2023 Medicare Part D Contract ID/Plan ID Search

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Review 2023 Medicare Advantage plans

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There are 151 2023 Medicare Advantage plans (MAPD) meeting your criteria.
Insulin on a Medicare Part D plan's formulary will have a monthly copay of $35 or less.

2023 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips
Plan Name			County	Monthly Prem. (Parts C & D)	Deduct- ible	(Donut Hole) Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance 30-Day Supply	MOOP for Part A & B Benefits
Cust. Service Rating	Member Plan Exper.	RxCost Info Rating
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Appling	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Atkinson	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Bacon	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Baker	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Baldwin	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Banks	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Barrow	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Bartow	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Ben Hill	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Berrien	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Bibb	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Bleckley	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Brantley	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Brooks	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Bryan	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Bulloch	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Burke	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Butts	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Calhoun	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Camden	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Candler	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Carroll	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Catoosa	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Charlton	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Chatham	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Chattahoochee	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Chattooga	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Cherokee	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Clarke	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Clay	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Clayton	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Clinch	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Cobb	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Coffee	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Colquitt	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Columbia	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Cook	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Coweta	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Crawford	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Crisp	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Dade	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Dawson	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Decatur	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			DeKalb	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Dodge	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Dooly	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Dougherty	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Douglas	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Early	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Echols	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Effingham	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Elbert	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Emanuel	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Evans	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Fannin	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Fayette	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Forsyth	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Franklin	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Fulton	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Gilmer	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Glascock	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Glynn	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Grady	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Greene	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Gwinnett	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Habersham	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Hall	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Hancock	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Haralson	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Harris	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Hart	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Heard	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Henry	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Houston	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Irwin	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Jackson	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Jasper	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Jeff Davis	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Jefferson	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Jenkins	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Johnson	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Jones	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Lamar	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Laurens	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Lee	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Liberty	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Lincoln	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Long	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Lumpkin	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			McDuffie	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			McIntosh	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Macon	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Madison	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Marion	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Meriwether	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Miller	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Mitchell	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Monroe	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Montgomery	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Morgan	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Murray	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Muscogee	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Newton	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Oconee	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Oglethorpe	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Paulding	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Peach	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Pickens	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Pierce	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Pike	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Polk	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Pulaski	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Putnam	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Quitman	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Rabun	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Randolph	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Richmond	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Rockdale	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Schley	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Screven	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Seminole	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Spalding	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Stephens	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Stewart	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Sumter	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Talbot	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Taliaferro	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Tattnall	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Taylor	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Telfair	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Terrell	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Thomas	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Tift	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Treutlen	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Troup	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Turner	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Twiggs	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Union	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Upson	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Walton	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Ware	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Warren	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Washington	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Wayne	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Webster	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Wheeler	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			White	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Wilcox	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Wilkes	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Wilkinson	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			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
Clover Health LiveHealthy Value (PPO) in GA - H5141-045-0 Benefit Details			Worth	$37.30	$395 Tier 1 exempt	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25% all covered insulin pay $35 or less	$6,600 Browse Formulary
			Higher cost-sharing at standard network pharmacies. Details:

• 2023 PDP-Finder (Drug Only Plans)
• Compare 2022 & 2023 Plans
• 2023 PDP-DrugFinder (Formulary Drug Search)

Review 2023 Medicare Advantage plans

Chart Legend:

Below are a few notes to help with the understanding of the 2023 Medicare Part D Prescription Drug Plan chart above and Search Tips to help you narrow down your list of plans to those that best meet your needs.

• Plan Name: This is the official plan name from the Centers for Medicare and Medicaid Services (CMS). The same plan name generally has a different plan id in each state. (Search Tip: If you would like to reduce the plans shown to just plans for one or two specific carriers, you can select the carrier name in the "Plan Family" fields 1 and 2. Select the empty (blank) option at the top of the list to remove the criteria. You can also click the "National Plans" checkbox to limit your search to just national plans.)
  
  
• CMS Plan Ratings: these are found under the Plan Name at the left side of the chart.
  This is a 1 to 5 star rating system with five (5) stars as excellent, four (4) stars as very good, three (3) stars as good, two (2) stars as fair and one (1) star as poor.
  
  
  • Cust. Service Rating - Drug Plan Customer Service - Medicare and members rate the drug plan and how well a drug plan provides customer service.
    
    This category includes measures of how drug plans rate on the following areas:
    
    • Time on Hold When Customer and Pharmacist Calls Drug Plan.
    • Calls Disconnected When Customer and Pharmacist Calls Drug Plan.
    • Drug Plan’s Timeliness in Giving a Decision for Members Who Make an Appeal.
    • Fairness of Drug Plan’s Denials to a Member’s Appeal, Based on an Independent Reviewer.
    
    
  • Member Plan Exper. - Member Experience with Drug Plan - This category shows how well drug plans make prescription drugs available to their members.
    
    This category includes measures of how drug plans rate on the following areas:
    
    • Drug Plan Provides Information or Help When Members Need It.
    • Members’ Overall Rating of Drug Plan.
    • Members’ Ability to Get Prescriptions Filled Easily When Using the Drug Plan.
    
    
  • RxCost Info Rating - This category shows how well drug plans are doing with pricing prescriptions and providing information on the Medicare website.
    
    This category includes measures of how drug plans rate on the following areas:
    • Completeness of the Drug Plan’s Information on Members Who Need Extra Help.
    • Drug Plan Provides Current Information on Costs and Coverage for Medicare’s Website (the same data is used on this Q1Medicare.com).
    • Drug Plan’s Prices that Did Not Increase More Than Expected During the Year.
    • Drug Plan’s Prices on Medicare’s Website (and this website) Are Similar to the Prices Members Pay at the Pharmacy.
    • Drug Plan’s Members 65 and Older Who Received Prescriptions for Certain Drugs with a High Risk of Side Effects, when There May Be Safer Drug Choices.
    
