State,County,Organization Name,Organization Type,Plan Name,Plan Type,Special Needs Plan,Special Needs Plan Type,Benefit Type,Contract ID,Plan ID,Segment ID,National PDP,Part D Basic Premium Below Regional Benchmark?,Part C Premium,Part D Basic Premium,Part D Supplemental Premium,Part D Total Premium,Part D Premium Obligation with Full Premium Assistance,Part D Drug Deductible,Tiers Not Subject to Deductible,Increased Initial Coverage Limit,Extra Coverage in Gap,2024 Star Rating Part C,2024 Star Rating Part D,2024 Overall Star Rating
Alabama,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,009,0,,Yes,,$23.70 ,$0.00 ,$23.70 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Alaska,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,029,0,,Yes,,$26.20 ,$0.00 ,$26.20 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Arizona,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,023,0,,Yes,,$26.70 ,$0.00 ,$26.70 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Arkansas,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,016,0,,Yes,,$14.50 ,$0.00 ,$14.50 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
California,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,027,0,,Yes,,$22.70 ,$0.00 ,$22.70 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Colorado,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,062,0,,Yes,,$27.20 ,$0.00 ,$27.20 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Connecticut,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,060,0,,Yes,,$24.80 ,$0.00 ,$24.80 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Delaware,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,002,0,,Yes,,$25.80 ,$0.00 ,$25.80 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
District of Columbia,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,002,0,,Yes,,$25.80 ,$0.00 ,$25.80 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Florida,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,008,0,,Yes,,$25.30 ,$0.00 ,$25.30 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Florida,Alachua,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Alachua,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Alachua,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Baker,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Baker,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Baker,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Bay,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,014,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$175.00 ,1,,Yes,2.5,3.5,3.0
Florida,Bay,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Bradford,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Bradford,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Bradford,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Brevard,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Brevard,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Brevard,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Broward,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Broward,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,012,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$100.00 ,1,,Yes,2.5,3.5,3.0
Florida,Broward,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Calhoun,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,014,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$175.00 ,1,,Yes,2.5,3.5,3.0
Florida,Calhoun,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Charlotte,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Charlotte,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,012,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$100.00 ,1,,Yes,2.5,3.5,3.0
Florida,Charlotte,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Citrus,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Citrus,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,012,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$100.00 ,1,,Yes,2.5,3.5,3.0
Florida,Citrus,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Clay,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Clay,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Clay,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Collier,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Collier,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,012,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$100.00 ,1,,Yes,2.5,3.5,3.0
Florida,Collier,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Columbia,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Columbia,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Columbia,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,DeSoto,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,DeSoto,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,012,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$100.00 ,1,,Yes,2.5,3.5,3.0
Florida,DeSoto,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Dixie,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Dixie,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Dixie,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Duval,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Duval,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Duval,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Escambia,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,014,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$175.00 ,1,,Yes,2.5,3.5,3.0
Florida,Escambia,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Flagler,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Flagler,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Flagler,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Franklin,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Gadsden,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,014,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$175.00 ,1,,Yes,2.5,3.5,3.0
Florida,Gadsden,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Gilchrist,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Gilchrist,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Gilchrist,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Glades,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Glades,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Gulf,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,014,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$175.00 ,1,,Yes,2.5,3.5,3.0
Florida,Gulf,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Hamilton,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Hamilton,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Hamilton,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Hardee,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Hardee,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,012,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$100.00 ,1,,Yes,2.5,3.5,3.0
Florida,Hardee,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Hendry,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Hendry,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Hernando,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Hernando,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,012,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$100.00 ,1,,Yes,2.5,3.5,3.0
Florida,Hernando,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Highlands,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Highlands,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Hillsborough,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Hillsborough,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,012,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$100.00 ,1,,Yes,2.5,3.5,3.0
Florida,Hillsborough,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Holmes,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,014,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$175.00 ,1,,Yes,2.5,3.5,3.0
