Medication coverage guide
Fluticasone-salmeterol (Advair, Wixela and others)
Generic name: Fluticasone Propion/Salmeterol
What it is used for
A combination maintenance inhaler (an inhaled corticosteroid, fluticasone, with a long-acting bronchodilator, salmeterol) used daily to control asthma and chronic obstructive pulmonary disease (COPD).
Which part of Medicare may cover it
Part D (inhalers 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
- 5,292 of 5,495
- Listing share
- 96.31%
- Most common tier
- Tier 3
- Share of listing plans at that tier
- 49.43%
Full tier distribution
| Tier | Plans |
|---|---|
| Tier 1 | 393 |
| Tier 2 | 2,245 |
| Tier 3 | 2,616 |
| Tier 4 | 38 |
CMS dashboard figures
Program averages from CMS dashboard data — average total spending across Part D (before rebates), NOT a reader's copay.
Fluticasone-Salmeterol
- Brand name
- Fluticasone-Salmeterol
- Generic name
- Fluticasone Propion/Salmeterol
- Total claims (2024)
- 2,594,479
- Total program spending (2024)
- 409,313,172.33
- Total beneficiaries (2024)
- 779,878
- Rank by beneficiaries (2024)
- 148
- Average spending per claim (2024)
- 157.76314718
- Average spending per beneficiary (2024)
- 524.84256811
- Average spending per dosage unit, weighted (2024)
- 8.7029494148
Wixela Inhub
- Brand name
- Wixela Inhub
- Generic name
- Fluticasone Propion/Salmeterol
- Total claims (2024)
- 1,281,804
- Total program spending (2024)
- 196,500,762.92
- Total beneficiaries (2024)
- 446,733
- Rank by beneficiaries (2024)
- 203
- Average spending per claim (2024)
- 153.30016361
- Average spending per beneficiary (2024)
- 439.86175841
- Average spending per dosage unit, weighted (2024)
- 1.5802110476
Advair HFA
- Brand name
- Advair HFA
- Generic name
- Fluticasone Propion/Salmeterol
- Total claims (2024)
- 715,505
- Total program spending (2024)
- 320,587,780.2
- Total beneficiaries (2024)
- 200,081
- Rank by beneficiaries (2024)
- 313
- Average spending per claim (2024)
- 448.05805718
- Average spending per beneficiary (2024)
- 1,602.2899736
- Average spending per dosage unit, weighted (2024)
- 28.713283272
Advair Diskus
- Brand name
- Advair Diskus
- Generic name
- Fluticasone Propion/Salmeterol
- Total claims (2024)
- 268,262
- Total program spending (2024)
- 71,212,975.07
- Total beneficiaries (2024)
- 109,574
- Rank by beneficiaries (2024)
- 416
- Average spending per claim (2024)
- 265.46053884
- Average spending per beneficiary (2024)
- 649.90759733
- Average spending per dosage unit, weighted (2024)
- 3.261556082
Fluticasone-Salmeterol HFA
- Brand name
- Fluticasone-Salmeterol HFA
- Generic name
- Fluticasone Propion/Salmeterol
- Total claims (2024)
- 71,939
- Total program spending (2024)
- 32,180,048.73
- Total beneficiaries (2024)
- 43,466
- Rank by beneficiaries (2024)
- 618
- Average spending per claim (2024)
- 447.32410417
- Average spending per beneficiary (2024)
- 740.34989946
- Average spending per dosage unit, weighted (2024)
- 32.220432755
Airduo Digihaler
- Brand name
- Airduo Digihaler
- Generic name
- Fluticasone Propion/Salmeterol
- Total claims (2024)
- 506
- Total program spending (2024)
- 276,639.35
- Total beneficiaries (2024)
- 353
- Rank by beneficiaries (2024)
- 2,237
- Average spending per claim (2024)
- 546.718083
- Average spending per beneficiary (2024)
- 783.68087819
- Average spending per dosage unit, weighted (2024)
- 422.10546158
Airduo Respiclick
- Brand name
- Airduo Respiclick
- Generic name
- Fluticasone Propion/Salmeterol
- Total claims (2024)
- 593
- Total program spending (2024)
- 257,079.58
- Total beneficiaries (2024)
- 346
- Rank by beneficiaries (2024)
- 2,244
- Average spending per claim (2024)
- 433.52374368
- Average spending per beneficiary (2024)
- 743.00456647
- Average spending per dosage unit, weighted (2024)
- 362.26895409
Part B status
No fluticasone or salmeterol 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 148 by beneficiaries 2024 for the primary row (Fluticasone-Salmeterol, 779,878); the same dashboard generic also carries Wixela Inhub (rank 203) and Advair HFA (rank 313) rows, all carried in this package. This drug IS a combination product: the formulary RxCUI set is filtered to concepts whose names contain BOTH fluticasone and salmeterol (single-ingredient fluticasone, fluticasone-vilanterol, and fluticasone-umeclidinium-vilanterol products are excluded), recorded in data/rxnorm/batch3_rxcuis.json. Modal tier is a plurality: Tier 3 at 49.43% of listing plans vs Tier 2 at 40.85% — the package carries the full distribution and page copy must not overstate the modal tier as settled.
