2013 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
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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 |
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AARP MedicareComplete (HMO) - H1080-045-0 Benefit Details |
Pinellas | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,900 Browse Formulary | |||||
AARP MedicareComplete Choice (PPO) - H5532-001-0 Benefit Details |
Pinellas | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $4,500 Browse Formulary | |||||
AARP MedicareComplete Choice Essential (Regional PPO) - R5287-002-0 Benefit Details |
Pinellas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,500 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
AARP MedicareComplete Choice Plan 2 (Regional PPO) - R5287-001-0 Benefit Details |
Pinellas | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $4,900 Browse Formulary | |||||
AARP MedicareComplete Plus (HMO-POS) - H1080-004-0 Benefit Details |
Pinellas | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $4,200 Browse Formulary | |||||
Amerivantage Classic+ Rx Plan (HMO) - H8991-028-0 Benefit Details |
Pinellas | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $4.00 Preferred Brand: $35.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
BlueMedicare HMO (HMO) - H1026-038-0 Benefit Details |
Pinellas | $0.00 | $0 | All Generics | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,000 Browse Formulary | |||||
BlueMedicare Regional PPO (Regional PPO) - R3332-001-0 Benefit Details |
Pinellas | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,900 Browse Formulary | |||||
CareDirect (HMO SNP) - H1019-059-0 Benefit Details |
Pinellas | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $55.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
CareFree (HMO) - H1019-060-0 Benefit Details |
Pinellas | $0.00 | $0 | Few Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Brand: $55.00 Specialty Tier: 33% | $4,000 Browse Formulary | |||||
CareOne (HMO) - H1019-014-0 Benefit Details |
Pinellas | $0.00 | $0 | Some Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $25.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $5,000 Browse Formulary | |||||
CareOne PLUS (HMO) - H1019-054-0 Benefit Details |
Pinellas | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $55.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Clear Skies (HMO SNP) - H4199-020-0 Benefit Details |
Pinellas | $0.00 | $0 | All Generics | Generic: $0.00 Preferred Brand: $10.00 Non-Preferred Brand: $40.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Coventry Advantra Ideal (HMO) - H5850-025-0 Benefit Details |
Pinellas | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Coventry Advantra Select Plus (HMO-POS) - H5850-026-0 Benefit Details |
Pinellas | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Day Light (HMO) - H4199-019-0 Benefit Details |
Pinellas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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Freedom Medicare Plan Rx (HMO) - H5427-059-0 Benefit Details |
Pinellas | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Freedom Savings Plan (HMO) - H5427-052-0 Benefit Details |
Pinellas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Freedom Savings Plan Rx (HMO) - H5427-053-0 Benefit Details |
Pinellas | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Freedom VIP Care (HMO SNP) - H5427-070-0 Benefit Details |
Pinellas | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Preferred Brand: $5.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Freedom VIP Care COPD (HMO SNP) - H5427-076-0 Benefit Details |
Pinellas | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Preferred Brand: $5.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Freedom VIP Savings (HMO SNP) - H5427-072-0 Benefit Details |
Pinellas | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Freedom VIP Savings COPD (HMO SNP) - H5427-077-0 Benefit Details |
Pinellas | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Humana Gold Plus H1036-052 (HMO) - H1036-052-0 Benefit Details |
Pinellas | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $55.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H1036-119 (HMO) - H1036-119-0 Benefit Details |
Pinellas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Humana Gold Plus H1036-141 (HMO) - H1036-141-0 Benefit Details |
Pinellas | $0.00 | $0 | Few Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Brand: $55.00 Specialty Tier: 33% | $4,000 Browse Formulary | |||||
Humana Gold Plus SNP-DB H1036-160 (HMO SNP) - H1036-160-0 Benefit Details |
Pinellas | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $55.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Humana Reader's Digest Healthy Living Plan (Regional PPO) - R5826-074-0 Benefit Details |
Pinellas | $0.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $4,950 Browse Formulary | |||||
HumanaChoice R5826-018 (Regional PPO) - R5826-018-0 Benefit Details |
Pinellas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Optimum Diamond Rewards (HMO-POS SNP) - H5594-028-0 Benefit Details |
Pinellas | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | 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 | |||||||||
Optimum Diamond Rewards COPD (HMO-POS SNP) - H5594-029-0 Benefit Details |
Pinellas | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Optimum Gold Rewards Plan (HMO-POS) - H5594-001-0 Benefit Details |
Pinellas | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Brand: $69.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Optimum Platinum Plan (HMO-POS) - H5594-002-0 Benefit Details |
Pinellas | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Preferred Brand: $5.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Preferred Secure Option (HMO) - H1045-023-0 Benefit Details |
Pinellas | $0.00 | $0 | