Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Alamance |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Alexander |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Alleghany |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Anson |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Ashe |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Avery |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Beaufort |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Bertie |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Bladen |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Brunswick |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Buncombe |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Burke |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Cabarrus |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Caldwell |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Caswell |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Catawba |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Chatham |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Chowan |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Cleveland |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Columbus |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Cumberland |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Davidson |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Davie |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Duplin |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Durham |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Edgecombe |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Forsyth |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Franklin |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Gaston |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Gates |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Graham |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Granville |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Greene |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Guilford |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Halifax |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Harnett |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Haywood |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Henderson |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Hertford |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Hoke |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Hyde |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Iredell |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Jackson |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Johnston |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Jones |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Lee |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Lenoir |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Lincoln |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
McDowell |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Macon |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Madison |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Martin |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Mecklenburg |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Mitchell |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Montgomery |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Moore |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Nash |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
New Hanover |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Northampton |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Orange |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Pamlico |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Pender |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Person |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Pitt |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Randolph |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Richmond |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Robeson |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Rockingham |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Rowan |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Rutherford |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Sampson |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Scotland |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Stanly |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Stokes |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Surry |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Swain |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Transylvania |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Tyrrell |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Union |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Vance |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Wake |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Warren |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Washington |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Watauga |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Wayne |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Wilkes |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Wilson |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
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Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
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Yadkin |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
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new |
new |
Higher cost-sharing at standard network pharmacies. Details:
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Healthy Blue + Medicare (HMO D-SNP) in NC - H9147-001-0
Benefit Details
|
Yancey |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Generics | Preferred Generic: $0.00 Generic: $18.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|