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 1–2 | Tier 1: 1 · Tier 2: 2 |
| ALIGN SENIOR CARE FLORIDA, INC. | 2 | Tier 1–2 | Tier 1: 1 · Tier 2: 1 |
| ALIGN SENIOR CARE IOWA INSURANCE COMPANY | 2 | Tier 1–2 | Tier 1: 1 · Tier 2: 1 |
| ALIGN SENIOR CARE MI, LLC | 2 | Tier 1–2 | Tier 1: 1 · Tier 2: 1 |
| ALIGNMENT HEALTH ADVANTAGE PLAN INC | 4 | Tier 3 | Tier 3: 4 |
| ALIGNMENT HEALTH ADVANTAGE PLAN INC. | 5 | Tier 3 | Tier 3: 5 |
| ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC | 10 | Tier 3 | Tier 3: 10 |
| ALIGNMENT HEALTH PLAN | 37 | Tier 3 | Tier 3: 37 |
| ALIGNMENT HEALTH PLAN OF ARIZONA, INC. | 7 | Tier 3 | Tier 3: 7 |
| ALIGNMENT HEALTH PLAN OF NEVADA, INC. | 4 | Tier 3 | Tier 3: 4 |
| ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | 10 | Tier 3 | Tier 3: 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 4 | Tier 4: 1 |
| AMERIHEALTH INSURANCE COMPANY OF NEW JERSEY | 1 | Tier 4 | Tier 4: 1 |
| AMERIHEALTH MICHIGAN, INC. | 2 | Tier 2 | Tier 2: 2 |
| AMH HEALTH, LLC | 5 | Tier 3 | Tier 3: 5 |
| ANTHEM HEALTH PLANS, INC. | 6 | Tier 3 | Tier 3: 6 |
| ANTHEM HP, LLC. | 6 | Tier 3 | Tier 3: 6 |
| ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT | 2 | Tier 3 | Tier 3: 2 |
| ANTHEM INSURANCE COMPANIES, INC. | 27 | Tier 3 | Tier 3: 27 |
| ARCADIAN HEALTH PLAN, INC. | 71 | Tier 3 | Tier 3: 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 2 | Tier 2: 8 |
| ATRIO HEALTH PLANS | 11 | Tier 1 | Tier 1: 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 3 | Tier 3: 5 |
| BANNER - UNIVERSITY CARE ADVANTAGE | 2 | Tier 1 | Tier 1: 2 |
| BANNER HEALTH PLAN, INC. | 1 | Tier 3 | Tier 3: 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 3 | Tier 3: 2 |
| BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY | 26 | Tier 3 | Tier 3: 26 |
| BCBSM, Inc. | 9 | Tier 3 | Tier 3: 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 3 | Tier 3: 3 |
| BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC. | 14 | Tier 3 | Tier 3: 14 |
| BLUE CROSS AND BLUE SHIELD OF KANSAS | 3 | Tier 3 | Tier 3: 3 |
| 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 3 | Tier 3: 4 |
| BLUE CROSS OF CALIFORNIA | 18 | Tier 3 | Tier 3: 18 |
| BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN, INC. | 18 | Tier 3 | Tier 3: 18 |
| BLUE CROSS OF IDAHO HEALTH SERVICE, INC. | 6 | Tier 3 | Tier 3: 6 |
| BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA | 6 | Tier 2 | Tier 2: 6 |
| BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC. | 3 | Tier 3 | Tier 3: 3 |
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 19 | Tier 2 | Tier 2: 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 3 | Tier 3: 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 3 | Tier 3: 24 |
| CAPITAL HEALTH PLAN | 4 | Tier 3 | Tier 3: 4 |
| CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO. | 204 | Tier 3 | Tier 3: 204 |
| CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA | 4 | Tier 3 | Tier 3: 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 3 | Tier 3: 37 |
| CARESOURCE OHIO, INC. | 1 | Tier 1 | Tier 1: 1 |
| CARITEN HEALTH PLAN INC. | 51 | Tier 3 | Tier 3: 51 |
| CELTIC INSURANCE COMPANY | 3 | Tier 1 | Tier 1: 3 |
| CHA HMO, INC. | 47 | Tier 3 | Tier 3: 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 3 | Tier 3: 2 |
| COMMUNITY CARE HEALTH PLAN, INC. | 1 | Tier 1 | Tier 1: 1 |
| COMMUNITY FIRST HEALTH PLANS, INC. | 3 | Tier 2 | Tier 2: 3 |
| COMMUNITY HEALTH CHOICE TEXAS, INC. | 5 | Tier 2 | Tier 2: 5 |
| COMMUNITY HEALTH GROUP | 2 | Tier 2 | Tier 2: 2 |
| COMMUNITY INSURANCE COMPANY | 10 | Tier 3 | Tier 3: 10 |
| COMMUNITYCARE GOVERNMENT PROGRAMS, INC. | 4 | Tier 2 | Tier 2: 4 |
| COMPCARE HEALTH SERVICES INSURANCE CORPORATION | 16 | Tier 3 | Tier 3: 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 2 | Tier 2: 3 |
| California Physicians' Service | 2 | Tier 2 | Tier 2: 2 |
| DEAN HEALTH PLAN, INC. | 4 | Tier 3 | Tier 3: 4 |
| DENVER HEALTH MEDICAL PLAN, INC. | 2 | Tier 2 | Tier 2: 2 |
| DEVOTED HEALTH PLAN OF OREGON | 1 | Tier 2 | Tier 2: 1 |
| DEVOTED HEALTH INSURANCE COMPANY | 5 | Tier 2 | Tier 2: 5 |
| DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC | 12 | Tier 2 | Tier 2: 12 |
| DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC. | 4 | Tier 2 | Tier 2: 4 |
| DEVOTED HEALTH INSURANCE COMPANY OF ARKANSAS INC | 10 | Tier 2 | Tier 2: 10 |
| DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC | 4 | Tier 2 | Tier 2: 4 |
| DEVOTED HEALTH INSURANCE COMPANY OF CONNECTICUT | 12 | Tier 2 | Tier 2: 12 |
| DEVOTED HEALTH INSURANCE COMPANY OF DELAWARE | 5 | Tier 2 | Tier 2: 5 |
| DEVOTED HEALTH INSURANCE COMPANY OF GEORGIA INC | 16 | Tier 2 | Tier 2: 16 |
| DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC | 9 | Tier 2 | Tier 2: 9 |
| DEVOTED HEALTH INSURANCE COMPANY OF INDIANA | 23 | Tier 2 | Tier 2: 23 |
| DEVOTED HEALTH INSURANCE COMPANY OF KANSAS | 11 | Tier 2 | Tier 2: 11 |
| DEVOTED HEALTH INSURANCE COMPANY OF KENTUCKY INC | 10 | Tier 2 | Tier 2: 10 |
| DEVOTED HEALTH INSURANCE COMPANY OF LOUISIANA | 23 | Tier 2 | Tier 2: 23 |
| DEVOTED HEALTH INSURANCE COMPANY OF MICHIGAN | 12 | Tier 2 | Tier 2: 12 |
| DEVOTED HEALTH INSURANCE COMPANY OF MISSISSIPPI | 10 | Tier 2 | Tier 2: 10 |
| DEVOTED HEALTH INSURANCE COMPANY OF MISSOURI | 4 | Tier 2 | Tier 2: 4 |
| DEVOTED HEALTH INSURANCE COMPANY OF NEBRASKA | 8 | Tier 2 | Tier 2: 8 |
| DEVOTED HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE | 6 | Tier 2 | Tier 2: 6 |
| DEVOTED HEALTH INSURANCE COMPANY OF NEW JERSEY | 6 | Tier 2 | Tier 2: 6 |
