 1 |
| AMERIHEALTH INSURANCE COMPANY OF NEW JERSEY | 1 | Tier 2 | Tier 2: 1 |
| AMERIHEALTH MICHIGAN, INC. | 2 | Tier 2 | Tier 2: 2 |
| AMH HEALTH, LLC | 5 | Tier 2 | Tier 2: 5 |
| ANTHEM HEALTH PLANS, INC. | 6 | Tier 2 | Tier 2: 6 |
| ANTHEM HP, LLC. | 6 | Tier 2 | Tier 2: 6 |
| ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT | 2 | Tier 3 | Tier 3: 2 |
| ANTHEM INSURANCE COMPANIES, INC. | 27 | Tier 2 | Tier 2: 27 |
| ARCADIAN HEALTH PLAN, INC. | 71 | Tier 2 | Tier 2: 71 |
| ARIZONA PHYSICIANS IPA, INC. | 2 | Tier 3 | Tier 3: 2 |
| ARKANSAS HEALTH & WELLNESS HEALTH PLAN, INC. | 4 | Tier 1 | Tier 1: 4 |
| ARKANSAS SUPERIOR SELECT, INC. | 2 | Tier 1 | Tier 1: 2 |
| ASPIRE HEALTH PLAN | 4 | Tier 2 | Tier 2: 4 |
| ASTIVA HEALTH, INC. | 8 | Tier 4 | Tier 4: 8 |
| ATRIO HEALTH PLANS | 11 | Tier 2 | Tier 2: 11 |
| AULTCARE HEALTH INSURING CORPORATION | 3 | Tier 3 | Tier 3: 3 |
| AmeriHealth Caritas VIP Next, Inc. | 2 | Tier 2 | Tier 2: 2 |
| Anthem HP, LLC | 5 | Tier 2 | Tier 2: 5 |
| BANNER - UNIVERSITY CARE ADVANTAGE | 2 | Tier 1 | Tier 1: 2 |
| BANNER HEALTH PLAN, INC. | 1 | Tier 2 | Tier 2: 1 |
| BAYCARE SELECT HEALTH PLANS, INC. | 2 | Tier 2 | Tier 2: 2 |
| BCBS OF MASSACHUSETTS HMO BLUE, INC. | 7 | Tier 2 | Tier 2: 7 |
| BCBS OF ALABAMA & UTIC INSURANCE COMPANY | 2 | Tier 2–3 | Tier 2: 1 · Tier 3: 1 |
| BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY | 26 | Tier 3 | Tier 3: 26 |
| BCBSM, Inc. | 9 | Tier 2 | Tier 2: 9 |
| BESHP, INC. | 2 | Tier 2 | Tier 2: 2 |
| BLUE CARE NETWORK OF MICHIGAN | 15 | Tier 3 | Tier 3: 15 |
| BLUE CROSS & BLUE SHIELD OF RHODE ISLAND | 5 | Tier 2 | Tier 2: 5 |
| BLUE CROSS AND BLUE SHIELD OF ALABAMA | 3 | Tier 2 | Tier 2: 3 |
| BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC. | 14 | Tier 2–3 | Tier 2: 2 · Tier 3: 12 |
| BLUE CROSS AND BLUE SHIELD OF KANSAS | 3 | Tier 2–3 | Tier 2: 2 · Tier 3: 1 |
| BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 14 | Tier 2–3 | Tier 2: 12 · Tier 3: 2 |
| BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA | 4 | Tier 2 | Tier 2: 4 |
| BLUE CROSS OF CALIFORNIA | 18 | Tier 2 | Tier 2: 18 |
| BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN, INC. | 18 | Tier 2 | Tier 2: 18 |
| BLUE CROSS OF IDAHO HEALTH SERVICE, INC. | 6 | Tier 2 | Tier 2: 6 |
| BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA | 6 | Tier 2 | Tier 2: 6 |
| BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC. | 3 | Tier 2 | Tier 2: 3 |
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 19 | Tier 4 | Tier 4: 19 |
| BRAVO HEALTH MID-ATLANTIC, INC. | 5 | Tier 2 | Tier 2: 5 |
| BRAVO HEALTH PENNSYLVANIA, INC. | 31 | Tier 2 | Tier 2: 31 |
| BUCKEYE COMMUNITY HEALTH PLAN, INC. | 4 | Tier 1 | Tier 1: 4 |
| Baylor Scott & White Insurance Company | 3 | Tier 2 | Tier 2: 3 |
| Bridgeway Health Solutions of Arizona, Inc. | 2 | Tier 1 | Tier 1: 2 |
| CALIFORNIA PHYSICIANS' SERVICE | 20 | Tier 2 | Tier 2: 20 |
| CAPITAL ADVANTAGE INSURANCE COMPANY | 24 | Tier 2–3 | Tier 2: 2 · Tier 3: 22 |
| CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC. | 3 | Tier 2 | Tier 2: 3 |
| CAPITAL HEALTH PLAN | 4 | Tier 2 | Tier 2: 4 |
| CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO. | 204 | Tier 3 | Tier 3: 204 |
| CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA | 4 | Tier 2 | Tier 2: 4 |
| CAREFIRST ADVANTAGE DSNP, INC. | 1 | Tier 3 | Tier 3: 1 |
| CAREFIRST ADVANTAGE PPO, INC. | 4 | Tier 3 | Tier 3: 4 |
| CAREPLUS HEALTH PLANS, INC. | 37 | Tier 2 | Tier 2: 37 |
| CARESOURCE OHIO, INC. | 1 | Tier 1 | Tier 1: 1 |
| CARITEN HEALTH PLAN INC. | 51 | Tier 2 | Tier 2: 51 |
| CELTIC INSURANCE COMPANY | 3 | Tier 1 | Tier 1: 3 |
| CHA HMO, INC. | 47 | Tier 2 | Tier 2: 47 |
| CHAMPION HEALTH PLAN OF CALIFORNIA INC | 10 | Tier 2 | Tier 2: 10 |
| CHAMPION HEALTH PLAN OF NEVADA, INC. | 6 | Tier 2 | Tier 2: 6 |
| CHINESE COMMUNITY HEALTH PLAN | 4 | Tier 2 | Tier 2: 4 |
| CLEVER CARE OF GOLDEN STATE, INC. | 6 | Tier 2 | Tier 2: 6 |
| CLOVER HMO OF NEW JERSEY INC. | 2 | Tier 2 | Tier 2: 2 |
| CLOVER INSURANCE COMPANY | 11 | Tier 2 | Tier 2: 11 |
| COMMONWEALTH CARE ALLIANCE, INC. | 2 | Tier 1 | Tier 1: 2 |
| COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC. | 2 | Tier 2 | Tier 2: 2 |
| COMMUNITY CARE HEALTH PLAN, INC. | 1 | Tier 1 | Tier 1: 1 |
| COMMUNITY FIRST HEALTH PLANS, INC. | 3 | Tier 1 | Tier 1: 3 |
| COMMUNITY HEALTH CHOICE TEXAS, INC. | 5 | Tier 1 | Tier 1: 5 |
| COMMUNITY HEALTH GROUP | 2 | Tier 2 | Tier 2: 2 |
| COMMUNITY HEALTH PLAN OF WASHINGTON | 2 | Tier 2 | Tier 2: 2 |
| COMMUNITY INSURANCE COMPANY | 10 | Tier 2 | Tier 2: 10 |
| COMMUNITYCARE GOVERNMENT PROGRAMS, INC. | 4 | Tier 1 | Tier 1: 4 |
| COMPCARE HEALTH SERVICES INSURANCE CORPORATION | 16 | Tier 2 | Tier 2: 16 |
| CONTRA COSTA COUNTY MEDICAL SERVICE DBA CONTRA COSTA HEALTH | 1 | Tier 2 | Tier 2: 1 |
| COORDINATED CARE CORPORATION | 3 | Tier 1 | Tier 1: 3 |
