REBIF REBIDOSE 22 MCG/0.5 ML (0.5 ML ) (NDC: 44087332201)
2016 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Additional Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP MedicareComplete SecureHorizons Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $6,393.55 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $6,393.55 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $6,393.55 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $6,393.55 |
Browse Plan Formulary |
Anthem MediBlue Plus (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $6,292.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem MediBlue Plus (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $6,292.97 |
Browse Plan Formulary |
Anthem MediBlue Select (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $6,343.87 |
Browse Plan Formulary |
Anthem MediBlue Select (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $6,343.87 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
|
$0.00 |
$0 |
to be determined |
6 |
Specialty Tier |
33% | n/a | Q:6 /28Days | $6,376.46 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
|
$0.00 |
$0 |
to be determined |
6 |
Specialty Tier |
33% | n/a | Q:6 /28Days | $6,376.46 |
Browse Plan Formulary |
Blue Shield 65 Plus Choice Plan (HMO)
|
$0.00 |
$0 |
to be determined |
6 |
Tier 6 |
33% | n/a | Q:6 /28Days | $6,376.46 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bridges Drug Savings (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | None | $6,265.32 |
Browse Plan Formulary |
Bridges Drug Savings (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | None | $6,265.32 |
Browse Plan Formulary |
Care1st AdvantageOptimum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $6,450.16 |
Browse Plan Formulary |
Care1st AdvantageOptimum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $6,450.16 |
Browse Plan Formulary |
Care1st Cal MediConnect Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $6,518.79 |
Browse Plan Formulary |
Care1st Cal MediConnect Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $6,518.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $6,486.14 |
Browse Plan Formulary |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $6,486.14 |
Browse Plan Formulary |
CareMore Cal MediConnect Medicare-Medicaid Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
0% | 0% | P | $6,486.14 |
Browse Plan Formulary |
CareMore Cal MediConnect Medicare-Medicaid Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
0% | 0% | P | $6,486.14 |
Browse Plan Formulary |
CareMore Connect (HMO SNP)
|
$0.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $6,486.14 |
Browse Plan Formulary |
CareMore Connect (HMO SNP)
|
$0.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $6,486.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareMore ESRD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $6,486.14 |
Browse Plan Formulary |
CareMore ESRD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $6,486.14 |
Browse Plan Formulary |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $6,486.14 |
Browse Plan Formulary |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $6,486.14 |
Browse Plan Formulary |
CareMore Reliance (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $6,486.14 |
Browse Plan Formulary |
CareMore Reliance (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $6,486.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareMore StartSmart Plus (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $6,486.14 |
Browse Plan Formulary |
CareMore StartSmart Plus (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $6,486.14 |
Browse Plan Formulary |
CareMore Touch (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $6,486.14 |
Browse Plan Formulary |
CareMore Touch (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $6,486.14 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $6,486.14 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $6,486.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Classic Care (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | None | $6,265.32 |
Browse Plan Formulary |
Classic Care (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | None | $6,265.32 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P Q:6 /28Days | $6,402.23 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P Q:6 /28Days | $6,402.23 |
Browse Plan Formulary |
Golden State Medicare Health Plan, Golden (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $6,293.34 |
Browse Plan Formulary |
Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $6,406.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $6,406.32 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $6,410.47 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $6,402.93 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $6,410.47 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $6,402.93 |
Browse Plan Formulary |