| DEVOTED HEALTH INSURANCE COMPANY OF NEW YORK | 23 | Tier 2 | Tier 2: 23 |
| DEVOTED HEALTH INSURANCE COMPANY OF OKLAHOMA | 12 | Tier 2 | Tier 2: 12 |
| DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC | 5 | Tier 2 | Tier 2: 5 |
| DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC | 43 | Tier 2 | Tier 2: 43 |
| DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC | 7 | Tier 2 | Tier 2: 7 |
| DEVOTED HEALTH INSURANCE COMPANY OF TEXAS | 1 | Tier 2 | Tier 2: 1 |
| DEVOTED HEALTH INSURANCE COMPANY OF UTAH, INC. | 7 | Tier 2 | Tier 2: 7 |
| DEVOTED HEALTH INSURANCE COMPANY OF WASHINGTON | 4 | Tier 2 | Tier 2: 4 |
| DEVOTED HEALTH PLAN OF ALABAMA INC | 6 | Tier 2 | Tier 2: 6 |
| DEVOTED HEALTH PLAN OF ARIZONA, INC. | 12 | Tier 2 | Tier 2: 12 |
| DEVOTED HEALTH PLAN OF COLORADO INC | 17 | Tier 2 | Tier 2: 17 |
| DEVOTED HEALTH PLAN OF FLORIDA, INC. | 100 | Tier 2 | Tier 2: 100 |
| DEVOTED HEALTH PLAN OF HAWAII, INC. | 9 | Tier 2 | Tier 2: 9 |
| DEVOTED HEALTH PLAN OF ILLINOIS, INC. | 6 | Tier 2 | Tier 2: 6 |
| DEVOTED HEALTH PLAN OF MISSOURI INC | 27 | Tier 2 | Tier 2: 27 |
| DEVOTED HEALTH PLAN OF NEW MEXICO, INC. | 11 | Tier 2 | Tier 2: 11 |
| DEVOTED HEALTH PLAN OF NORTH CAROLINA INC | 36 | Tier 2 | Tier 2: 36 |
| DEVOTED HEALTH PLAN OF OHIO INC | 2 | Tier 2 | Tier 2: 2 |
| DEVOTED HEALTH PLAN OF OHIO, INC. | 20 | Tier 2 | Tier 2: 20 |
| DEVOTED HEALTH PLAN OF OREGON INC | 22 | Tier 2 | Tier 2: 22 |
| DEVOTED HEALTH PLAN OF PENNSYLVANIA INC | 30 | Tier 2 | Tier 2: 30 |
| DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC | 1 | Tier 2 | Tier 2: 1 |
| DEVOTED HEALTH PLAN OF TENNESSEE INC | 9 | Tier 2 | Tier 2: 9 |
| DEVOTED HEALTH PLAN OF TEXAS, INC. | 75 | Tier 2 | Tier 2: 75 |
| DEVOTED HEALTH PLAN OF VIRGINIA INC | 16 | Tier 2 | Tier 2: 16 |
| DEVOTED HEALTH PLAN OF WASHINGTON, INC. | 18 | Tier 2 | Tier 2: 18 |
| DIGNITY CARE CORPORATION | 2 | Tier 1 | Tier 1: 2 |
| DOCTORS HEALTHCARE PLANS, INC. | 9 | Tier 3 | Tier 3: 9 |
| Devoted Health Insurance Company of Illinois, Inc. | 2 | Tier 2 | Tier 2: 2 |
| Devoted of Illinois, Inc. | 16 | Tier 2 | Tier 2: 16 |
| EL PASO FIRST HEALTH PLANS, INC. | 4 | Tier 2 | Tier 2: 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 2 | Tier 2: 2 |
| EMPHESYS INSURANCE COMPANY | 111 | Tier 3 | Tier 3: 111 |
| ESSENCE HEALTHCARE PPO, INC. | 7 | Tier 3 | Tier 3: 7 |
| ESSENCE HEALTHCARE, INC. | 7 | Tier 3 | Tier 3: 7 |
| ETERNALHEALTH OF ARIZONA INC | 3 | Tier 2 | Tier 2: 3 |
| ETERNALHEALTH, INC. | 3 | Tier 2 | Tier 2: 3 |
| 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 3 | Tier 3: 20 |
| FREEDOM HEALTH, INC. | 24 | Tier 1 | Tier 1: 24 |
| GATEWAY HEALTH PLAN, INC. | 4 | Tier 4 | Tier 4: 4 |
| GEISINGER HEALTH PLAN | 9 | Tier 2 | Tier 2: 9 |