| COORDINATED CARE OF WASHINGTON, INC. | 2 | Tier 1 | Tier 1: 2 |
| COVENTRY HEALTH AND LIFE INSURANCE COMPANY | 27 | Tier 2 | Tier 2: 27 |
| COVENTRY HEALTH CARE OF ILLINOIS, INC. | 14 | Tier 2 | Tier 2: 14 |
| COVENTRY HEALTH CARE OF KANSAS, INC. | 9 | Tier 2 | Tier 2: 9 |
| COVENTRY HEALTH CARE OF MISSOURI, INC. | 35 | Tier 2 | Tier 2: 35 |
| COVENTRY HEALTH CARE OF NEBRASKA, INC. | 3 | Tier 2 | Tier 2: 3 |
| COVENTRY HEALTH CARE OF VIRGINIA, INC. | 1 | Tier 2 | Tier 2: 1 |
| COVENTRY HEALTH CARE OF WEST VIRGINIA, INC. | 6 | Tier 2 | Tier 2: 6 |
| COX HEALTH SYSTEMS HMO INC | 3 | Tier 4 | Tier 4: 3 |
| California Physicians' Service | 2 | Tier 2 | Tier 2: 2 |
| DEAN HEALTH PLAN, INC. | 4 | Tier 2 | Tier 2: 4 |
| DENVER HEALTH MEDICAL PLAN, INC. | 2 | Tier 2 | Tier 2: 2 |
| DEVOTED HEALTH PLAN OF OREGON | 1 | Tier 3 | Tier 3: 1 |
| DEVOTED HEALTH INSURANCE COMPANY | 5 | Tier 3 | Tier 3: 5 |
| DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC | 12 | Tier 3 | Tier 3: 12 |
| DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC. | 4 | Tier 3 | Tier 3: 4 |
| DEVOTED HEALTH INSURANCE COMPANY OF ARKANSAS INC | 10 | Tier 3 | Tier 3: 10 |
| DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC | 4 | Tier 3 | Tier 3: 4 |
| DEVOTED HEALTH INSURANCE COMPANY OF CONNECTICUT | 12 | Tier 3 | Tier 3: 12 |
| DEVOTED HEALTH INSURANCE COMPANY OF DELAWARE | 5 | Tier 3 | Tier 3: 5 |
| DEVOTED HEALTH INSURANCE COMPANY OF GEORGIA INC | 16 | Tier 3 | Tier 3: 16 |
| DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC | 9 | Tier 3 | Tier 3: 9 |
| DEVOTED HEALTH INSURANCE COMPANY OF INDIANA | 23 | Tier 3 | Tier 3: 23 |
| DEVOTED HEALTH INSURANCE COMPANY OF KANSAS | 11 | Tier 3 | Tier 3: 11 |
| DEVOTED HEALTH INSURANCE COMPANY OF KENTUCKY INC | 10 | Tier 3 | Tier 3: 10 |
| DEVOTED HEALTH INSURANCE COMPANY OF LOUISIANA | 23 | Tier 3 | Tier 3: 23 |
| DEVOTED HEALTH INSURANCE COMPANY OF MICHIGAN | 12 | Tier 3 | Tier 3: 12 |
| DEVOTED HEALTH INSURANCE COMPANY OF MISSISSIPPI | 10 | Tier 3 | Tier 3: 10 |
| DEVOTED HEALTH INSURANCE COMPANY OF MISSOURI | 4 | Tier 3 | Tier 3: 4 |
| DEVOTED HEALTH INSURANCE COMPANY OF NEBRASKA | 8 | Tier 3 | Tier 3: 8 |
| DEVOTED HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE | 6 | Tier 3 | Tier 3: 6 |
| DEVOTED HEALTH INSURANCE COMPANY OF NEW JERSEY | 6 | Tier 3 | Tier 3: 6 |
| DEVOTED HEALTH INSURANCE COMPANY OF NEW YORK | 23 | Tier 3 | Tier 3: 23 |
| DEVOTED HEALTH INSURANCE COMPANY OF OKLAHOMA | 12 | Tier 3 | Tier 3: 12 |
| DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC | 5 | Tier 3 | Tier 3: 5 |
| DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC | 43 | Tier 3 | Tier 3: 43 |
| DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC | 7 | Tier 3 | Tier 3: 7 |
| DEVOTED HEALTH INSURANCE COMPANY OF TEXAS | 1 | Tier 3 | Tier 3: 1 |
| DEVOTED HEALTH INSURANCE COMPANY OF UTAH, INC. | 7 | Tier 3 | Tier 3: 7 |
| DEVOTED HEALTH INSURANCE COMPANY OF WASHINGTON | 4 | Tier 3 | Tier 3: 4 |
| DEVOTED HEALTH PLAN OF ALABAMA INC | 6 | Tier 3 | Tier 3: 6 |
| DEVOTED HEALTH PLAN OF ARIZONA, INC. | 12 | Tier 2–3 | Tier 2: 2 · Tier 3: 10 |
| DEVOTED HEALTH PLAN OF COLORADO INC | 17 | Tier 3 | Tier 3: 17 |
| DEVOTED HEALTH PLAN OF FLORIDA, INC. | 100 | Tier 2–3 | Tier 2: 30 · Tier 3: 70 |
| DEVOTED HEALTH PLAN OF HAWAII, INC. | 9 | Tier 3 | Tier 3: 9 |
| DEVOTED HEALTH PLAN OF ILLINOIS, INC. | 6 | Tier 3 | Tier 3: 6 |
| DEVOTED HEALTH PLAN OF MISSOURI INC | 27 | Tier 3 | Tier 3: 27 |
| DEVOTED HEALTH PLAN OF NEW MEXICO, INC. | 11 | Tier 3 | Tier 3: 11 |
| DEVOTED HEALTH PLAN OF NORTH CAROLINA INC | 36 | Tier 3 | Tier 3: 36 |
| DEVOTED HEALTH PLAN OF OHIO INC | 2 | Tier 3 | Tier 3: 2 |
| DEVOTED HEALTH PLAN OF OHIO, INC. | 20 | Tier 3 | Tier 3: 20 |
| DEVOTED HEALTH PLAN OF OREGON INC | 22 | Tier 3 | Tier 3: 22 |
| DEVOTED HEALTH PLAN OF PENNSYLVANIA INC | 30 | Tier 3 | Tier 3: 30 |
| DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC | 1 | Tier 3 | Tier 3: 1 |
| DEVOTED HEALTH PLAN OF TENNESSEE INC | 9 | Tier 3 | Tier 3: 9 |
| DEVOTED HEALTH PLAN OF TEXAS, INC. | 75 | Tier 3 | Tier 3: 75 |
| DEVOTED HEALTH PLAN OF VIRGINIA INC | 16 | Tier 3 | Tier 3: 16 |
| DEVOTED HEALTH PLAN OF WASHINGTON, INC. | 18 | Tier 3 | Tier 3: 18 |
| DIGNITY CARE CORPORATION | 2 | Tier 1 | Tier 1: 2 |
| DOCTORS HEALTHCARE PLANS, INC. | 9 | Tier 2 | Tier 2: 9 |
| Devoted Health Insurance Company of Illinois, Inc. | 2 | Tier 3 | Tier 3: 2 |
| Devoted of Illinois, Inc. | 16 | Tier 3 | Tier 3: 16 |
| EL PASO FIRST HEALTH PLANS, INC. | 4 | Tier 1 | Tier 1: 4 |
| ELDERPLAN, INC. | 4 | Tier 1–3 | Tier 1: 3 · Tier 3: 1 |
| ELDERSERVE HEALTH, INC. | 2 | Tier 1 | Tier 1: 2 |
| ELITE HEALTH PLAN, INC. | 2 | Tier 4 | Tier 4: 2 |
| EMPHESYS INSURANCE COMPANY | 111 | Tier 2 | Tier 2: 111 |
| ESSENCE HEALTHCARE PPO, INC. | 7 | Tier 2 | Tier 2: 7 |
| ESSENCE HEALTHCARE, INC. | 7 | Tier 2 | Tier 2: 7 |
| ETERNALHEALTH OF ARIZONA INC | 3 | Tier 2 | Tier 2: 3 |
