VOSEVI 400-100-100 MG TABLET (28 EA ) (NDC: 61958240101)
2020 Medicare Prescription Drug Plan (MAPD) Information
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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 Medicare Advantage SecureHorizons Focus (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | 33% | P Q:30 /30Days | $27,738.00 |
Browse Plan Formulary |
AARP Medicare Advantage SecureHorizons Plan 1 (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | 33% | P Q:30 /30Days | $27,738.00 |
Browse Plan Formulary |
AARP Medicare Advantage SecureHorizons Plan 2 (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | 33% | P Q:30 /30Days | $27,738.00 |
Browse Plan Formulary |
Aetna Medicare Plus Plan (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $26,985.60 |
Browse Plan Formulary |
Aetna Medicare Prime Plan (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $26,985.60 |
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 |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $26,985.60 |
Browse Plan Formulary |
Alignment Health Plan Heart & Diabetes (HMO C-SNP)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $27,153.90 |
Browse Plan Formulary |
Alignment Health Plan My Choice (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $27,133.50 |
Browse Plan Formulary |
Alignment Health Plan Platinum (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $27,153.90 |
Browse Plan Formulary |
Alignment Health Plan smartHMO (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $27,153.90 |
Browse Plan Formulary |
Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $26,375.40 |
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 Breathe (HMO C-SNP)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $26,375.40 |
Browse Plan Formulary |
Anthem MediBlue Care On Site (HMO I-SNP)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $26,373.90 |
Browse Plan Formulary |
Anthem MediBlue Connect (HMO D-SNP)
|
$0.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $26,378.10 |
Browse Plan Formulary |
Anthem MediBlue Diabetes (HMO C-SNP)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $26,375.40 |
Browse Plan Formulary |
Anthem MediBlue ESRD (HMO C-SNP)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $26,375.40 |
Browse Plan Formulary |
Anthem MediBlue Heart (HMO C-SNP)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $26,375.40 |
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 |
No |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $26,843.40 |
Browse Plan Formulary |
Anthem MediBlue Select (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $26,839.20 |
Browse Plan Formulary |
Anthem MediBlue StartSmart Plus (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $26,373.90 |
Browse Plan Formulary |
Anthem MediBlue Value Plus (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $26,375.40 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:1 /1Days | $26,001.60 |
Browse Plan Formulary |
Blue Shield 65 Plus Choice Plan (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:1 /1Days | $26,025.60 |
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 |
Blue Shield Inspire (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:1 /1Days | $26,001.60 |
Browse Plan Formulary |
Blue Shield Promise AdvantageOptimum Plan (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $26,001.00 |
Browse Plan Formulary |
Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
No |
3 |
Tier 3 |
0% | 0% | P | $26,032.50 |
Browse Plan Formulary |
Blue Shield Vital (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:1 /1Days | $26,001.60 |
Browse Plan Formulary |
Central Health Focus Plan (HMO C-SNP)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:28 /28Days | $25,920.30 |
Browse Plan Formulary |
Central Health Medicare Plan (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:28 /28Days | $25,920.30 |
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 |
Connected Care (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | 15% | P Q:84 /365Days | $25,920.30 |
Browse Plan Formulary |
Connected Care Select (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | 15% | P Q:84 /365Days | $25,920.30 |
Browse Plan Formulary |
Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | P | $26,382.30 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $27,256.50 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $27,122.10 |
Browse Plan Formulary |
Health Net Jade (HMO C-SNP)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $27,125.10 |
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)
|
$0.00 |
$370 |
No |
5 |
Tier 5 |
26% | n/a | P | $26,969.70 |
Browse Plan Formulary |
Humana Gold Plus H5619-021 (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:28 /28Days | $28,152.90 |
Browse Plan Formulary |
Imperial Senior Value (HMO C-SNP)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $27,019.50 |
Browse Plan Formulary |
Imperial Traditional (HMO) (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $27,019.50 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | 33% | P | $23,062.50 |
Browse Plan Formulary |
L.A. Care Cal MediConnect Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $26,950.20 |
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 |
Molina Dual Options (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | P | $26,032.50 |
Browse Plan Formulary |
PHP (HMO C-SNP)
|
$0.00 |
$435 |
No |
4 |
Tier 4 |
25% | n/a | P Q:28 /28Days | $25,921.80 |
Browse Plan Formulary |
WellCare Best (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $28,195.20 |
Browse Plan Formulary |
WellCare Dividend (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $28,195.20 |
Browse Plan Formulary |
WellCare Plus (HMO)
|
$0.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $28,195.20 |
Browse Plan Formulary |