| GEISINGER INDEMNITY INSURANCE COMPANY | 4 | Tier 2 | Tier 2: 4 |
| GEORGIA ASSURANCE, INC. | 2 | Tier 1–2 | Tier 1: 1 · Tier 2: 1 |
| GLOBALHEALTH, INC. | 6 | Tier 1 | Tier 1: 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 |
| HAMASPIK, INC. | 2 | Tier 1 | Tier 1: 2 |
| HAP CARESOURCE | 1 | Tier 3 | Tier 3: 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 3 | Tier 3: 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 3 | Tier 3: 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 3 | Tier 3: 6 |
| HEALTH PARTNERS PLANS, INC. | 7 | Tier 3 | Tier 3: 7 |
| HEALTH PLAN OF CAREOREGON, INC. | 1 | Tier 1 | Tier 1: 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 3 | Tier 3: 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 3 | Tier 3: 3 |
| HEALTHY MISSISSIPPI, INC. | 3 | Tier 3 | Tier 3: 3 |
| HIGHMARK BCBSD INC. | 3 | Tier 3 | Tier 3: 3 |
| HIGHMARK BCBSD, INC. | 2 | Tier 4 | Tier 4: 2 |
| HIGHMARK CHOICE COMPANY | 31 | Tier 3 | Tier 3: 31 |
| HIGHMARK HEALTH OPTIONS WEST VIRGINIA INC. | 1 | Tier 4 | Tier 4: 1 |
| HIGHMARK SENIOR HEALTH COMPANY | 38 | Tier 3 | Tier 3: 38 |
| HIGHMARK SENIOR SOLUTIONS COMPANY | 8 | Tier 3 | Tier 3: 8 |
| HMO COLORADO, INC. | 11 | Tier 3 | Tier 3: 11 |
| HMO LOUISIANA, INC. | 9 | Tier 3 | Tier 3: 9 |
| HMO Minnesota | 1 | Tier 3 | Tier 3: 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 1–3 | Tier 1: 1 · Tier 3: 1 |
| HORIZON INSURANCE COMPANY | 2 | Tier 3 | Tier 3: 2 |
| HPMP OF FLORIDA, INC. | 5 | Tier 3 | Tier 3: 5 |
| HUMANA BENEFIT PLAN OF ILLINOIS, INC. | 33 | Tier 3 | Tier 3: 33 |
| HUMANA BENEFIT PLAN OF SOUTH CAROLINA, INC. | 1 | Tier 3 | Tier 3: 1 |
| HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC. | 7 | Tier 3 | Tier 3: 7 |
| HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC. | 23 | Tier 3 | Tier 3: 23 |
| HUMANA HEALTH COMPANY OF NEW YORK, INC. | 5 | Tier 3 | Tier 3: 5 |
| HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC. | 6 | Tier 3 | Tier 3: 6 |
| HUMANA HEALTH PLAN OF CALIFORNIA, INC. | 2 | Tier 3 | Tier 3: 2 |
| HUMANA HEALTH PLAN OF OHIO, INC. | 4 | Tier 3 | Tier 3: 4 |
| HUMANA HEALTH PLAN OF TEXAS, INC. | 1 | Tier 3 | Tier 3: 1 |
| HUMANA HEALTH PLAN, INC. | 3 | Tier 3 | Tier 3: 3 |
| HUMANA INSURANCE COMPANY | 221 | Tier 3 | Tier 3: 221 |
| HUMANA INSURANCE COMPANY OF KENTUCKY | 3 | Tier 3 | Tier 3: 3 |
| HUMANA INSURANCE COMPANY OF NEW YORK | 2 | Tier 3 | Tier 3: 2 |
| HUMANA MEDICAL PLAN OF MICHIGAN, INC. | 4 | Tier 3 | Tier 3: 4 |
| HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC. | 2 | Tier 3 | Tier 3: 2 |
| HUMANA MEDICAL PLAN OF UTAH, INC. | 2 | Tier 3 | Tier 3: 2 |
| HUMANA MEDICAL PLAN, INC. | 84 | Tier 3 | Tier 3: 84 |
| HUMANA REGIONAL HEALTH PLAN, INC. | 2 | Tier 3 | Tier 3: 2 |