| ETERNALHEALTH, INC. | 3 | Tier 2 | Tier 2: 3 |
| EXCELLUS HEALTH PLAN COMMUNITY CARE LLC | 4 | Tier 2 | Tier 2: 4 |
| EXCELLUS HEALTH PLAN, INC. | 14 | Tier 2 | Tier 2: 14 |
| FALLON COMMUNITY HEALTH PLAN | 12 | Tier 1–3 | Tier 1: 2 · Tier 3: 10 |
| FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY | 1 | Tier 2 | Tier 2: 1 |
| FLORIDA BLUE MEDICARE, INC. | 20 | Tier 2–3 | Tier 2: 2 · Tier 3: 18 |
| FREEDOM HEALTH, INC. | 24 | Tier 1 | Tier 1: 24 |
| GATEWAY HEALTH PLAN, INC. | 4 | Tier 2 | Tier 2: 4 |
| GEISINGER HEALTH PLAN | 9 | Tier 3 | Tier 3: 9 |
| GEISINGER INDEMNITY INSURANCE COMPANY | 4 | Tier 3 | Tier 3: 4 |
| GEORGIA ASSURANCE, INC. | 2 | Tier 1 | Tier 1: 2 |
| GLOBALHEALTH, INC. | 6 | Tier 4 | Tier 4: 6 |
| GOLD KIDNEY OF ARIZONA | 6 | Tier 1–2 | Tier 1: 1 · Tier 2: 5 |
| GOLD KIDNEY OF FLORIDA INC | 9 | Tier 1–2 | Tier 1: 2 · Tier 2: 7 |
| GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC. | 2 | Tier 2 | Tier 2: 2 |
| GROUP HEALTH COOPERATIVE OF EAU CLAIRE | 2 | Tier 2 | Tier 2: 2 |
| HAMASPIK, INC. | 2 | Tier 1 | Tier 1: 2 |
| HAP CARESOURCE | 1 | Tier 2 | Tier 2: 1 |
| HARMONY HEALTH PLAN, INC. | 14 | Tier 1 | Tier 1: 14 |
| HAWAII MEDICAL SERVICE ASSOCIATION | 4 | Tier 3 | Tier 3: 4 |
| HAWAII MEDICAL SERVICE ASSOCIATION (HMSA) | 2 | Tier 1–3 | Tier 1: 1 · Tier 3: 1 |
| HEALTH ALLIANCE PLAN OF MICHIGAN | 7 | Tier 2 | Tier 2: 7 |
| HEALTH CARE SERVICE CORPORATION | 5 | Tier 2 | Tier 2: 5 |
| HEALTH CHOICE ARIZONA, INC. | 1 | Tier 1 | Tier 1: 1 |
| HEALTH FIRST HEALTH PLANS | 6 | Tier 2 | Tier 2: 6 |
| HEALTH INSURANCE PLAN OF GREATER NEW YORK | 9 | Tier 2 | Tier 2: 9 |
| HEALTH NET COMMUNITY SOLUTIONS, INC. | 4 | Tier 1 | Tier 1: 4 |
| HEALTH NET HEALTH PLAN OF OREGON, INC. | 2 | Tier 1 | Tier 1: 2 |
| HEALTH NET LIFE INSURANCE COMPANY | 4 | Tier 1 | Tier 1: 4 |
| HEALTH NET OF ARIZONA, INC. | 5 | Tier 1 | Tier 1: 5 |
| HEALTH NET OF CALIFORNIA, INC. | 8 | Tier 1 | Tier 1: 8 |
| HEALTH NEW ENGLAND, INC. | 6 | Tier 2 | Tier 2: 6 |
| HEALTH PARTNERS PLANS, INC. | 7 | Tier 2 | Tier 2: 7 |
| HEALTH PLAN OF CAREOREGON, INC. | 1 | Tier 2 | Tier 2: 1 |
| HEALTHFIRST HEALTH PLAN, INC. | 7 | Tier 1–3 | Tier 1: 1 · Tier 3: 6 |
| HEALTHFIRST INSURANCE COMPANY, INC. | 1 | Tier 3 | Tier 3: 1 |
| HEALTHKEEPERS, INC. | 22 | Tier 2 | Tier 2: 22 |
| HEALTHPARTNERS INSURANCE COMPANY | 2 | Tier 3 | Tier 3: 2 |
| HEALTHPARTNERS, INC. | 5 | Tier 3 | Tier 3: 5 |
| HEALTHSPRING HEALTHCARE OF COLORADO, INC. | 5 | Tier 2 | Tier 2: 5 |
| HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | 135 | Tier 2 | Tier 2: 135 |
| HEALTHSPRING OF FLORIDA, INC. | 10 | Tier 2 | Tier 2: 10 |
| HEALTHSUN HEALTH PLANS, INC. | 11 | Tier 2 | Tier 2: 11 |
| HEALTHY ARKANSAS, INC. | 3 | Tier 2 | Tier 2: 3 |
| HEALTHY MISSISSIPPI, INC. | 3 | Tier 2 | Tier 2: 3 |
| HIGHMARK BCBSD INC. | 3 | Tier 4 | Tier 4: 3 |
| HIGHMARK BCBSD, INC. | 2 | Tier 2 | Tier 2: 2 |
| HIGHMARK CHOICE COMPANY | 31 | Tier 4 | Tier 4: 31 |
| HIGHMARK HEALTH OPTIONS WEST VIRGINIA INC. | 1 | Tier 2 | Tier 2: 1 |
| HIGHMARK SENIOR HEALTH COMPANY | 38 | Tier 4 | Tier 4: 38 |
| HIGHMARK SENIOR SOLUTIONS COMPANY | 8 | Tier 4 | Tier 4: 8 |
| HMO COLORADO, INC. | 11 | Tier 2 | Tier 2: 11 |
| HMO LOUISIANA, INC. | 9 | Tier 2 | Tier 2: 9 |
| HMO Minnesota | 1 | Tier 2 | Tier 2: 1 |
| HOME STATE HEALTH PLAN, INC. | 3 | Tier 1 | Tier 1: 3 |
| HOPKINS HEALTH ADVANTAGE, INC. | 6 | Tier 1–3 | Tier 1: 2 · Tier 2: 3 · Tier 3: 1 |
| HORIZON HEALTHCARE OF NEW JERSEY, INC. | 2 | Tier 1–2 | Tier 1: 1 · Tier 2: 1 |
| HORIZON INSURANCE COMPANY | 2 | Tier 2–3 | Tier 2: 1 · Tier 3: 1 |
| HPMP OF FLORIDA, INC. | 5 | Tier 2 | Tier 2: 5 |
| HUMANA BENEFIT PLAN OF ILLINOIS, INC. | 33 | Tier 2 | Tier 2: 33 |
| HUMANA BENEFIT PLAN OF SOUTH CAROLINA, INC. | 1 | Tier 2 | Tier 2: 1 |
| HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC. | 7 | Tier 2 | Tier 2: 7 |
| HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC. | 23 | Tier 2 | Tier 2: 23 |
| HUMANA HEALTH COMPANY OF NEW YORK, INC. | 5 | Tier 2 | Tier 2: 5 |
| HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC. | 6 | Tier 2 | Tier 2: 6 |
| HUMANA HEALTH PLAN OF CALIFORNIA, INC. | 2 | Tier 2 | Tier 2: 2 |
| HUMANA HEALTH PLAN OF OHIO, INC. | 4 | Tier 2 | Tier 2: 4 |
| HUMANA HEALTH PLAN OF TEXAS, INC. | 1 | Tier 2 | Tier 2: 1 |
| HUMANA HEALTH PLAN, INC. | 3 | Tier 2 | Tier 2: 3 |
| HUMANA INSURANCE COMPANY | 221 | Tier 2 | Tier 2: 221 |
| HUMANA INSURANCE COMPANY OF KENTUCKY | 3 | Tier 2 | Tier 2: 3 |
| HUMANA INSURANCE COMPANY OF NEW YORK | 2 | Tier 2 | Tier 2: 2 |
| HUMANA MEDICAL PLAN OF MICHIGAN, INC. | 4 | Tier 2 | Tier 2: 4 |
| HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC. | 2 | Tier 2 | Tier 2: 2 |
| HUMANA MEDICAL PLAN OF UTAH, INC. | 2 | Tier 2 | Tier 2: 2 |
| HUMANA MEDICAL PLAN, INC. | 84 | Tier 2 | Tier 2: 84 |
| HUMANA REGIONAL HEALTH PLAN, INC. | 2 | Tier 2 | Tier 2: 2 |