Florida,Holmes,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Indian River,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Indian River,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Indian River,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Jackson,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Jefferson,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Jefferson,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Jefferson,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Lafayette,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Lafayette,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Lafayette,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Lake,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Lake,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Lake,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Lee,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Lee,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,012,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$100.00 ,1,,Yes,2.5,3.5,3.0
Florida,Lee,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Leon,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Leon,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Leon,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Levy,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Levy,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Levy,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Liberty,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,014,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$175.00 ,1,,Yes,2.5,3.5,3.0
Florida,Liberty,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Madison,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Madison,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Madison,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Manatee,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Manatee,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,012,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$100.00 ,1,,Yes,2.5,3.5,3.0
Florida,Manatee,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Marion,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Marion,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Marion,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Martin,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Martin,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,012,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$100.00 ,1,,Yes,2.5,3.5,3.0
Florida,Martin,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Miami-Dade,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Nassau,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Nassau,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Nassau,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Okaloosa,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,014,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$175.00 ,1,,Yes,2.5,3.5,3.0
Florida,Okaloosa,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Okeechobee,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Okeechobee,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Orange,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Orange,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,012,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$100.00 ,1,,Yes,2.5,3.5,3.0
Florida,Orange,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Osceola,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Osceola,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,012,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$100.00 ,1,,Yes,2.5,3.5,3.0
Florida,Osceola,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Palm Beach,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Palm Beach,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,012,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$100.00 ,1,,Yes,2.5,3.5,3.0
Florida,Palm Beach,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Pasco,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Pasco,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,012,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$100.00 ,1,,Yes,2.5,3.5,3.0
Florida,Pasco,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Pinellas,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Pinellas,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,012,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$100.00 ,1,,Yes,2.5,3.5,3.0
Florida,Pinellas,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Polk,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Polk,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,012,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$100.00 ,1,,Yes,2.5,3.5,3.0
Florida,Polk,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Putnam,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Putnam,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Putnam,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Santa Rosa,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,014,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$175.00 ,1,,Yes,2.5,3.5,3.0
Florida,Santa Rosa,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Sarasota,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Sarasota,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,012,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$100.00 ,1,,Yes,2.5,3.5,3.0
Florida,Sarasota,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Seminole,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Seminole,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,012,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$100.00 ,1,,Yes,2.5,3.5,3.0
Florida,Seminole,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,St. Johns,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,St. Johns,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,St. Johns,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,St. Lucie,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,St. Lucie,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,012,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$100.00 ,1,,Yes,2.5,3.5,3.0
Florida,St. Lucie,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Sumter,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Sumter,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Sumter,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Suwannee,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Suwannee,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Taylor,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Taylor,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Taylor,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Union,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Union,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Union,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Volusia,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Volusia,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Volusia,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Wakulla,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,008,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$450.00 ,1,,Yes,2.5,3.5,3.0
Florida,Wakulla,Wellcare,Local CCP,Wellcare Premium Enhanced Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,010,0,,,$79.20 ,$13.80 ,$0.00 ,$13.80 ,$0.00 ,$0.00 ,,,Yes,2.5,3.5,3.0
Florida,Wakulla,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Walton,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,014,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$175.00 ,1,,Yes,2.5,3.5,3.0
