Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Appling |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Bacon |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Baker |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Baldwin |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Banks |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Bartow |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Ben Hill |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Berrien |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Bibb |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Bleckley |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Brantley |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Brooks |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Bryan |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Bulloch |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Burke |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Calhoun |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Candler |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Chatham |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Chattahoochee |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Chattooga |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Cherokee |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Clay |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Clinch |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Coffee |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Colquitt |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Columbia |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Coweta |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Crawford |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Crisp |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Dade |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Dawson |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Dougherty |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Douglas |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Echols |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Emanuel |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Evans |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Fayette |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Franklin |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Gilmer |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Glascock |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Gordon |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Greene |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Habersham |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Hancock |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Harris |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Hart |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Heard |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Henry |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Houston |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Irwin |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Jackson |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Jasper |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Jeff Davis |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Jefferson |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Jenkins |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Johnson |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Jones |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Lamar |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Lee |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Liberty |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Lincoln |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Long |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Lumpkin |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
McDuffie |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
McIntosh |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Macon |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Madison |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Marion |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Meriwether |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Miller |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Mitchell |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Monroe |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Montgomery |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Muscogee |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Newton |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Oconee |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Oglethorpe |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Paulding |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Peach |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Pickens |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Pierce |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Polk |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Pulaski |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Putnam |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Quitman |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Randolph |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Richmond |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Rockdale |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Schley |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Screven |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Spalding |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Stephens |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Stewart |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Sumter |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Talbot |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Taliaferro |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Tattnall |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Taylor |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Telfair |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Terrell |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Tift |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Toombs |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Treutlen |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Turner |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Twiggs |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Upson |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Walton |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Ware |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Warren |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Washington |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Wayne |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Webster |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Wheeler |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Wilcox |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Wilkes |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Wilkinson |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) in GA - H8093-002-0
Benefit Details
|
Worth |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|