Health Net Jade (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $6,410.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Net Jade (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $6,410.47 |
Browse Plan Formulary |
Healthy Heart Drug Savings (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | None | $6,265.32 |
Browse Plan Formulary |
Healthy Heart Drug Savings (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | None | $6,265.32 |
Browse Plan Formulary |
Hope Drug Savings (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | None | $6,265.32 |
Browse Plan Formulary |
Hope Drug Savings (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | None | $6,265.32 |
Browse Plan Formulary |
Humana Gold Plus H5619-021 (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P Q:6 /28Days | $6,290.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-021 (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P Q:6 /28Days | $6,290.55 |
Browse Plan Formulary |
In Control Drug Savings (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | None | $6,265.32 |
Browse Plan Formulary |
In Control Drug Savings (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | None | $6,265.32 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $6,075.04 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $6,075.04 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $6,075.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $6,075.04 |
Browse Plan Formulary |
L.A Care Cal MediConnect Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | Q:6 /28Days | $6,338.75 |
Browse Plan Formulary |
L.A Care Cal MediConnect Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | Q:6 /28Days | $6,338.75 |
Browse Plan Formulary |
PHP (HMO SNP)
|
$0.00 |
$360 |
to be determined |
4 |
Specialty Tier |
25% | n/a | None | $6,518.79 |
Browse Plan Formulary |
PHP (HMO SNP)
|
$0.00 |
$360 |
to be determined |
4 |
Specialty Tier |
25% | n/a | None | $6,518.79 |
Browse Plan Formulary |
SCAN Balance (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $6,299.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SCAN Balance (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $6,299.38 |
Browse Plan Formulary |
SCAN Classic (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $6,351.31 |
Browse Plan Formulary |
SCAN Classic (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $6,351.31 |
Browse Plan Formulary |
SCAN Healthy at Home (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $6,299.66 |
Browse Plan Formulary |
SCAN Healthy at Home (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $6,299.66 |
Browse Plan Formulary |
Easy Choice Plus Plan (HMO)
|
$12.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | P Q:6 /28Days | $6,402.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Easy Choice Plus Plan (HMO)
|
$12.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | P Q:6 /28Days | $6,402.23 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$20.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $6,410.47 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$20.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $6,402.93 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$20.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $6,410.47 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$20.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $6,402.93 |
Browse Plan Formulary |
CareMore Connect Plus (HMO)
|
$22.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $6,486.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareMore Connect Plus (HMO)
|
$22.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $6,486.14 |
Browse Plan Formulary |
Humana Gold Plus H5619-037 (HMO)
|
$23.40 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | P Q:6 /28Days | $6,290.55 |
Browse Plan Formulary |
Humana Gold Plus H5619-037 (HMO)
|
$23.40 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | P Q:6 /28Days | $6,290.55 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$25.20 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $6,075.04 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$25.20 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $6,075.04 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 3 (HMO)
|
$27.40 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $6,353.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete SecureHorizons Plan 3 (HMO)
|
$27.40 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $6,353.95 |
Browse Plan Formulary |
Anthem MediBlue Coordination Plus (HMO)
|
$31.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | P | $6,292.97 |
Browse Plan Formulary |
Anthem MediBlue Coordination Plus (HMO)
|
$31.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | P | $6,292.97 |
Browse Plan Formulary |
Bridges - Dual Access (HMO SNP)
|
$31.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $6,265.32 |
Browse Plan Formulary |
Bridges - Dual Access (HMO SNP)
|
$31.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $6,265.32 |