Florida,Walton,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Florida,Washington,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H5199,014,0,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$175.00 ,1,,Yes,2.5,3.5,3.0
Florida,Washington,Wellcare,Local CCP,Wellcare Dual Access Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H5199,016,0,,Yes,$0.00 ,$25.50 ,$0.00 ,$25.50 ,$0.00 ,$545.00 ,,,,2.5,3.5,3.0
Georgia,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,007,0,,Yes,,$23.80 ,$0.00 ,$23.80 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Hawaii,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,028,0,,Yes,,$21.50 ,$0.00 ,$21.50 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Idaho,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,026,0,,Yes,,$29.30 ,$0.00 ,$29.30 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Illinois,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,014,0,,Yes,,$16.80 ,$0.00 ,$16.80 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Indiana,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,012,0,,Yes,,$19.60 ,$0.00 ,$19.60 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Iowa,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,022,0,,Yes,,$28.80 ,$0.00 ,$28.80 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Kansas,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,021,0,,Yes,,$23.30 ,$0.00 ,$23.30 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Kentucky,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,012,0,,Yes,,$19.60 ,$0.00 ,$19.60 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Louisiana,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,018,0,,Yes,,$26.00 ,$0.00 ,$26.00 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Maine,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,059,0,,Yes,,$21.30 ,$0.00 ,$21.30 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Maryland,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,002,0,,Yes,,$25.80 ,$0.00 ,$25.80 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Massachusetts,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,060,0,,Yes,,$24.80 ,$0.00 ,$24.80 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Michigan,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,010,0,,Yes,,$18.70 ,$0.00 ,$18.70 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Minnesota,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,022,0,,Yes,,$28.80 ,$0.00 ,$28.80 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Mississippi,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,017,0,,Yes,,$21.60 ,$0.00 ,$21.60 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Missouri,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,015,0,,Yes,,$27.30 ,$0.00 ,$27.30 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Montana,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,022,0,,Yes,,$28.80 ,$0.00 ,$28.80 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Nebraska,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,022,0,,Yes,,$28.80 ,$0.00 ,$28.80 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Nevada,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,024,0,,Yes,,$20.80 ,$0.00 ,$20.80 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
New Hampshire,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,059,0,,Yes,,$21.30 ,$0.00 ,$21.30 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
New Jersey,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,001,0,,Yes,,$24.30 ,$0.00 ,$24.30 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
New Mexico,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,061,0,,Yes,,$23.80 ,$0.00 ,$23.80 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
New York,Albany,MVP HEALTH CARE,Local CCP,MVP DualAccess Plus (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H3305,035,0,,Yes,$0.00 ,$34.50 ,$0.00 ,$34.50 ,$0.00 ,$545.00 ,,,,4.5,4.0,4.5
New York,Albany,Nascentia Health Plus,Local CCP,Nascentia Medicaid Advantage Plus (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H9066,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Not enough data available,Not enough data available,Not enough data available
New York,Broome,Excellus Health Plan Community Care LLC,Local CCP,Medicare Blue Dual Secure (HMO D-SNP),HMO,Yes,Dual-Eligible,Enhanced Alternative,H7524,004,0,,,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Plan too new to be measured,Plan too new to be measured,Plan too new to be measured
New York,Broome,"iCircle Services of the Finger Lakes, Inc",Local CCP,iCircle Dual Advantage (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H7813,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Plan too new to be measured,Plan too new to be measured,Plan too new to be measured
New York,Broome,Nascentia Health Plus,Local CCP,Nascentia Medicaid Advantage Plus (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H9066,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Not enough data available,Not enough data available,Not enough data available
New York,Cayuga,"iCircle Services of the Finger Lakes, Inc",Local CCP,iCircle Dual Advantage (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H7813,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Plan too new to be measured,Plan too new to be measured,Plan too new to be measured
New York,Chenango,"iCircle Services of the Finger Lakes, Inc",Local CCP,iCircle Dual Advantage (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H7813,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Plan too new to be measured,Plan too new to be measured,Plan too new to be measured
New York,Columbia,MVP HEALTH CARE,Local CCP,MVP DualAccess Plus (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H3305,035,0,,Yes,$0.00 ,$34.50 ,$0.00 ,$34.50 ,$0.00 ,$545.00 ,,,,4.5,4.0,4.5
New York,Columbia,Nascentia Health Plus,Local CCP,Nascentia Medicaid Advantage Plus (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H9066,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Not enough data available,Not enough data available,Not enough data available
New York,Cortland,"iCircle Services of the Finger Lakes, Inc",Local CCP,iCircle Dual Advantage (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H7813,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Plan too new to be measured,Plan too new to be measured,Plan too new to be measured
New York,Delaware,Nascentia Health Plus,Local CCP,Nascentia Medicaid Advantage Plus (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H9066,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Not enough data available,Not enough data available,Not enough data available
New York,Dutchess,MVP HEALTH CARE,Local CCP,MVP DualAccess Plus (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H3305,035,0,,Yes,$0.00 ,$34.50 ,$0.00 ,$34.50 ,$0.00 ,$545.00 ,,,,4.5,4.0,4.5
New York,Erie,Excellus Health Plan Community Care LLC,Local CCP,Univera Medicare Total Care (HMO D-SNP),HMO,Yes,Dual-Eligible,Enhanced Alternative,H7524,002,0,,,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Plan too new to be measured,Plan too new to be measured,Plan too new to be measured
New York,Erie,Nascentia Health Plus,Local CCP,Nascentia Medicaid Advantage Plus (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H9066,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Not enough data available,Not enough data available,Not enough data available
New York,Greene,MVP HEALTH CARE,Local CCP,MVP DualAccess Plus (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H3305,035,0,,Yes,$0.00 ,$34.50 ,$0.00 ,$34.50 ,$0.00 ,$545.00 ,,,,4.5,4.0,4.5
New York,Greene,Nascentia Health Plus,Local CCP,Nascentia Medicaid Advantage Plus (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H9066,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Not enough data available,Not enough data available,Not enough data available