| HUMANA WI HEALTH ORGANIZATION INSURANCE CORP | 58 | Tier 2 | Tier 2: 58 |
| HUMANADENTAL INSURANCE COMPANY | 1 | Tier 2 | Tier 2: 1 |
| HealthKeepers, Inc. | 4 | Tier 2 | Tier 2: 4 |
| Healthy Mississippi, Inc. | 1 | Tier 2 | Tier 2: 1 |
| Highmark Western and Northeastern New York Inc. | 11 | Tier 4 | Tier 4: 11 |
| Humana Insurance Co. & Humana Insurance Co. of NY | 102 | Tier 2 | Tier 2: 102 |
| IMPERIAL COUNTY LOCAL HEALTH AUTHORITY | 1 | Tier 2 | Tier 2: 1 |
| IMPERIAL HEALTH PLAN OF CALIFORNIA, INC. | 3 | Tier 4 | Tier 4: 3 |
| INDEPENDENT CARE HEALTH PLAN | 1 | Tier 2 | Tier 2: 1 |
| INDEPENDENT HEALTH ASSOCIATION, INC. | 5 | Tier 2–3 | Tier 2: 3 · Tier 3: 2 |
| INDEPENDENT HEALTH BENEFITS CORPORATION | 1 | Tier 3 | Tier 3: 1 |
| ISNP VENTURES, LLC | 2 | Tier 1 | Tier 1: 2 |
| ITASCA MEDICAL CARE | 1 | Tier 3 | Tier 3: 1 |
| Inland Empire Health Plan | 1 | Tier 1 | Tier 1: 1 |
| JOHNS HOPKINS HEALTH PLAN OF VIRGINIA, INC. | 1 | Tier 3 | Tier 3: 1 |
| KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES | 19 | Tier 2 | Tier 2: 19 |
| KAISER FOUNDATION HEALTH PLAN OF NEVADA | 3 | Tier 2 | Tier 2: 3 |
| KAISER FOUNDATION HEALTH PLAN OF WASHINGTON | 13 | Tier 2 | Tier 2: 13 |
| KAISER FOUNDATION HP OF CO | 11 | Tier 2 | Tier 2: 11 |
| KAISER FOUNDATION HP OF GA, INC. | 8 | Tier 2 | Tier 2: 8 |
| KAISER FOUNDATION HP OF THE N W | 4 | Tier 2 | Tier 2: 4 |
| KAISER FOUNDATION HP, INC. | 54 | Tier 2 | Tier 2: 54 |
| KANSAS SUPERIOR SELECT, INC. | 2 | Tier 1 | Tier 1: 2 |
| KERN HEALTH SYSTEMS | 1 | Tier 2 | Tier 2: 1 |
| KEYSTONE HEALTH PLAN CENTRAL, INC. | 11 | Tier 2–3 | Tier 2: 6 · Tier 3: 5 |
| KEYSTONE HEALTH PLAN EAST, INC. | 9 | Tier 2 | Tier 2: 9 |
| KS PLAN ADMINISTRATORS, LLC | 2 | Tier 2 | Tier 2: 2 |
| LAGNIAPPE ADVANTAGE INSURANCE COMPANY | 1 | Tier 1 | Tier 1: 1 |
| LEON HEALTH, INC. | 4 | Tier 1 | Tier 1: 4 |
| LIBERTY ADVANTAGE, LLC | 3 | Tier 1 | Tier 1: 3 |
| LIFEWORKS ADVANTAGE, LLC | 2 | Tier 1 | Tier 1: 2 |
| LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY | 1 | Tier 2 | Tier 2: 1 |
| LONGEVITY HEALTH PLAN OF COLORADO, INC. | 1 | Tier 1 | Tier 1: 1 |
| LONGEVITY HEALTH PLAN OF FLORIDA, INC. | 1 | Tier 1 | Tier 1: 1 |
| LONGEVITY HEALTH PLAN OF ILLINOIS, INC. | 1 | Tier 1 | Tier 1: 1 |
| LONGEVITY HEALTH PLAN OF MICHIGAN, INC. | 1 | Tier 1 | Tier 1: 1 |
| LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP | 2 | Tier 1 | Tier 1: 2 |
| LONGEVITY HEALTH PLAN OF NEW YORK, INC. | 1 | Tier 1 | Tier 1: 1 |
| LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC. | 1 | Tier 1 | Tier 1: 1 |
| LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY | 3 | Tier 2 | Tier 2: 3 |
| MANAGED HEALTH SERVICES INSURANCE CORP. | 3 | Tier 1 | Tier 1: 3 |
| MARQUIS ADVANTAGE, INC. | 3 | Tier 1 | Tier 1: 3 |
| MARTIN'S POINT GENERATIONS ADVANTAGE, INC. | 8 | Tier 2–3 | Tier 2: 2 · Tier 3: 6 |
| MASS GENERAL BRIGHAM HEALTH PLAN, INC | 2 | Tier 1 | Tier 1: 2 |
| MCLAREN HEALTH PLAN, INC. | 3 | Tier 2 | Tier 2: 3 |
| MCS ADVANTAGE, INC. | 20 | Tier 4 | Tier 4: 20 |
| MEDCARE PARTNERS HEALTH PLAN OF TEXAS, LLC | 3 | Tier 4 | Tier 4: 3 |
| MEDCO CONTAINMENT LIFE & MEDCO CONTAINMENT NY & HEALTH CARE | 40 | Tier 2–3 | Tier 2: 35 · Tier 3: 5 |
| MEDICA HEALTH PLANS | 23 | Tier 2 | Tier 2: 23 |
| MEDICA INSURANCE COMPANY | 4 | Tier 2 | Tier 2: 4 |
| MEDICAL MUTUAL OF OHIO | 16 | Tier 2 | Tier 2: 16 |
| MEDISUN, INC. | 5 | Tier 2–3 | Tier 2: 3 · Tier 3: 2 |
| MERCY CARE | 3 | Tier 1 | Tier 1: 3 |
| MERIDIAN HEALTH PLAN OF ILLINOIS, INC. | 4 | Tier 1 | Tier 1: 4 |
| MERIDIAN HEALTH PLAN OF MICHIGAN, INC. | 6 | Tier 1 | Tier 1: 6 |
| METROPLUS HEALTH PLAN, INC. | 3 | Tier 1–3 | Tier 1: 2 · Tier 3: 1 |
| MISSOURI CARE, INCORPORATED | 2 | Tier 2 | Tier 2: 2 |
| MMM HEALTHCARE, LLC | 24 | Tier 2 | Tier 2: 24 |
| MOLINA HEALTHCARE OF ARIZONA, INC. | 1 | Tier 3 | Tier 3: 1 |
| MOLINA HEALTHCARE OF CALIFORNIA | 4 | Tier 3 | Tier 3: 4 |
| MOLINA HEALTHCARE OF ILLINOIS, INC. | 1 | Tier 3 | Tier 3: 1 |
| MOLINA HEALTHCARE OF IOWA, INC. | 2 | Tier 3 | Tier 3: 2 |
| MOLINA HEALTHCARE OF KENTUCKY, INC. | 3 | Tier 3 | Tier 3: 3 |
| MOLINA HEALTHCARE OF MICHIGAN, INC. | 3 | Tier 3 | Tier 3: 3 |
| MOLINA HEALTHCARE OF NEBRASKA, INC. | 2 | Tier 3 | Tier 3: 2 |
| MOLINA HEALTHCARE OF NEW MEXICO, INC. | 1 | Tier 3 | Tier 3: 1 |
| MOLINA HEALTHCARE OF OHIO, INC. | 2 | Tier 3 | Tier 3: 2 |
| MOLINA HEALTHCARE OF SOUTH CAROLINA,INC | 2 | Tier 3 | Tier 3: 2 |
| MOLINA HEALTHCARE OF TEXAS, INC. | 7 | Tier 3 | Tier 3: 7 |
| MOLINA HEALTHCARE OF UTAH, INC. | 3 | Tier 3 | Tier 3: 3 |
| MOLINA HEALTHCARE OF WASHINGTON, INC. | 3 | Tier 3 | Tier 3: 3 |
| MOUNT CARMEL HEALTH INSURANCE COMPANY | 1 | Tier 3 | Tier 3: 1 |
| MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC. | 2 | Tier 3 | Tier 3: 2 |
| MOUNT CARMEL HEALTH PLAN, INC. | 9 | Tier 3 | Tier 3: 9 |
| MULTICARE HEALTH PLAN | 2 | Tier 1 | Tier 1: 2 |
| MVP HEALTH PLAN, INC. | 8 | Tier 3 | Tier 3: 8 |