Browse Plan Formulary |
Care1st TotalDual Plan (HMO SNP)
|
$31.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P | $6,518.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Care1st TotalDual Plan (HMO SNP)
|
$31.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P | $6,518.79 |
Browse Plan Formulary |
Classic Choice for Medi-Medi (HMO)
|
$31.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $6,265.32 |
Browse Plan Formulary |
Classic Choice for Medi-Medi (HMO)
|
$31.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $6,265.32 |
Browse Plan Formulary |
Coordinated Choice Plan (HMO)
|
$31.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P | $6,448.88 |
Browse Plan Formulary |
Coordinated Choice Plan (HMO)
|
$31.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P | $6,448.88 |
Browse Plan Formulary |
Dual Coverage (HMO SNP)
|
$31.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $6,265.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Dual Coverage (HMO SNP)
|
$31.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $6,265.32 |
Browse Plan Formulary |
Harmony - Dual Access (HMO SNP)
|
$31.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $6,265.32 |
Browse Plan Formulary |
Harmony - Dual Access (HMO SNP)
|
$31.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $6,265.32 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
|
$31.00 |
$270 |
to be determined |
5 |
Specialty Tier |
27% | 27% | P | $6,406.39 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
|
$31.00 |
$270 |
to be determined |
5 |
Specialty Tier |
27% | 27% | P | $6,406.39 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$31.00 |
$280 |
to be determined |
5 |
Specialty Tier |
26% | 26% | P | $6,406.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Net Seniority Plus Amber II (HMO SNP)
|
$31.00 |
$280 |
to be determined |
5 |
Specialty Tier |
26% | 26% | P | $6,402.75 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$31.00 |
$280 |
to be determined |
5 |
Specialty Tier |
26% | 26% | P | $6,406.52 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$31.00 |
$280 |
to be determined |
5 |
Specialty Tier |
26% | 26% | P | $6,402.75 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire (HMO)
|
$31.00 |
$290 |
to be determined |
5 |
Specialty Tier |
26% | 26% | P | $6,406.52 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire (HMO)
|
$31.00 |
$290 |
to be determined |
5 |
Specialty Tier |
26% | 26% | P | $6,402.75 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire (HMO)
|
$31.00 |
$290 |
to be determined |
5 |
Specialty Tier |
26% | 26% | P | $6,406.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Net Seniority Plus Sapphire (HMO)
|
$31.00 |
$290 |
to be determined |
5 |
Specialty Tier |
26% | 26% | P | $6,402.75 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire Premier (HMO)
|
$31.00 |
$310 |
to be determined |
5 |
Specialty Tier |
26% | 26% | P | $6,406.52 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire Premier (HMO)
|
$31.00 |
$310 |
to be determined |
5 |
Specialty Tier |
26% | 26% | P | $6,406.52 |
Browse Plan Formulary |
Healthy Heart - Dual Access (HMO SNP)
|
$31.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $6,265.32 |
Browse Plan Formulary |
Healthy Heart - Dual Access (HMO SNP)
|
$31.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $6,265.32 |
Browse Plan Formulary |
In Control - Dual Access (HMO SNP)
|
$31.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $6,265.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
In Control - Dual Access (HMO SNP)
|
$31.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $6,265.32 |
Browse Plan Formulary |
SCAN Connections (HMO SNP)
|
$31.10 |
$360 |
to be determined |
5 |
Tier 5 |
$0.00 | $0.00 | P | $6,349.15 |
Browse Plan Formulary |
SCAN Connections (HMO SNP)
|
$31.10 |
$360 |
to be determined |
5 |
Tier 5 |
$0.00 | $0.00 | P | $6,349.15 |
Browse Plan Formulary |
SCAN Connections at Home (HMO SNP)
|
$31.10 |
$360 |
to be determined |
5 |
Tier 5 |
$0.00 | $0.00 | P | $6,351.31 |
Browse Plan Formulary |
SCAN Connections at Home (HMO SNP)
|
$31.10 |
$360 |
to be determined |
5 |
Tier 5 |
$0.00 | $0.00 | P | $6,351.31 |
Browse Plan Formulary |
SCAN Plus (HMO)
|
$31.10 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $6,349.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SCAN Plus (HMO)
|
$31.10 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $6,349.15 |
Browse Plan Formulary |
VillageHealth (HMO-POS SNP)
|
$31.10 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $6,299.38 |
Browse Plan Formulary |
VillageHealth (HMO-POS SNP)
|
$31.10 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $6,299.38 |
Browse Plan Formulary |
Humana Gold Plus H5619-022 (HMO)
|
$39.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P Q:6 /28Days | $6,290.55 |
Browse Plan Formulary |
Humana Gold Plus H5619-022 (HMO)
|
$39.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P Q:6 /28Days | $6,290.55 |
Browse Plan Formulary |