New York,Herkimer,Excellus Health Plan Community Care LLC,Local CCP,Medicare Blue Dual Secure (HMO D-SNP),HMO,Yes,Dual-Eligible,Enhanced Alternative,H7524,004,0,,,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Plan too new to be measured,Plan too new to be measured,Plan too new to be measured
New York,Kings,Aetna Medicare,Local CCP,Aetna Medicare Assure Plus Plan (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H3312,073,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,3.5,4.0,3.5
New York,Livingston,Excellus Health Plan Community Care LLC,Local CCP,Medicare Blue Dual Secure (HMO D-SNP),HMO,Yes,Dual-Eligible,Enhanced Alternative,H7524,004,0,,,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Plan too new to be measured,Plan too new to be measured,Plan too new to be measured
New York,Livingston,"iCircle Services of the Finger Lakes, Inc",Local CCP,iCircle Dual Advantage (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H7813,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Plan too new to be measured,Plan too new to be measured,Plan too new to be measured
New York,Madison,Nascentia Health Plus,Local CCP,Nascentia Medicaid Advantage Plus (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H9066,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Not enough data available,Not enough data available,Not enough data available
New York,Monroe,Excellus Health Plan Community Care LLC,Local CCP,Medicare Blue Dual Secure (HMO D-SNP),HMO,Yes,Dual-Eligible,Enhanced Alternative,H7524,004,0,,,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Plan too new to be measured,Plan too new to be measured,Plan too new to be measured
New York,Monroe,"iCircle Services of the Finger Lakes, Inc",Local CCP,iCircle Dual Advantage (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H7813,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Plan too new to be measured,Plan too new to be measured,Plan too new to be measured
New York,Monroe,Nascentia Health Plus,Local CCP,Nascentia Medicaid Advantage Plus (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H9066,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Not enough data available,Not enough data available,Not enough data available
New York,Niagara,Nascentia Health Plus,Local CCP,Nascentia Medicaid Advantage Plus (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H9066,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Not enough data available,Not enough data available,Not enough data available
New York,Oneida,Excellus Health Plan Community Care LLC,Local CCP,Medicare Blue Dual Secure (HMO D-SNP),HMO,Yes,Dual-Eligible,Enhanced Alternative,H7524,004,0,,,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Plan too new to be measured,Plan too new to be measured,Plan too new to be measured
New York,Oneida,Nascentia Health Plus,Local CCP,Nascentia Medicaid Advantage Plus (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H9066,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Not enough data available,Not enough data available,Not enough data available
New York,Onondaga,Excellus Health Plan Community Care LLC,Local CCP,Medicare Blue Dual Secure (HMO D-SNP),HMO,Yes,Dual-Eligible,Enhanced Alternative,H7524,004,0,,,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Plan too new to be measured,Plan too new to be measured,Plan too new to be measured
New York,Onondaga,"iCircle Services of the Finger Lakes, Inc",Local CCP,iCircle Dual Advantage (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H7813,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Plan too new to be measured,Plan too new to be measured,Plan too new to be measured
New York,Onondaga,Nascentia Health Plus,Local CCP,Nascentia Medicaid Advantage Plus (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H9066,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Not enough data available,Not enough data available,Not enough data available
New York,Ontario,Excellus Health Plan Community Care LLC,Local CCP,Medicare Blue Dual Secure (HMO D-SNP),HMO,Yes,Dual-Eligible,Enhanced Alternative,H7524,004,0,,,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Plan too new to be measured,Plan too new to be measured,Plan too new to be measured
New York,Ontario,"iCircle Services of the Finger Lakes, Inc",Local CCP,iCircle Dual Advantage (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H7813,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Plan too new to be measured,Plan too new to be measured,Plan too new to be measured
New York,Orange,MVP HEALTH CARE,Local CCP,MVP DualAccess Plus (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H3305,035,0,,Yes,$0.00 ,$34.50 ,$0.00 ,$34.50 ,$0.00 ,$545.00 ,,,,4.5,4.0,4.5
New York,Orleans,Excellus Health Plan Community Care LLC,Local CCP,Univera Medicare Total Care (HMO D-SNP),HMO,Yes,Dual-Eligible,Enhanced Alternative,H7524,002,0,,,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Plan too new to be measured,Plan too new to be measured,Plan too new to be measured
New York,Orleans,"iCircle Services of the Finger Lakes, Inc",Local CCP,iCircle Dual Advantage (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H7813,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Plan too new to be measured,Plan too new to be measured,Plan too new to be measured
New York,Otsego,Excellus Health Plan Community Care LLC,Local CCP,Medicare Blue Dual Secure (HMO D-SNP),HMO,Yes,Dual-Eligible,Enhanced Alternative,H7524,004,0,,,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Plan too new to be measured,Plan too new to be measured,Plan too new to be measured
New York,Otsego,Nascentia Health Plus,Local CCP,Nascentia Medicaid Advantage Plus (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H9066,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Not enough data available,Not enough data available,Not enough data available
New York,Putnam,MVP HEALTH CARE,Local CCP,MVP DualAccess Plus (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H3305,035,0,,Yes,$0.00 ,$34.50 ,$0.00 ,$34.50 ,$0.00 ,$545.00 ,,,,4.5,4.0,4.5
New York,Rensselaer,MVP HEALTH CARE,Local CCP,MVP DualAccess Plus (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H3305,035,0,,Yes,$0.00 ,$34.50 ,$0.00 ,$34.50 ,$0.00 ,$545.00 ,,,,4.5,4.0,4.5
New York,Rensselaer,Nascentia Health Plus,Local CCP,Nascentia Medicaid Advantage Plus (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H9066,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Not enough data available,Not enough data available,Not enough data available
New York,Rockland,MVP HEALTH CARE,Local CCP,MVP DualAccess Plus (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H3305,035,0,,Yes,$0.00 ,$34.50 ,$0.00 ,$34.50 ,$0.00 ,$545.00 ,,,,4.5,4.0,4.5
New York,Saratoga,MVP HEALTH CARE,Local CCP,MVP DualAccess Plus (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H3305,035,0,,Yes,$0.00 ,$34.50 ,$0.00 ,$34.50 ,$0.00 ,$545.00 ,,,,4.5,4.0,4.5
New York,Saratoga,Nascentia Health Plus,Local CCP,Nascentia Medicaid Advantage Plus (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H9066,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Not enough data available,Not enough data available,Not enough data available
New York,Schenectady,MVP HEALTH CARE,Local CCP,MVP DualAccess Plus (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H3305,035,0,,Yes,$0.00 ,$34.50 ,$0.00 ,$34.50 ,$0.00 ,$545.00 ,,,,4.5,4.0,4.5
New York,Schenectady,Nascentia Health Plus,Local CCP,Nascentia Medicaid Advantage Plus (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H9066,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Not enough data available,Not enough data available,Not enough data available