WellCare Freedom (HMO D-SNP)
|
$1.10 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $28,195.20 |
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 Extra (HMO)
|
$14.40 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $26,856.90 |
Browse Plan Formulary |
UnitedHealthcare Medicare Advantage Assure (HMO)
|
$14.90 |
$435 |
No |
5 |
Tier 5 |
25% | 25% | P Q:30 /30Days | $27,768.90 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$15.40 |
$0 |
No |
5 |
Tier 5 |
33% | 33% | P | $23,134.20 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$16.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $27,256.50 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$16.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $27,122.10 |
Browse Plan Formulary |
Humana Value Plus H5619-037 (HMO)
|
$16.80 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:28 /28Days | $28,128.60 |
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 Medicare Advantage SecureHorizons Premier (HMO)
|
$18.70 |
$0 |
No |
5 |
Tier 5 |
33% | 33% | P Q:30 /30Days | $27,738.00 |
Browse Plan Formulary |
Anthem MediBlue Connect Plus (HMO)
|
$20.20 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $26,375.10 |
Browse Plan Formulary |
Anthem MediBlue Coordination Plus (HMO)
|
$25.30 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $26,843.40 |
Browse Plan Formulary |
Alignment Health Plan CalPlus (HMO)
|
$27.30 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $27,116.10 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO D-SNP)
|
$31.10 |
$435 |
No |
5 |
Tier 5 |
15% | 15% | P | $23,134.20 |
Browse Plan Formulary |
AARP Medicare Advantage SecureHorizons Focus (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | 33% | P Q:30 /30Days | $27,738.00 |
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 Medicare Advantage SecureHorizons Plan 1 (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | 33% | P Q:30 /30Days | $27,738.00 |
Browse Plan Formulary |
AARP Medicare Advantage SecureHorizons Plan 2 (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | 33% | P Q:30 /30Days | $27,738.00 |
Browse Plan Formulary |
AARP Medicare Advantage SecureHorizons Premier (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | 33% | P Q:30 /30Days | $27,738.00 |
Browse Plan Formulary |
Aetna Medicare Choice Plan (PPO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $26,987.70 |
Browse Plan Formulary |
Aetna Medicare Plus Plan (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $26,985.60 |
Browse Plan Formulary |
Aetna Medicare Prime Plan (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $26,985.60 |
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 |
Aetna Medicare Select Plan (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $26,985.60 |
Browse Plan Formulary |
Alignment Health Plan CalPlus (HMO)
|
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $27,116.10 |
Browse Plan Formulary |
Alignment Health Plan Heart & Diabetes (HMO C-SNP)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $27,153.90 |
Browse Plan Formulary |
Alignment Health Plan My Choice (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $27,133.50 |
Browse Plan Formulary |
Alignment Health Plan Platinum (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $27,153.90 |
Browse Plan Formulary |
Alignment Health Plan smartHMO (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $27,153.90 |
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 Blue Cross Cal MediConnect (Medicare-Medicaid Plan)
|
$32.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $26,375.40 |
Browse Plan Formulary |
Anthem MediBlue Breathe (HMO C-SNP)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $26,375.40 |
Browse Plan Formulary |
Anthem MediBlue Care On Site (HMO I-SNP)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $26,373.90 |
Browse Plan Formulary |
Anthem MediBlue Connect (HMO D-SNP)
|
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $26,378.10 |
Browse Plan Formulary |
Anthem MediBlue Connect Plus (HMO)
|
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $26,375.10 |
Browse Plan Formulary |
Anthem MediBlue Coordination Plus (HMO)
|
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $26,843.40 |
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 Diabetes (HMO C-SNP)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $26,375.40 |
Browse Plan Formulary |
Anthem MediBlue ESRD (HMO C-SNP)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $26,375.40 |
Browse Plan Formulary |
Anthem MediBlue Extra (HMO)
|
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $26,856.90 |
Browse Plan Formulary |
Anthem MediBlue Heart (HMO C-SNP)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $26,375.40 |
Browse Plan Formulary |
Anthem MediBlue Plus (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $26,843.40 |
Browse Plan Formulary |
Anthem MediBlue Select (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $26,839.20 |
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 StartSmart Plus (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $26,373.90 |
Browse Plan Formulary |
Anthem MediBlue Value Plus (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $26,375.40 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:1 /1Days | $26,001.60 |
Browse Plan Formulary |
Blue Shield Inspire (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:1 /1Days | $26,001.60 |
Browse Plan Formulary |
Blue Shield Promise AdvantageOptimum Plan (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $26,001.00 |
Browse Plan Formulary |
Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan)
|
$32.00 |
$0 |
No |
3 |
Tier 3 |
0% | 0% | P | $26,032.50 |
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 |
Blue Shield Promise Coordinated Choice Plan (HMO)
|
