2026 Medicare Advantage Plans in Saint Clair County, IL
Last update: . Enrollment data updated: May 2, 2026
For 2026, Saint Clair County, IL includes 47 Medicare Advantage plans. Enrollment across these plans totals approximately 20,274, with 37 $0 premium options and 35% rated 4 stars or higher.
This page and its statistics exclude Medicare Advantage Special Needs Plans (SNPs). Special Needs Plans in Saint Clair County, IL are summarized separately. Visit Medicare Options in Saint Clair County, IL to see more options.
Medicare Advantage PPO Plans
Preferred Provider Organization (PPO) plans allow members to choose care from both in-network and out-of-network providers. Out-of-network care usually costs more, but PPOs offer greater flexibility in how members access care.
- Total PPO Plans
- 27
- Average Monthly Premium
- $21.78/mo
- Total PPO Enrollment
- 5,436
- $0 Premium PPO Plans
- 20
- Average MOOP
- $5,657
- Top PPO by Enrollment
- Humana Value Choice H5216-318 (PPO) — 802 enrollees
- PPO Plans Without Drug Coverage
- 4
- What is the average monthly premium for PPO plans in Saint Clair?
- PPO plans in Saint Clair cost $21.78 per month on average.
- Which PPO plan has the highest enrollment in Saint Clair?
- The most popular PPO plan in Saint Clair is Humana Value Choice H5216-318 (PPO), with 802 enrollees.
- How many PPO plans in Saint Clair do not include prescription drug coverage?
- 4 PPO plans in Saint Clair do not include prescription drug coverage.
Medicare Advantage HMO Plans
Health Maintenance Organization (HMO) plans are built around a defined network of doctors and hospitals. Care is generally covered only within the network, except in emergencies, but this structure often results in lower premiums and out-of-pocket costs.
| Plan Name | CMS Stars* | Premium/Mo | MOOP | Rx Ded. | CMS ID |
|---|---|---|---|---|---|
| Essence Advantage | $0 | $3,400 | $0 | H2610-005-0 | |
| Essence Advantage Plus | $59 | $2,900 | $0 | H2610-006-0 | |
| Essence Advantage Select | $0 | $3,900 | $340 | H2610-016-0 | |
| Humana Gold Plus Giveback H0028-065 | $0 | $4,200 | $615 | H0028-065-0 | |
| Humana Gold Plus H0028-014 | $0 | $2,700 | $615 | H0028-014-0 | |
| Blue Cross Medicare Advantage Value | $0 | $4,000 | $450 | H3822-014-0 | |
| Wellcare Giveback | $0 | $7,500 | $615 | H5779-010-0 | |
| Wellcare Patriot Giveback | $0 | $5,500 | N/A | H5779-011-0 | |
| Wellcare Simple Essential | $0 | $4,200 | $615 | H5779-002-0 | |
| Wellcare Simple Essential Value | $0 | $3,900 | $615 | H5779-009-0 | |
| Clear Spring Health BrightPath Advantage | $0 | $4,200 | $200 | H5454-001-0 | |
| Molina Medicare Choice Care | $0 | $9,250 | $0 | H2715-003-0 |
What is the total number of HMO plans offered in Saint Clair?
There are 12 HMO plans in 2026, covering 5,943 enrollees.
How much do HMO plans cost in Saint Clair?
The average HMO premium in Saint Clair is $4.92 per month, with 11 plans offering $0 premiums.
What is the top HMO by enrollment in Saint Clair?
Essence Advantage (HMO) is the top HMO in Saint Clair, with 2,644 enrollees.
What is the number of HMO plans without Part D coverage in Saint Clair?
1 HMO plans in Saint Clair do not include prescription drug coverage.
Medicare Advantage HMO-POS Plans
HMO-POS plans are structured like HMOs, requiring in-network care for the lowest costs, while allowing limited out-of-network access at higher cost. This provides added flexibility compared with standard HMO plans.