    
• Monthly Premium: This is the amount you must pay each month to use the plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase. (Search Tip: If you would like to reduce the plans shown to just plans under a certain premium, enter this value in the "Maximum Premium" field.)
  
  (Search Tip: If you have selected an amount in the "LIS Subsidy Amount" filed, the premium shown is the premium based on your Low-Income Subsidy selection.
  
  
• Deductible: The standard CMS plan initial deductible is $505. Many Medicare plans do not have a deductible; however their plan premium may be higher. (Search Tip: If you would like to reduce the plans shown to just plans with a deductible under a certain value, enter this value in the "Maximum Deductible" field.) Some plans that have an annual deductible exempt certain drug tiers from the deductible. For example, "Tier 1 exempt" may be shown. This would mean that Tier 1 drugs purchased during the Deductible phase, would not fall into the deductible and would be charged the Initial Coverage Phase tier 1 cost-sharing.
  
  
• Gap Coverage: In the CMS Standard Plan, the beneficiary, or others on their behalf (e.g. the brand-name drug manufacturer discount), pay(s) up to $5,856 in drug costs, depending on your mix of generics and brand-name drugs. The Healthcare Reform provides that for plan year 2023, all formulary drugs will have at least a 75% discount in the coverage gap (Donut Hole). The Gap Coverage Types discussed in this section are supplemental coverage your plan pays in addition to the Healthcare Reform mandated discounts. In our chart, you will see one of the following:
  • No Gap Coverage: You receive the 75% Donut Hole Discount and pay up to $5,856 depending on your mix of generics and brand-name drugs, before exiting into Catastrophic Coverage. Read more...
  • Yes: This plan offers some supplemental gap coverage in addition to the 75% Donut Hole Discount. See plan details for a description of the gap coverage. The description may read similar to: Under this plan you may pay even less for the brand and generic drugs on the formulary. Your cost varies by tier. You will need to use your formulary to locate your drug's tier. See the chart that follows to find out how much it will cost you.
  
  
• $0 Premium with Full LIS - Does the plan qualify for $0 premium with full Low-Income Subsidy?: If Yes is in the field, then you would pay a $0 premium if you have a Full Low-Income Subsidy (LIS). If No is in the field, then you would be responsible for the difference between what the state provides as the Full Low-Income Subsidy and the actual cost of the plan even if you have a Full Low-Income Subsidy. (Search Tip: If you would like to reduce the plans shown to just plans that qualify for the $0 premium (Benchmark plans), select "Yes..." in the "Full Low-Income Subsidy?" field.)
  
  
• Plan ID: This is the unique id for this particular plan.
  
  
• Copay / Coinsurance - Cost Sharing - This is what you will pay for formulary drugs in the Initial Coverage Phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in "tiers". Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on the drug’s tier. Plans can form their own tiers, so you should contact the plan or reference their summary of benefits to find out what copays and limitations are associated with each tier. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. (Search Tip: If you would like to reduce the plans shown to just plans that have a tier 1 (Generics) co-pay of up to a certain value (ex: $0 co-pay), enter the value (ex: 0) in the "Max. Co-pay Tier 1 (Generics)" field.)
  
  All forms of insulin covered by any Medicare Part D plan will have a copay of $35 or less through all phases of coverage. Please contact the drug plan for more details.
  
  

Additional Information Fields:
You can select one of the following additional pieces of plan information to display (Search Tip: to change the type of information shown in the last column of the chart, select the data to be shown in the "Additional Info" field.)

• Total Formulary Drugs (default) - This is the total number of medications on the plans formulary or drug list. This total drug count does not include "Bonus Drugs". These are non-Medicare Part D drugs which are covered by the plan, however they do not count toward your plan deductible, retail drug cost, or TrOOP.
  
  
• Plan’s Summary Star Rating - This is the overall star rating for the Medicare Part D plan. To learn more about the star ratings, please see our Plan Quality Star Ratings.
  
  
• Offers Mail Order - "Yes" is displayed if this plan offers mail order on any medications. It does NOT mean that ALL medications are available through mail order.
  
  
• Members in This State (updated: September 2023 figures) - This is the total number of members in this plan for this PDP CMS Region. For regions that contain more than one state, this is the total for all of those states combined. If the CMS Region contains more than one state, the actual state enrollment is shown, along with the CMS region and national enrollment figures on the plan details page. you can access the plan details by clicking the plan name, orange enroll options button, or the plan details icon.
  
  
• Members Nation Wide (updated: September 2023 figures) - This is the total number of member for this plan in all CMS Regions (States) combined.
  
  
• Initial Coverage Limit (ICL) - The Initial Coverage Phase of a Medicare Part D plan is the phase AFTER the initial deductible is met (if the plan has an initial deductible) and BEFORE the coverage gap (or donut hole) begins. The ICL is the phase of the prescription drug plan during which you and your plan share your prescription costs. During this phase you will pay either a co-payment (a flat fee per prescription) or co-insurance (a percentage of the drug cost). The details of the cost-sharing for the plan are shown in the Cost-Sharing column directly to the left of this column. The CMS standard Initial Coverage Limit for 2023 is $4,660 and increases each year.
  
  
• National or Regional Plans - This column simply displays the word "National" if the plan is sponsored by a national carrier or "Regional" if the plan sponsor is a regional carrier.
  
  

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(Chart Source: various files provided by the Centers for Medicare and Medicaid Services along with data from the Medicare.gov website plan finder.)

Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, we cannot guarantee the accuracy of this information. You should always verify cost and coverage information with your Medicare plan provider.