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $26,031.30 |
Browse Plan Formulary |
Blue Shield Promise Coordinated Choice Plan (HMO)
|
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $26,031.30 |
Browse Plan Formulary |
Blue Shield Promise TotalDual Plan (HMO D-SNP)
|
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $26,032.50 |
Browse Plan Formulary |
Blue Shield Promise TotalDual Plan (HMO D-SNP)
|
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $26,032.50 |
Browse Plan Formulary |
Blue Shield Vital (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:1 /1Days | $26,001.60 |
Browse Plan Formulary |
Central Health Focus Plan (HMO C-SNP)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:28 /28Days | $25,920.30 |
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 |
Central Health Medi-Medi Plan (HMO D-SNP)
|
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:28 /28Days | $25,920.30 |
Browse Plan Formulary |
Central Health Medi-Medi Plan (HMO D-SNP)
|
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:28 /28Days | $25,920.30 |
Browse Plan Formulary |
Central Health Medicare Plan (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:28 /28Days | $25,920.30 |
Browse Plan Formulary |
Central Health Premier Plan (HMO)
|
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:28 /28Days | $25,920.30 |
Browse Plan Formulary |
Central Health Premier Plan (HMO)
|
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:28 /28Days | $25,920.30 |
Browse Plan Formulary |
Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)
|
$32.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | P | $26,382.30 |
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 Gold Select (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $27,256.50 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $27,122.10 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $27,256.50 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $27,122.10 |
Browse Plan Formulary |
Health Net Jade (HMO C-SNP)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $27,125.10 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO D-SNP)
|
$32.00 |
$350 |
No |
5 |
Tier 5 |
26% | n/a | P | $26,972.70 |
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 I (HMO D-SNP)
|
$32.00 |
$350 |
No |
5 |
Tier 5 |
26% | n/a | P | $26,972.70 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO D-SNP)
|
$32.00 |
$350 |
No |
5 |
Tier 5 |
26% | n/a | P | $26,972.70 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO D-SNP)
|
$32.00 |
$350 |
No |
5 |
Tier 5 |
26% | n/a | P | $26,972.70 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire (HMO)
|
$32.00 |
$370 |
No |
5 |
Tier 5 |
26% | n/a | P | $26,969.70 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire Premier (HMO)
|
$32.00 |
$370 |
No |
5 |
Tier 5 |
26% | n/a | P | $26,974.20 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire Premier (HMO)
|
$32.00 |
$370 |
No |
5 |
Tier 5 |
26% | n/a | P | $26,974.20 |
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 Premier II (HMO)
|
$32.00 |
$410 |
No |
5 |
Tier 5 |
25% | n/a | P | $26,974.20 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire Premier II (HMO)
|
$32.00 |
$410 |
No |
5 |
Tier 5 |
25% | n/a | P | $26,974.20 |
Browse Plan Formulary |
Humana Gold Plus H5619-021 (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:28 /28Days | $28,152.90 |
Browse Plan Formulary |
Humana Value Plus H5619-037 (HMO)
|
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:28 /28Days | $28,128.60 |
Browse Plan Formulary |
Imperial Senior Value (HMO C-SNP)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $27,019.50 |
Browse Plan Formulary |
Imperial Traditional (HMO) (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $27,019.50 |
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 |
Imperial Traditional Plus (HMO) (HMO)
|
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $27,019.50 |
Browse Plan Formulary |
Imperial Traditional Plus (HMO) (HMO)
|
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $27,019.50 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | 33% | P | $23,134.20 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | 33% | P | $23,062.50 |
Browse Plan Formulary |
L.A. Care Cal MediConnect Plan (Medicare-Medicaid Plan)
|
$32.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $26,950.20 |
Browse Plan Formulary |
Molina Dual Options (Medicare-Medicaid Plan)
|
$32.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | P | $26,032.50 |
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 |
Molina Medicare Complete Care (HMO D-SNP)
|
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $26,032.50 |
Browse Plan Formulary |
Molina Medicare Complete Care (HMO D-SNP)
|
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $26,032.50 |
Browse Plan Formulary |
PHP (HMO C-SNP)
|
$32.00 |
$435 |
No |
4 |
Tier 4 |
25% | n/a | P Q:28 /28Days | $25,921.80 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO D-SNP)
|
$32.00 |
$435 |
No |
5 |
Tier 5 |
15% | 15% | P | $23,134.20 |
Browse Plan Formulary |
UnitedHealthcare Medicare Advantage Assure (HMO)
|
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | 25% | P Q:30 /30Days | $27,768.90 |
Browse Plan Formulary |
WellCare Best (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $28,195.20 |
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 |
WellCare Dividend (HMO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $28,195.20 |
Browse Plan Formulary |
WellCare Freedom (HMO D-SNP)
|
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $28,195.20 |
Browse Plan Formulary |
WellCare Plus (HMO)
|
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $28,195.20 |
Browse Plan Formulary |
Aetna Medicare Choice Plan (PPO)
|
$98.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $26,987.70 |
Browse Plan Formulary |