| Mass General Brigham Health Plan, Inc. | 3 | Tier 2 | Tier 2: 3 |
| Molina Healthcare of Wisconsin, Inc. | 4 | Tier 3 | Tier 3: 4 |
| NATIVE ADVANTAGE, INC. | 1 | Tier 1 | Tier 1: 1 |
| NEBRASKA TOTAL CARE, INC. | 3 | Tier 1 | Tier 1: 3 |
| NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND | 2 | Tier 3 | Tier 3: 2 |
| NETWORK HEALTH INSURANCE CORPORATION | 7 | Tier 3 | Tier 3: 7 |
| NEW CENTURY HEALTH PLAN, INC. | 2 | Tier 2 | Tier 2: 2 |
| NEW YORK QUALITY HEALTHCARE CORPORATION | 7 | Tier 1 | Tier 1: 7 |
| NHC ADVANTAGE, LLC | 2 | Tier 1 | Tier 1: 2 |
| OH CHS SNP INC. | 4 | Tier 1 | Tier 1: 4 |
| OKLAHOMA SUPERIOR SELECT, INC. | 1 | Tier 1 | Tier 1: 1 |
| OPTIMUM HEALTHCARE, INC. | 13 | Tier 1 | Tier 1: 13 |
| ORANGE COUNTY HEALTH AUTHORITY | 1 | Tier 1 | Tier 1: 1 |
| OXFORD HEALTH PLANS (NJ), INC. | 5 | Tier 3 | Tier 3: 5 |
| PACIFICSOURCE COMMUNITY HEALTH PLANS | 5 | Tier 3 | Tier 3: 5 |
| PARTNERS INSURANCE COMPANY INC | 2 | Tier 2 | Tier 2: 2 |
| PARTNERS INSURANCE COMPANY OF NEW JERSEY INC | 1 | Tier 2 | Tier 2: 1 |
| PEAK HEALTH INSURANCE CORPORATION | 9 | Tier 1 | Tier 1: 9 |
| PENNSYLVANIA HEALTH & WELLNESS, INC. | 3 | Tier 1 | Tier 1: 3 |
| PEOPLES HEALTH, INC. | 18 | Tier 3 | Tier 3: 18 |
| PERENNIAL ADVANTAGE OF COLORADO, INC. | 6 | Tier 1 | Tier 1: 6 |
| PERENNIAL ADVANTAGE OF OHIO, INC. | 3 | Tier 1 | Tier 1: 3 |
| PHYSICIANS HEALTH CHOICE OF TEXAS, LLC | 23 | Tier 3 | Tier 3: 23 |
| PREFERRED CARE PARTNERS, INC. | 32 | Tier 3 | Tier 3: 32 |
| PRESBYTERIAN HEALTH PLAN | 3 | Tier 3 | Tier 3: 3 |
| PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE | 2 | Tier 1 | Tier 1: 2 |
| PRIORITY HEALTH | 35 | Tier 2 | Tier 2: 35 |
| PRIORITY HEALTH CHOICE, INC. | 5 | Tier 2 | Tier 2: 5 |
| PROCARE ADVANTAGE, LLC | 3 | Tier 1 | Tier 1: 3 |
| PROMINENCE HEALTHFIRST | 10 | Tier 2 | Tier 2: 10 |
| PROMINENCE HEALTHFIRST OF FLORIDA INC | 6 | Tier 2 | Tier 2: 6 |
| PROMINENCE HEALTHFIRST OF TEXAS | 13 | Tier 2 | Tier 2: 13 |
| PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS | 1 | Tier 1 | Tier 1: 1 |
| PROVIDER PARTNERS HEALTH PLAN OF INDIANA | 3 | Tier 1 | Tier 1: 3 |
| PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | 3 | Tier 1 | Tier 1: 3 |
| PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | 3 | Tier 1 | Tier 1: 3 |
| PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | 3 | Tier 1 | Tier 1: 3 |
| PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC. | 1 | Tier 1 | Tier 1: 1 |
| PRUITTHEALTH PREMIER NORTH CAROLINA, LLC | 3 | Tier 1 | Tier 1: 3 |
| PRUITTHEALTH PREMIER, INC. | 3 | Tier 1 | Tier 1: 3 |
| Preferred Care Network, Inc. | 3 | Tier 3 | Tier 3: 3 |
| QCC INSURANCE COMPANY | 3 | Tier 2 | Tier 2: 3 |
| QUARTZ HEALTH PLAN CORPORATION | 10 | Tier 2 | Tier 2: 10 |
| QUARTZ HEALTH PLAN MN CORPORATION | 4 | Tier 2 | Tier 2: 4 |
| RANGE HEALTH, INC. | 4 | Tier 2 | Tier 2: 4 |
| REGENCE BLUECROSS BLUESHIELD OF OREGON | 9 | Tier 2 | Tier 2: 9 |
| REGENCE BLUECROSS BLUESHIELD OF UTAH | 2 | Tier 2 | Tier 2: 2 |
| REGENCE BLUESHIELD | 2 | Tier 2 | Tier 2: 2 |
| SAMARITAN HEALTH PLANS, INC. | 1 | Tier 3 | Tier 3: 1 |
| SAN FRANCISCO HEALTH AUTHORITY DBA SAN FRANCISCO HEALTH PLAN | 1 | Tier 4 | Tier 4: 1 |
| SAN JOAQUIN COUNTY HEALTH COMMISSION | 1 | Tier 2 | Tier 2: 1 |
| SAN MATEO HEALTH COMMISSION | 1 | Tier 1 | Tier 1: 1 |
| SANFORD HEALTH PLAN | 4 | Tier 2 | Tier 2: 4 |
| SANFORD HEALTH PLAN OF MINNESOTA | 2 | Tier 2 | Tier 2: 2 |
| SANTA BARBARA SAN LUIS OBISPO REGIONAL HEALTH AUTHORITY DBA | 1 | Tier 4 | Tier 4: 1 |
| SANTA CLARA COUNTY HEALTH AUTHORITY | 1 | Tier 2 | Tier 2: 1 |
| SANTA CRUZ MONTEREY MERCED SAN BENITO MARIPOSA MANAGED MEDIC | 1 | Tier 4 | Tier 4: 1 |
| SAPPHIRE EDGE, INC. | 3 | Tier 3 | Tier 3: 3 |
| SCAN DESERT HEALTH PLAN, INC. | 8 | Tier 2 | Tier 2: 8 |
| SCAN HEALTH PLAN | 66 | Tier 2 | Tier 2: 66 |
| SCAN HEALTH PLAN (OR) | 2 | Tier 2 | Tier 2: 2 |
| SCAN HEALTH PLAN (WA) | 1 | Tier 2 | Tier 2: 1 |
| SCAN HEALTH PLAN NEVADA, INC. | 4 | Tier 2 | Tier 2: 4 |
| SCAN HEALTH PLAN TEXAS, INC. | 4 | Tier 2 | Tier 2: 4 |
| SCOTT AND WHITE HEALTH PLAN | 4 | Tier 2 | Tier 2: 4 |
| SECUR INC | 4 | Tier 1 | Tier 1: 4 |
| SECURITY HEALTH PLAN OF WISCONSIN, INC. | 4 | Tier 2 | Tier 2: 4 |
| SELECT HEALTH OF SOUTH CAROLINA, INC. | 1 | Tier 2 | Tier 2: 1 |
| SELECTCARE OF TEXAS, INC. | 1 | Tier 1 | Tier 1: 1 |
| SELECTHEALTH, INC. | 10 | Tier 3 | Tier 3: 10 |
| SENIOR WHOLE HEALTH OF NEW YORK, INC. | 2 | Tier 3 | Tier 3: 2 |
| SENIOR WHOLE HEALTH, LLC | 3 | Tier 3 | Tier 3: 3 |
| SENTARA HEALTH PLANS | 2 | Tier 2 | Tier 2: 2 |
| SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC. | 81 | Tier 3 | Tier 3: 81 |
| SIGNATURE ADVANTAGE, LLC | 2 | Tier 1 | Tier 1: 2 |
| SILVERSCRIPT INSURANCE COMPANY | 35 | Tier 2–3 | Tier 2: 15 · Tier 3: 20 |
| SIMPLY HEALTHCARE PLANS, INC. | 3 | Tier 2 | Tier 2: 3 |
| SIMPRA ADVANTAGE, INC. | 3 | Tier 1 | Tier 1: 3 |
| SOLIS HEALTH PLANS, INC. | 19 | Tier 2 | Tier 2: 19 |
