Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Adams |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Allegheny |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Armstrong |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Beaver |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Bedford |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Berks |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Blair |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Bradford |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Butler |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Cambria |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Cameron |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Carbon |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Centre |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Clarion |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Clearfield |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Clinton |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Crawford |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Cumberland |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Dauphin |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Elk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Erie |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Fayette |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Forest |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Fulton |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Greene |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Huntingdon |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Indiana |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Jefferson |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Juniata |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Lancaster |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Lawrence |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Lebanon |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Lehigh |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Lycoming |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
McKean |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Mercer |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Mifflin |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Monroe |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Northampton |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Perry |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Potter |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Schuylkill |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Snyder |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Somerset |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Sullivan |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Tioga |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Union |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Venango |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Warren |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Washington |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Westmoreland |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
Wyoming |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) in PA - H5932-001-0
Benefit Details
|
York |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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