Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
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Adjuntas |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Aguada |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Aguadilla |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Aguas Buenas |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Aibonito |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Anasco |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Arecibo |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Arroyo |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Barceloneta |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Barranquitas |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Bayamon |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Cabo Rojo |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Caguas |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Camuy |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Canovanas |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Carolina |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Catano |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Cayey |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Ceiba |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Ciales |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Cidra |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Coamo |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Comerio |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Corozal |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Culebra |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Dorado |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Fajardo |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Florida |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Guanica |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Guayama |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Guayanilla |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Guaynabo |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Gurabo |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Hatillo |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Hormigueros |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Humacao |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Isabela |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Jayuya |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Juana Diaz |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Juncos |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Lajas |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Lares |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Las Marias |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Las Piedras |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Loiza |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Luquillo |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Manati |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Maricao |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Maunabo |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Mayaguez |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Moca |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Morovis |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Naguabo |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Naranjito |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Orocovis |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Patillas |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Penuelas |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Ponce |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Quebradillas |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Rincon |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Rio Grande |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Sabana Grande |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Salinas |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
San German |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
San Juan |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
San Lorenzo |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
San Sebastian |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Santa Isabel |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Toa Alta |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Toa Baja |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Trujillo Alto |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Utuado |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
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|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Vega Alta |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
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|
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Vega Baja |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Vieques |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
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|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Villalba |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Yabucoa |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
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Genesis @ Home Constellation Health (HMO SNP) in PR - H3054-004-0
Sanctioned Plan
|
Yauco |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $6.50 Preferred Brand: $40.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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