| SOUTH COUNTRY HEALTH ALLIANCE | 2 | Tier 2 | Tier 2: 2 |
| SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC. | 3 | Tier 2 | Tier 2: 3 |
| ST. LUKE'S HEALTH PLAN, INC. | 3 | Tier 2 | Tier 2: 3 |
| SUMMACARE INC. | 5 | Tier 4 | Tier 4: 5 |
| SUNFLOWER STATE HEALTH PLAN, INC. | 3 | Tier 1 | Tier 1: 3 |
| SUPERIOR HEALTHPLAN, INC. | 12 | Tier 1 | Tier 1: 12 |
| Sunshine State Health Plan, Inc. | 20 | Tier 1 | Tier 1: 20 |
| TEXAS INDEPENDENCE HEALTH PLAN, INC. | 2 | Tier 1 | Tier 1: 2 |
| THE HEALTH PLAN OF WEST VIRGINIA, INC. | 3 | Tier 2 | Tier 2: 3 |
| THP INSURANCE COMPANY | 3 | Tier 2 | Tier 2: 3 |
| TRILLIUM COMMUNITY HEALTH PLAN, INC. | 1 | Tier 1 | Tier 1: 1 |
| TRINITY HEALTH PLAN OF MICHIGAN INC | 3 | Tier 3 | Tier 3: 3 |
| TRIPLE S ADVANTAGE, INC. | 17 | Tier 1–2 | Tier 1: 9 · Tier 2: 8 |
| TROY HEALTH, INC. | 2 | Tier 2 | Tier 2: 2 |
| TSG GUARD, INC. | 1 | Tier 1 | Tier 1: 1 |
| TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION | 21 | Tier 1–4 | Tier 1: 2 · Tier 4: 19 |
| TUFTS HEALTH PUBLIC PLANS, INC. | 2 | Tier 1 | Tier 1: 2 |
| UHC OF CALIFORNIA | 39 | Tier 3 | Tier 3: 39 |
| ULTIMATE HEALTH PLANS, INC. | 16 | Tier 2 | Tier 2: 16 |
| UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C. | 14 | Tier 3 | Tier 3: 14 |
| UNITEDHEALTHCARE COMMUNITY PLAN, INC. | 7 | Tier 3 | Tier 3: 7 |
| UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | 73 | Tier 3 | Tier 3: 73 |
| UNITEDHEALTHCARE INSURANCE COMPANY | 18 | Tier 3 | Tier 3: 18 |
| UNITEDHEALTHCARE OF FLORIDA, INC. | 3 | Tier 3 | Tier 3: 3 |
| UNITEDHEALTHCARE OF NEW ENGLAND, INC. | 5 | Tier 3 | Tier 3: 5 |
| UNITEDHEALTHCARE OF NEW YORK, INC. | 19 | Tier 3 | Tier 3: 19 |
| UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC. | 8 | Tier 3 | Tier 3: 8 |
| UNITEDHEALTHCARE OF THE MIDLANDS, INC. | 49 | Tier 3 | Tier 3: 49 |
| UNITEDHEALTHCARE OF THE ROCKIES, INC. | 21 | Tier 3 | Tier 3: 21 |
| UNITEDHEALTHCARE OF WISCONSIN, INC. | 149 | Tier 3 | Tier 3: 149 |
| UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC. | 7 | Tier 3 | Tier 3: 7 |
| UPMC FOR YOU, INC | 4 | Tier 3 | Tier 3: 4 |
| UPMC HEALTH COVERAGE, INC. | 1 | Tier 3 | Tier 3: 1 |
| UPMC HEALTH NETWORK, INC. | 8 | Tier 3 | Tier 3: 8 |
| UPMC HEALTH PLAN, INC. | 17 | Tier 3 | Tier 3: 17 |
| UPPER PENINSULA HEALTH PLAN, LLC | 1 | Tier 2 | Tier 2: 1 |
| USABLE HMO, INC. | 2 | Tier 3 | Tier 3: 2 |
| USABLE MUTUAL INSURANCE COMPANY | 3 | Tier 3 | Tier 3: 3 |
| UnitedHealthcare Benefits of Texas, Inc. | 66 | Tier 3 | Tier 3: 66 |
| UnitedHealthcare of New England, Inc. | 2 | Tier 3 | Tier 3: 2 |
| VERDA HEALTH PLAN OF ARIZONA, INC. | 2 | Tier 4 | Tier 4: 2 |
| VERDA HEALTH PLAN OF TEXAS INC | 4 | Tier 4 | Tier 4: 4 |
| VILLAGE SENIOR SERVICES CORPORATION | 3 | Tier 3 | Tier 3: 3 |
| VISTA HEALTH PLAN, INC. | 2 | Tier 2 | Tier 2: 2 |
| VIVA HEALTH, INC. | 8 | Tier 1–3 | Tier 1: 2 · Tier 3: 6 |
| VNA HOMECARE OPTIONS, LLC | 3 | Tier 1 | Tier 1: 3 |
| VNS CHOICE | 3 | Tier 1–2 | Tier 1: 2 · Tier 2: 1 |
| VOLUNTEER STATE HEALTH PLAN | 3 | Tier 4 | Tier 4: 3 |
| Ventura County Medi-Cal Managed Care Commission | 1 | Tier 2 | Tier 2: 1 |
| WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC | 7 | Tier 1 | Tier 1: 7 |
| WELLCARE HEALTH INSURANCE OF ARIZONA, INC. | 10 | Tier 1 | Tier 1: 10 |
| WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC. | 4 | Tier 1 | Tier 1: 4 |
| WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC. | 3 | Tier 1 | Tier 1: 3 |
| WELLCARE HEALTH PLANS OF NEW JERSEY, INC. | 3 | Tier 1 | Tier 1: 3 |
| WELLCARE OF CALIFORNIA, INC. | 2 | Tier 1 | Tier 1: 2 |
| WELLCARE OF CONNECTICUT, INC. | 3 | Tier 1 | Tier 1: 3 |
| WELLCARE OF GEORGIA, INC. | 13 | Tier 1 | Tier 1: 13 |
| WELLCARE OF IOWA, INC. | 4 | Tier 1 | Tier 1: 4 |
| WELLCARE OF MAINE, INC. | 2 | Tier 1 | Tier 1: 2 |
| WELLCARE OF MISSISSIPPI, INC. | 2 | Tier 1 | Tier 1: 2 |
| WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC | 2 | Tier 1 | Tier 1: 2 |
| WELLCARE OF SOUTH CAROLINA, INC. | 5 | Tier 1 | Tier 1: 5 |
| WELLCARE OF TEXAS, INC. | 12 | Tier 1 | Tier 1: 12 |
| WELLCARE PRESCRIPTION INSURANCE, INC. | 68 | Tier 1 | Tier 1: 68 |
| WELLMARK IA & SD, & BCBS MN, MT, NE, ND,& WY | 1 | Tier 2 | Tier 2: 1 |
| WELLPOINT HEALTH PLANS, INC. | 6 | Tier 2 | Tier 2: 6 |
| WELLPOINT INSURANCE COMPANY | 33 | Tier 2 | Tier 2: 33 |
| WELLPOINT IOWA, INC. | 1 | Tier 2 | Tier 2: 1 |
| WELLPOINT NEW JERSEY, INC. | 3 | Tier 2 | Tier 2: 3 |
| WELLPOINT TENNESSEE, INC. | 9 | Tier 2 | Tier 2: 9 |
| WELLPOINT TEXAS, INC. | 8 | Tier 2 | Tier 2: 8 |
| WELLPOINT WEST VIRGINIA , INC. | 3 | Tier 2 | Tier 2: 3 |
| WEST VIRGINIA SENIOR ADVANTAGE, INC. | 1 | Tier 1 | Tier 1: 1 |
| WYOBLUE ADVANTAGE INC | 2 | Tier 3 | Tier 3: 2 |
| ZING HEALTH OF MICHIGAN, INC. | 36 | Tier 2–3 | Tier 2: 30 · Tier 3: 6 |
Plan-level detail
Search the complete plan list by plan name, organization, contract, or plan number.