New York,Seneca,Excellus Health Plan Community Care LLC,Local CCP,Medicare Blue Dual Secure (HMO D-SNP),HMO,Yes,Dual-Eligible,Enhanced Alternative,H7524,004,0,,,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Plan too new to be measured,Plan too new to be measured,Plan too new to be measured
New York,Seneca,"iCircle Services of the Finger Lakes, Inc",Local CCP,iCircle Dual Advantage (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H7813,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Plan too new to be measured,Plan too new to be measured,Plan too new to be measured
New York,Steuben,"iCircle Services of the Finger Lakes, Inc",Local CCP,iCircle Dual Advantage (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H7813,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Plan too new to be measured,Plan too new to be measured,Plan too new to be measured
New York,Sullivan,MVP HEALTH CARE,Local CCP,MVP DualAccess Plus (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H3305,035,0,,Yes,$0.00 ,$34.50 ,$0.00 ,$34.50 ,$0.00 ,$545.00 ,,,,4.5,4.0,4.5
New York,Tioga,"iCircle Services of the Finger Lakes, Inc",Local CCP,iCircle Dual Advantage (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H7813,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Plan too new to be measured,Plan too new to be measured,Plan too new to be measured
New York,Ulster,MVP HEALTH CARE,Local CCP,MVP DualAccess Plus (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H3305,035,0,,Yes,$0.00 ,$34.50 ,$0.00 ,$34.50 ,$0.00 ,$545.00 ,,,,4.5,4.0,4.5
New York,Wayne,Excellus Health Plan Community Care LLC,Local CCP,Medicare Blue Dual Secure (HMO D-SNP),HMO,Yes,Dual-Eligible,Enhanced Alternative,H7524,004,0,,,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Plan too new to be measured,Plan too new to be measured,Plan too new to be measured
New York,Westchester,MVP HEALTH CARE,Local CCP,MVP DualAccess Plus (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H3305,035,0,,Yes,$0.00 ,$34.50 ,$0.00 ,$34.50 ,$0.00 ,$545.00 ,,,,4.5,4.0,4.5
New York,Wyoming,"iCircle Services of the Finger Lakes, Inc",Local CCP,iCircle Dual Advantage (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H7813,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Plan too new to be measured,Plan too new to be measured,Plan too new to be measured
New York,Yates,Excellus Health Plan Community Care LLC,Local CCP,Medicare Blue Dual Secure (HMO D-SNP),HMO,Yes,Dual-Eligible,Enhanced Alternative,H7524,004,0,,,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Plan too new to be measured,Plan too new to be measured,Plan too new to be measured
New York,Yates,"iCircle Services of the Finger Lakes, Inc",Local CCP,iCircle Dual Advantage (HMO D-SNP),HMO,Yes,Dual-Eligible,Defined Standard Benefit,H7813,001,0,,Yes,$0.00 ,$48.70 ,$0.00 ,$48.70 ,$0.00 ,$545.00 ,,,,Plan too new to be measured,Plan too new to be measured,Plan too new to be measured
North Carolina,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,005,0,,Yes,,$29.00 ,$0.00 ,$29.00 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
North Carolina,Alamance,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Alamance,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Alamance,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Alamance,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Alexander,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Alexander,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Alexander,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Alexander,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Alleghany,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Alleghany,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Alleghany,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Alleghany,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Anson,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Anson,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Anson,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Anson,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Ashe,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Ashe,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Ashe,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Ashe,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Avery,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Avery,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Avery,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Avery,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Bladen,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Bladen,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Bladen,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Bladen,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Buncombe,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Buncombe,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Buncombe,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Buncombe,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Burke,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Burke,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Burke,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Burke,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Cabarrus,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Cabarrus,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Cabarrus,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Cabarrus,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Caldwell,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Caldwell,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Caldwell,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Caldwell,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Caswell,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Caswell,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Caswell,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Caswell,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Catawba,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Catawba,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Catawba,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Catawba,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Chatham,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Chatham,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Chatham,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Chatham,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Clay,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Clay,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Clay,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Clay,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Cleveland,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Cleveland,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Cleveland,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Cleveland,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Columbus,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Columbus,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Columbus,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Columbus,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Cumberland,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Cumberland,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Cumberland,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Cumberland,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Davidson,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Davidson,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Davidson,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Davidson,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Davie,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Davie,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Davie,