| HUMANA WI HEALTH ORGANIZATION INSURANCE CORP | 58 | Tier 3 | Tier 3: 58 |
| HUMANADENTAL INSURANCE COMPANY | 1 | Tier 3 | Tier 3: 1 |
| HealthKeepers, Inc. | 4 | Tier 3 | Tier 3: 4 |
| Healthy Mississippi, Inc. | 1 | Tier 3 | Tier 3: 1 |
| Highmark Western and Northeastern New York Inc. | 11 | Tier 3 | Tier 3: 11 |
| IMPERIAL COUNTY LOCAL HEALTH AUTHORITY | 1 | Tier 2 | Tier 2: 1 |
| IMPERIAL HEALTH PLAN OF CALIFORNIA, INC. | 3 | Tier 2 | Tier 2: 3 |
| INDEPENDENT CARE HEALTH PLAN | 1 | Tier 3 | Tier 3: 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 2 | Tier 2: 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 3 | Tier 3: 11 |
| KEYSTONE HEALTH PLAN EAST, INC. | 9 | Tier 4 | Tier 4: 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 1–2 | Tier 1: 2 · Tier 2: 1 |
| LIFEWORKS ADVANTAGE, LLC | 2 | Tier 1–2 | Tier 1: 1 · Tier 2: 1 |
| 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 3 | Tier 3: 3 |
| MANAGED HEALTH SERVICES INSURANCE CORP. | 3 | Tier 1 | Tier 1: 3 |
| MARQUIS ADVANTAGE, INC. | 3 | Tier 2 | Tier 2: 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 1 | Tier 1: 3 |
| MCS ADVANTAGE, INC. | 20 | Tier 2 | Tier 2: 20 |
| MEDCARE PARTNERS HEALTH PLAN OF TEXAS, LLC | 3 | Tier 1 | Tier 1: 3 |
| MEDCO CONTAINMENT LIFE & MEDCO CONTAINMENT NY & HEALTH CARE | 40 | Tier 3 | Tier 3: 40 |
| MEDICA HEALTH PLANS | 1 | Tier 3 | Tier 3: 1 |
| 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 3 | Tier 3: 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 2 | Tier 2: 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 2 | Tier 2: 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 2 | Tier 2: 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 2 | Tier 2: 2 |
| OH CHS SNP INC. | 4 | Tier 1–2 | Tier 1: 3 · Tier 2: 1 |
| 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 3 | Tier 3: 2 |
| PARTNERS INSURANCE COMPANY OF NEW JERSEY INC | 1 | Tier 3 | Tier 3: 1 |
| PEAK HEALTH INSURANCE CORPORATION | 9 | Tier 2 | Tier 2: 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 1–2 | Tier 1: 2 · Tier 2: 4 |
| PERENNIAL ADVANTAGE OF OHIO, INC. | 3 | Tier 1–2 | Tier 1: 1 · Tier 2: 2 |
| 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 4 | Tier 4: 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 2 | Tier 2: 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 2 | Tier 2: 3 |
| PRUITTHEALTH PREMIER, INC. | 3 | Tier 2 | Tier 2: 3 |
| Preferred Care Network, Inc. | 3 | Tier 3 | Tier 3: 3 |
| QCC INSURANCE COMPANY | 3 | Tier 4 | Tier 4: 3 |
| QUARTZ HEALTH PLAN CORPORATION | 10 | Tier 4 | Tier 4: 10 |
| QUARTZ HEALTH PLAN MN CORPORATION | 4 | Tier 4 | Tier 4: 4 |
| RANGE HEALTH, INC. | 4 | Tier 3 | Tier 3: 4 |
| REGENCE BLUECROSS BLUESHIELD OF OREGON | 9 | Tier 3 | Tier 3: 9 |
| REGENCE BLUECROSS BLUESHIELD OF UTAH | 2 | Tier 3 | Tier 3: 2 |