Showing 100 of 5,495 matching plans
| Plan name | Organization | Contract / plan / segment | Tier |
|---|---|---|---|
| Wellcare Absolute Total Care Dual Align (HMO D-SNP) | ABSOLUTE TOTAL CARE, INC. | H5272 / 001 / 000 | Tier 1 |
| Aetna Medicare Chronic Care (HMO-POS C-SNP) | AETNA BETTER HEALTH INC. (CT) | H6303 / 001 / 000 | Tier 2 |
| Aetna Medicare Enhanced (HMO-POS) | AETNA BETTER HEALTH INC. (CT) | H6303 / 002 / 000 | Tier 2 |
| Aetna Medicare Full Dual Extra (HMO-POS D-SNP) | AETNA BETTER HEALTH INC. (CT) | H6303 / 004 / 000 | Tier 2 |
| Aetna Medicare QMB Only Extra (HMO-POS D-SNP) | AETNA BETTER HEALTH INC. (CT) | H6303 / 005 / 000 | Tier 2 |
| Aetna Medicare Chronic Care (HMO C-SNP) | AETNA BETTER HEALTH INC. (GA) | H3146 / 037 / 000 | Tier 2 |
| Aetna Medicare Chronic Care (HMO C-SNP) | AETNA BETTER HEALTH INC. (GA) | H3146 / 038 / 000 | Tier 2 |
| Aetna Medicare Chronic Care (HMO C-SNP) | AETNA BETTER HEALTH INC. (GA) | H3146 / 053 / 000 | Tier 2 |
| Aetna Medicare Chronic Care Total (HMO C-SNP) | AETNA BETTER HEALTH INC. (GA) | H3146 / 036 / 000 | Tier 2 |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | AETNA BETTER HEALTH INC. (GA) | H3146 / 044 / 000 | Tier 2 |
| Aetna Medicare Enhanced (HMO) | AETNA BETTER HEALTH INC. (GA) | H3146 / 039 / 000 | Tier 2 |
| Aetna Medicare Enhanced (HMO) | AETNA BETTER HEALTH INC. (GA) | H3146 / 040 / 000 | Tier 2 |
| Aetna Medicare Enhanced (HMO) | AETNA BETTER HEALTH INC. (GA) | H3146 / 047 / 000 | Tier 2 |
| Aetna Medicare Enhanced (HMO) | AETNA BETTER HEALTH INC. (GA) | H3146 / 058 / 000 | Tier 2 |
| Aetna Medicare Enhanced (HMO) | AETNA BETTER HEALTH INC. (GA) | H3146 / 059 / 000 | Tier 2 |
| Aetna Medicare Full Dual (HMO D-SNP) | AETNA BETTER HEALTH INC. (GA) | H3146 / 002 / 000 | Tier 2 |
| Aetna Medicare Full Dual (HMO D-SNP) | AETNA BETTER HEALTH INC. (GA) | H3146 / 016 / 000 | Tier 2 |
| Aetna Medicare Full Dual Care (HMO D-SNP) | AETNA BETTER HEALTH INC. (GA) | H3146 / 022 / 000 | Tier 2 |
| Aetna Medicare Full Dual Care (HMO D-SNP) | AETNA BETTER HEALTH INC. (GA) | H3146 / 023 / 000 | Tier 2 |
| Aetna Medicare Prime (HMO) | AETNA BETTER HEALTH INC. (GA) | H3146 / 007 / 000 | Tier 2 |
| Aetna Medicare Signature (HMO) | AETNA BETTER HEALTH INC. (GA) | H3146 / 001 / 000 | Tier 2 |
| Aetna Medicare Signature (HMO) | AETNA BETTER HEALTH INC. (GA) | H3146 / 004 / 000 | Tier 2 |
| Aetna Medicare Signature (HMO) | AETNA BETTER HEALTH INC. (GA) | H3146 / 014 / 000 | Tier 2 |
| Aetna Medicare Signature (HMO) | AETNA BETTER HEALTH INC. (GA) | H3146 / 048 / 000 | Tier 2 |
| Aetna Medicare Signature (HMO) | AETNA BETTER HEALTH INC. (GA) | H3146 / 049 / 000 | Tier 2 |
| Aetna Medicare Signature (HMO) | AETNA BETTER HEALTH INC. (GA) | H3146 / 051 / 000 | Tier 2 |
| Aetna Medicare Signature (HMO) | AETNA BETTER HEALTH INC. (GA) | H3146 / 052 / 000 | Tier 2 |
| Aetna Medicare Signature (HMO) | AETNA BETTER HEALTH INC. (GA) | H3146 / 060 / 000 | Tier 2 |
| Aetna Medicare Signature Extra (HMO) | AETNA BETTER HEALTH INC. (GA) | H3146 / 050 / 000 | Tier 2 |
| Aetna Medicare Value Plus (HMO) | AETNA BETTER HEALTH INC. (GA) | H3146 / 006 / 000 | Tier 2 |
| Aetna Medicare Value Plus (HMO) | AETNA BETTER HEALTH INC. (GA) | H3146 / 011 / 000 | Tier 2 |
| Aetna Medicare Value Plus (HMO) | AETNA BETTER HEALTH INC. (GA) | H3146 / 012 / 000 | Tier 2 |
| Aetna Medicare FIDE (HMO D-SNP) | AETNA BETTER HEALTH INC. (NJ) | H6399 / 001 / 000 | Tier 2 |
| Aetna Medicare Prime Extra (HMO) | AETNA BETTER HEALTH OF CALIFORNIA INC. | H4982 / 025 / 000 | Tier 2 |
| Aetna Medicare Prime Extra (HMO) | AETNA BETTER HEALTH OF CALIFORNIA INC. | H4982 / 026 / 000 | Tier 2 |
| Aetna Medicare Prime Value Plus (HMO) | AETNA BETTER HEALTH OF CALIFORNIA INC. | H4982 / 022 / 000 | Tier 2 |
| Aetna Medicare Signature (HMO) | AETNA BETTER HEALTH OF CALIFORNIA INC. | H4982 / 001 / 000 | Tier 2 |
| Aetna Medicare Signature (HMO) | AETNA BETTER HEALTH OF CALIFORNIA INC. | H4982 / 002 / 000 | Tier 2 |
| Aetna Medicare Signature (HMO) | AETNA BETTER HEALTH OF CALIFORNIA INC. | H4982 / 003 / 000 | Tier 2 |
| Aetna Medicare Signature (HMO) | AETNA BETTER HEALTH OF CALIFORNIA INC. | H4982 / 007 / 000 | Tier 2 |
| Aetna Medicare Signature Extra (HMO) | AETNA BETTER HEALTH OF CALIFORNIA INC. | H4982 / 030 / 000 | Tier 2 |
| Aetna Medicare Elite (HMO) | AETNA BETTER HEALTH OF MICHIGAN INC. | H2056 / 003 / 000 | Tier 2 |
| Aetna Medicare Elite (HMO) | AETNA BETTER HEALTH OF MICHIGAN INC. | H2056 / 005 / 000 | Tier 2 |
| Aetna Medicare HIDE (HMO D-SNP) | AETNA BETTER HEALTH OF MICHIGAN INC. | H9314 / 001 / 000 | Tier 2 |
| Aetna Medicare Signature (HMO) | AETNA BETTER HEALTH OF OKLAHOMA INC. | H4835 / 002 / 000 | Tier 2 |
| Aetna Medicare Full Dual Care (HMO D-SNP) | AETNA BETTER HEALTH OF TEXAS INC. | H8597 / 001 / 000 | Tier 2 |
| Aetna Medicare Full Dual Care (HMO D-SNP) | AETNA BETTER HEALTH OF TEXAS INC. | H8597 / 002 / 000 | Tier 2 |
| Aetna Medicare Full Dual Care (HMO D-SNP) | AETNA BETTER HEALTH OF TEXAS INC. | H8597 / 003 / 000 | Tier 2 |
| Aetna Medicare QMB Only Care (HMO D-SNP) | AETNA BETTER HEALTH OF TEXAS INC. | H8597 / 004 / 000 | Tier 2 |
| Aetna Medicare QMB Only Care (HMO D-SNP) | AETNA BETTER HEALTH OF TEXAS INC. | H8597 / 005 / 000 | Tier 2 |