- Total HMO-POS Plans
- 6
- Average Monthly Premium
- $6.67/mo
- Total HMO-POS Enrollment
- 8,895
- $0 Premium HMO-POS Plans
- 5
- Average MOOP
- $4,800
- Top HMO-POS by Enrollment
- AARP Medicare Advantage Extras from UHC ST-4 (HMO-POS) — 3,980 enrollees
- HMO-POS Plans Without Drug Coverage
- 1
| Plan Name | CMS Stars* | Premium/Mo | MOOP | Rx Ded. | CMS ID |
|---|---|---|---|---|---|
| AARP Medicare Advantage CareFlex from UHC ST-6 | $0 | $6,700 | $600 | H2802-073-0 | |
| AARP Medicare Advantage Essentials from UHC ST-3 | $0 | $3,200 | $440 | H2802-028-0 | |
| AARP Medicare Advantage Extras from UHC ST-4 | $0 | $3,900 | $520 | H2802-052-0 | |
| AARP Medicare Advantage Patriot No Rx MO-MA01 | $0 | $4,900 | N/A | H2802-050-0 | |
| Aetna Medicare Enhanced Extra | $40 | $5,900 | $615 | H2663-006-0 | |
| Aetna Medicare Signature | $0 | $4,200 | $615 | H2663-103-0 |
What is the average monthly premium for HMO-POS plans?
HMO-POS plans in Saint Clair cost $6.67 per month on average.
Which HMO-POS plan is most popular in Saint Clair?
The most popular HMO-POS plan in Saint Clair is AARP Medicare Advantage Extras from UHC ST-4 (HMO-POS), with 3,980 enrollees.
How many HMO-POS plans in Saint Clair do not include drug coverage?
There are 1 HMO-POS plans in Saint Clair without prescription drug coverage.
Medicare Advantage PFFS Plans
Private Fee-for-Service (PFFS) plans allow members to visit any Medicare-approved provider that accepts the plan’s payment terms. This provides flexibility in choosing doctors and hospitals, but provider acceptance should be confirmed before receiving care.
- Total PFFS Plans 2
- Average Monthly Premium $18.50/mo
- Total PFFS Enrollment 0
- $0 Premium PFFS Plans 1
- Average MOOP $6,750
- Top PFFS by Enrollment — 0 enrollees
- PFFS Plans Without Drug Coverage 1
| Plan Name | CMS Stars* | Premium/Mo | MOOP | Rx Ded. | CMS ID |
|---|---|---|---|---|---|
| Humana Gold Choice H8145-006 | $37 | $6,800 | $615 | H8145-006-0 | |
| Humana Gold Choice H8145-126 | $0 | $6,700 | N/A | H8145-126-0 |
What is the top PFFS plan in Saint Clair?
is the top PFFS in Saint Clair, with 0 enrollees.
What is the number of PFFS plans without Part D coverage in Saint Clair?
1 PFFS plans in Saint Clair do not include prescription drug coverage.
CMS quality ratings for Medicare Advantage plans in Saint Clair County, IL (2026) are summarized below.
| Rating Category | Number of Plans | Percent of Plans |
|---|---|---|
| 5 Stars | No 5-star plans available. | 0% |
| 4 Stars (includes 5 Stars) | 15 | 35% |
| 3 Stars | 28 | 65% |
| Below 3 Stars | 0 | 0% |
| Not Rated | 4 | 9% |
| Average Rating | 3.59 | |
* CMS assigns Medicare Advantage star ratings annually based on plan quality and performance measures.
- CMS.gov, Medicare Advantage Landscape Source Files — Last accessed May 2, 2026
- CMS.gov, Medicare Part C & D Performance Data — Last accessed May 2, 2026
- CMS.gov, Medicare Advantage & Part D Contract and Enrollment Data — Last accessed May 2, 2026
All plan counts, enrollment totals, averages, and percentage distributions are calculated at the county level using CMS data and include standard Medicare Advantage (MA/MAPD) plans only, based on a consistent aggregation methodology.
Data sources and methodology documentation .
- Medicare.gov, "Understanding Medicare Advantage Plans" — Last accessed 25 May, 2025
- Medicare.gov, "Compare Original Medicare & Medicare Advantage" — Last accessed 25 May, 2025
- NCOA.org, "5 Steps to Choosing the Right Medicare Plan for You" — Last accessed 25 May, 2025
MedicarePlans.com is an independent informational resource and has no affiliation with, or endorsement from, the U.S. Government or the federal Medicare program.
Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard .
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.