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Davie,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Duplin,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Duplin,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Duplin,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Duplin,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Durham,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Durham,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Durham,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Durham,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Forsyth,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Forsyth,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Forsyth,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Forsyth,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Franklin,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Franklin,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Franklin,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Franklin,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Gaston,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Gaston,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Gaston,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Gaston,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Graham,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Graham,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Graham,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Graham,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Granville,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Granville,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Granville,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Granville,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Greene,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Greene,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Greene,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Greene,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Guilford,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Guilford,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Guilford,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Guilford,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Harnett,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Harnett,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Harnett,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Harnett,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Haywood,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Haywood,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Haywood,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Haywood,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Henderson,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Henderson,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Henderson,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Henderson,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Hoke,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Hoke,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Hoke,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Hoke,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Iredell,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Iredell,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Iredell,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Iredell,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Jackson,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Jackson,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Jackson,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Jackson,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Johnston,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Johnston,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Johnston,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Johnston,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Lee,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Lee,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Lee,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Lee,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Lincoln,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Lincoln,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Lincoln,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Lincoln,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Macon,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Macon,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Macon,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Macon,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Madison,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Madison,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Madison,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Madison,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,McDowell,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,McDowell,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,McDowell,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,McDowell,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Mecklenburg,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Mecklenburg,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Mecklenburg,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Mecklenburg,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Mitchell,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Mitchell,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Mitchell,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Mitchell,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Montgomery,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Montgomery,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Montgomery,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Montgomery,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Moore,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Moore,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Moore,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Moore,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Nash,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Nash,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Nash,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Nash,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Orange,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Orange,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Orange,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Orange,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Person,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Person,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Person,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Person,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Polk,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Polk,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Polk,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Polk,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Randolph,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Randolph,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Randolph,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Randolph,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Richmond,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Richmond,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Richmond,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Richmond,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Robeson,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Robeson,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Robeson,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Robeson,