| REGENCE BLUESHIELD | 2 | Tier 3 | Tier 3: 2 |
| SAMARITAN HEALTH PLANS, INC. | 1 | Tier 3 | Tier 3: 1 |
| SAN FRANCISCO HEALTH AUTHORITY DBA SAN FRANCISCO HEALTH PLAN | 1 | Tier 2 | Tier 2: 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 2 | Tier 2: 1 |
| SANTA CLARA COUNTY HEALTH AUTHORITY | 1 | Tier 2 | Tier 2: 1 |
| SANTA CRUZ MONTEREY MERCED SAN BENITO MARIPOSA MANAGED MEDIC | 1 | Tier 1 | Tier 1: 1 |
| SAPPHIRE EDGE, INC. | 3 | Tier 3 | Tier 3: 3 |
| SCAN DESERT HEALTH PLAN, INC. | 8 | Tier 3 | Tier 3: 8 |
| SCAN HEALTH PLAN | 66 | Tier 3 | Tier 3: 66 |
| SCAN HEALTH PLAN (OR) | 2 | Tier 3 | Tier 3: 2 |
| SCAN HEALTH PLAN (WA) | 1 | Tier 3 | Tier 3: 1 |
| SCAN HEALTH PLAN NEVADA, INC. | 4 | Tier 3 | Tier 3: 4 |
| SCAN HEALTH PLAN TEXAS, INC. | 4 | Tier 3 | Tier 3: 4 |
| SCOTT AND WHITE HEALTH PLAN | 4 | Tier 3 | Tier 3: 4 |
| SECUR INC | 4 | Tier 1–2 | Tier 1: 2 · Tier 2: 2 |
| 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 | Tier 2: 35 |
| SIMPLY HEALTHCARE PLANS, INC. | 3 | Tier 2 | Tier 2: 3 |
| SIMPRA ADVANTAGE, INC. | 3 | Tier 1–2 | Tier 1: 2 · Tier 2: 1 |
| SOLIS HEALTH PLANS, INC. | 19 | Tier 3 | Tier 3: 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 3 | Tier 3: 3 |
| SUMMACARE INC. | 5 | Tier 3 | Tier 3: 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 3 | Tier 3: 3 |
| THP INSURANCE COMPANY | 3 | Tier 3 | Tier 3: 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 1–3 | Tier 1: 2 · Tier 3: 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 2 | Tier 2: 4 |
| UPMC HEALTH COVERAGE, INC. | 1 | Tier 2 | Tier 2: 1 |
| UPMC HEALTH NETWORK, INC. | 8 | Tier 2 | Tier 2: 8 |
| UPMC HEALTH PLAN, INC. | 17 | Tier 2 | Tier 2: 17 |
| UPPER PENINSULA HEALTH PLAN, LLC | 1 | Tier 3 | Tier 3: 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 2 | Tier 2: 2 |
| VERDA HEALTH PLAN OF TEXAS INC | 4 | Tier 2 | Tier 2: 4 |
| VILLAGE SENIOR SERVICES CORPORATION | 3 | Tier 2 | Tier 2: 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 2 | Tier 2: 3 |
| Ventura County Medi-Cal Managed Care Commission | 1 | Tier 3 | Tier 3: 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. | 34 | Tier 2 | Tier 2: 34 |
| WELLMARK IA & SD, & BCBS MN, MT, NE, ND,& WY | 1 | Tier 3 | Tier 3: 1 |
| WELLPOINT HEALTH PLANS, INC. | 6 | Tier 3 | Tier 3: 6 |
| WELLPOINT INSURANCE COMPANY | 33 | Tier 3 | Tier 3: 33 |
| WELLPOINT IOWA, INC. | 1 | Tier 3 | Tier 3: 1 |
| WELLPOINT NEW JERSEY, INC. | 3 | Tier 3 | Tier 3: 3 |
| WELLPOINT TENNESSEE, INC. | 9 | Tier 3 | Tier 3: 9 |
| WELLPOINT TEXAS, INC. | 8 | Tier 3 | Tier 3: 8 |
| WELLPOINT WEST VIRGINIA , INC. | 3 | Tier 3 | Tier 3: 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 5,292 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 |