| Aetna Medicare QMB Only Care (HMO D-SNP) | AETNA BETTER HEALTH OF TEXAS INC. | H8597 / 006 / 000 | Tier 2 |
| Aetna Medicare Chronic Care (HMO C-SNP) | AETNA BETTER HEALTH OF WASHINGTON, INC. | H3748 / 020 / 000 | Tier 2 |
| Aetna Medicare Signature (HMO) | AETNA BETTER HEALTH OF WASHINGTON, INC. | H3748 / 003 / 000 | Tier 2 |
| Aetna Medicare FIDE (HMO D-SNP) | AETNA BETTER HEALTH PREMIER PLAN MMAI INC. | H9771 / 001 / 000 | Tier 2 |
| Aetna Medicare Chronic Care (HMO C-SNP) | AETNA BETTER HEALTH, INC. (LA) | H3239 / 030 / 000 | Tier 2 |
| Aetna Medicare Dual Care (HMO D-SNP) | AETNA BETTER HEALTH, INC. (LA) | H3239 / 010 / 000 | Tier 2 |
| Aetna Medicare Dual Care (HMO D-SNP) | AETNA BETTER HEALTH, INC. (LA) | H3239 / 012 / 000 | Tier 2 |
| Aetna Medicare Dual Extra (HMO D-SNP) | AETNA BETTER HEALTH, INC. (LA) | H3239 / 005 / 000 | Tier 2 |
| Aetna Medicare Dual Extra Care (HMO D-SNP) | AETNA BETTER HEALTH, INC. (LA) | H3239 / 002 / 000 | Tier 2 |
| Aetna Medicare Dual Extra Care (HMO D-SNP) | AETNA BETTER HEALTH, INC. (LA) | H3239 / 015 / 000 | Tier 2 |
| Aetna Medicare Full Dual Care (HMO D-SNP) | AETNA BETTER HEALTH, INC. (LA) | H3239 / 026 / 000 | Tier 2 |
| Aetna Medicare Full Dual Care (HMO D-SNP) | AETNA BETTER HEALTH, INC. (LA) | H3239 / 027 / 000 | Tier 2 |
| Aetna Medicare Full Dual Care (HMO D-SNP) | AETNA BETTER HEALTH, INC. (LA) | H3239 / 028 / 000 | Tier 2 |
| Aetna Medicare Partial Dual Care (HMO D-SNP) | AETNA BETTER HEALTH, INC. (LA) | H3239 / 023 / 000 | Tier 2 |
| Aetna Medicare QMB Only Care (HMO D-SNP) | AETNA BETTER HEALTH, INC. (LA) | H3239 / 001 / 000 | Tier 2 |
| Aetna Medicare Signature (HMO) | AETNA BETTER HEALTH, INC. (LA) | H3239 / 014 / 000 | Tier 2 |
| Aetna Medicare Signature Care (HMO) | AETNA BETTER HEALTH, INC. (LA) | H3239 / 017 / 000 | Tier 2 |
| Aetna Medicare Signature Care (HMO) | AETNA BETTER HEALTH, INC. (LA) | H3239 / 020 / 000 | Tier 2 |
| Aetna Medicare Signature Care (HMO) | AETNA BETTER HEALTH, INC. (LA) | H3239 / 022 / 000 | Tier 2 |
| Aetna Medicare Signature Extra Care (HMO) | AETNA BETTER HEALTH, INC. (LA) | H3239 / 031 / 000 | Tier 2 |
| Aetna Medicare Dual Care (PPO D-SNP) | AETNA HEALTH AND LIFE INSURANCE COMPANY | H3288 / 053 / 000 | Tier 2 |
| Aetna Medicare Elite (PPO) | AETNA HEALTH AND LIFE INSURANCE COMPANY | H3288 / 027 / 000 | Tier 2 |
| Aetna Medicare Enhanced (PPO) | AETNA HEALTH AND LIFE INSURANCE COMPANY | H3288 / 007 / 000 | Tier 2 |
| Aetna Medicare Enhanced (PPO) | AETNA HEALTH AND LIFE INSURANCE COMPANY | H3288 / 009 / 000 | Tier 2 |
| Aetna Medicare Enhanced (PPO) | AETNA HEALTH AND LIFE INSURANCE COMPANY | H3288 / 042 / 000 | Tier 2 |
| Aetna Medicare Enhanced (PPO) | AETNA HEALTH AND LIFE INSURANCE COMPANY | H3288 / 047 / 000 | Tier 2 |
| Aetna Medicare Signature (PPO) | AETNA HEALTH AND LIFE INSURANCE COMPANY | H3288 / 005 / 000 | Tier 2 |
| Aetna Medicare Signature (PPO) | AETNA HEALTH AND LIFE INSURANCE COMPANY | H3288 / 008 / 000 | Tier 2 |
| Aetna Medicare Signature (PPO) | AETNA HEALTH AND LIFE INSURANCE COMPANY | H3288 / 011 / 000 | Tier 2 |
| Aetna Medicare Signature (PPO) | AETNA HEALTH AND LIFE INSURANCE COMPANY | H3288 / 020 / 000 | Tier 2 |
| Aetna Medicare Signature (PPO) | AETNA HEALTH AND LIFE INSURANCE COMPANY | H3288 / 046 / 000 | Tier 2 |
| Aetna Medicare Signature Extra (PPO) | AETNA HEALTH AND LIFE INSURANCE COMPANY | H3288 / 006 / 000 | Tier 2 |
| Aetna Medicare Value Plus (PPO) | AETNA HEALTH AND LIFE INSURANCE COMPANY | H3288 / 001 / 000 | Tier 2 |
| Aetna Medicare Value Plus (PPO) | AETNA HEALTH AND LIFE INSURANCE COMPANY | H3288 / 002 / 000 | Tier 2 |
| Aetna Medicare Value Plus (PPO) | AETNA HEALTH AND LIFE INSURANCE COMPANY | H3288 / 003 / 000 | Tier 2 |
| Aetna Medicare Value Plus (PPO) | AETNA HEALTH AND LIFE INSURANCE COMPANY | H3288 / 004 / 000 | Tier 2 |
| Aetna Medicare Value Plus (PPO) | AETNA HEALTH AND LIFE INSURANCE COMPANY | H3288 / 017 / 000 | Tier 2 |
| Aetna Medicare Value Plus (PPO) | AETNA HEALTH AND LIFE INSURANCE COMPANY | H3288 / 018 / 000 | Tier 2 |
| Aetna Medicare Value Plus (PPO) | AETNA HEALTH AND LIFE INSURANCE COMPANY | H3288 / 019 / 000 | Tier 2 |
| Aetna Medicare Value Plus (PPO) | AETNA HEALTH AND LIFE INSURANCE COMPANY | H3288 / 048 / 000 | Tier 2 |
| Aetna Medicare Full Dual (HMO-POS D-SNP) | AETNA HEALTH INC. (CT) | H5793 / 017 / 000 | Tier 2 |
| Aetna Medicare Prime Care (HMO-POS) | AETNA HEALTH INC. (CT) | H5793 / 019 / 000 | Tier 2 |
| Aetna Medicare QMB Only (HMO-POS D-SNP) | AETNA HEALTH INC. (CT) | H5793 / 020 / 000 | Tier 2 |
| Aetna Medicare Signature (HMO-POS) | AETNA HEALTH INC. (CT) | H5793 / 001 / 000 | Tier 2 |
| Aetna Medicare Signature (HMO-POS) | AETNA HEALTH INC. (CT) | H5793 / 014 / 000 | Tier 2 |
| Aetna Medicare Signature (HMO-POS) | AETNA HEALTH INC. (CT) | H5793 / 018 / 000 | Tier 2 |
| Aetna Medicare Chronic Care (HMO C-SNP) | AETNA HEALTH INC. (FL) | H1609 / 080 / 000 | Tier 2 |
| Aetna Medicare Chronic Care (HMO C-SNP) | AETNA HEALTH INC. (FL) | H1609 / 081 / 000 | Tier 2 |
| Aetna Medicare Chronic Care (HMO C-SNP) | AETNA HEALTH INC. (FL) | H1609 / 082 / 000 | Tier 2 |
| Aetna Medicare Chronic Care (HMO C-SNP) | AETNA HEALTH INC. (FL) | H1609 / 084 / 000 | Tier 2 |