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Rockingham,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Rockingham,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Rockingham,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Rockingham,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Rowan,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Rowan,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Rowan,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Rowan,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Rutherford,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Rutherford,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Rutherford,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Rutherford,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Sampson,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Sampson,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Sampson,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Sampson,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Scotland,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Scotland,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Scotland,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Scotland,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Stanly,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Stanly,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Stanly,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Stanly,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Stokes,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Stokes,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Stokes,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Stokes,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Surry,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Surry,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Surry,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Surry,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Swain,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Swain,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Swain,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Swain,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Transylvania,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Transylvania,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Transylvania,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Transylvania,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Union,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Union,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Union,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Union,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Vance,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Vance,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Vance,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Vance,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Wake,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Wake,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Wake,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Wake,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Warren,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Warren,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Warren,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Warren,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Watauga,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Watauga,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Watauga,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Watauga,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Wilkes,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Wilkes,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Wilkes,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Wilkes,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Wilson,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Wilson,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Wilson,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Wilson,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Yadkin,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Yadkin,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Yadkin,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Yadkin,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Carolina,Yancey,Wellcare,Local CCP,Wellcare No Premium Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,001,0,,,$0.00 ,($0.70),$0.70 ,$0.00 ,$0.00 ,$250.00 ,1,,,2.5,2.5,3.0
North Carolina,Yancey,Wellcare,Local CCP,Wellcare Dual Liberty Open (PPO D-SNP),Local PPO,Yes,Dual-Eligible,Defined Standard Benefit,H7175,002,0,,Yes,$0.00 ,$46.90 ,$0.00 ,$46.90 ,$0.00 ,$545.00 ,,,,2.5,2.5,3.0
North Carolina,Yancey,Wellcare,Local CCP,Wellcare Assist Open (PPO),Local PPO,No,,Basic Alternative,H7175,003,0,,Yes,$0.00 ,$36.40 ,$0.00 ,$36.40 ,$0.00 ,$430.00 ,1,,,2.5,2.5,3.0
North Carolina,Yancey,Wellcare,Local CCP,Wellcare Giveback Open (PPO),Local PPO,No,,Enhanced Alternative,H7175,004,0,,,$0.00 ,($4.90),$4.90 ,$0.00 ,$0.00 ,$545.00 ,1,,Yes,2.5,2.5,3.0
North Dakota,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,022,0,,Yes,,$28.80 ,$0.00 ,$28.80 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Ohio,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,011,0,,Yes,,$23.30 ,$0.00 ,$23.30 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Oklahoma,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,020,0,,Yes,,$21.70 ,$0.00 ,$21.70 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Oregon,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,025,0,,Yes,,$23.20 ,$0.00 ,$23.20 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Pennsylvania,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,003,0,,Yes,,$29.30 ,$0.00 ,$29.30 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Rhode Island,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,060,0,,Yes,,$24.80 ,$0.00 ,$24.80 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
South Carolina,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,006,0,,Yes,,$21.10 ,$0.00 ,$21.10 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
South Dakota,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,022,0,,Yes,,$28.80 ,$0.00 ,$28.80 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Tennessee,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,009,0,,Yes,,$23.70 ,$0.00 ,$23.70 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Texas,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,019,0,,Yes,,$18.30 ,$0.00 ,$18.30 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Utah,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,026,0,,Yes,,$29.30 ,$0.00 ,$29.30 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Vermont,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,060,0,,Yes,,$24.80 ,$0.00 ,$24.80 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Virginia,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,004,0,,Yes,,$23.60 ,$0.00 ,$23.60 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Washington,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,025,0,,Yes,,$23.20 ,$0.00 ,$23.20 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
West Virginia,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,003,0,,Yes,,$29.30 ,$0.00 ,$29.30 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Wisconsin,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,013,0,,Yes,,$34.30 ,$0.00 ,$34.30 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable
Wyoming,(All Counties),Clear Spring Health,PDP,Clear Spring Health Value Rx (PDP),Medicare Prescription Drug Plan,No,,Actuarially Equivalent Standard,S6946,022,0,,Yes,,$28.80 ,$0.00 ,$28.80 ,$0.00 ,$545.00 ,,,,Not Applicable,2.0,Not Applicable