UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Anderson |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Andrews |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Angelina |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| 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 |
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Archer |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Armstrong |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Austin |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| 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 |
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Bandera |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Baylor |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Bell |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| 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 |
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Brazos |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Cherokee |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Clay |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| 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 |
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Cooke |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Coryell |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Delta |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| 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 |
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
DeWitt |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Dimmit |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Duval |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| 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 |
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Eastland |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Ector |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Erath |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Falls |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Fannin |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Frio |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| 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 |
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Gonzales |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Gray |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Grayson |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| 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 |
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Gregg |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Grimes |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Hale |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Hardin |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Harrison |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Hill |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Hockley |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Hood |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Hopkins |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Houston |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Howard |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Hunt |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Jasper |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Karnes |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Lavaca |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Limestone |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
|
|
|
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Lubbock |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
|
|
|
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
McLennan |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Matagorda |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
|
|
|
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Maverick |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
|
|
|
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Medina |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Midland |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
|
|
|
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Milam |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
|
|
|
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Montague |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Morris |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
|
|
|
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Nacogdoches |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
|
|
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Navarro |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| 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 |
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Nolan |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Orange |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Palo Pinto |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| 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 |
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Panola |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Parker |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Potter |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| 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 |
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Rains |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Randall |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Red River |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| 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 |
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Roberts |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Rusk |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
San Augustine |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| 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 |
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
San Jacinto |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Shelby |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Starr |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| 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 |
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Taylor |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Titus |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Tom Green |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| 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 |
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Trinity |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Tyler |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Upshur |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| 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 |
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Victoria |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Walker |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Washington |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| 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 |
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Webb |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Wharton |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Wise |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| 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 |
UnitedHealthcare Dual Complete (HMO D-SNP) in TX - H5322-025-0
Sanctioned Plan
|
Zavala |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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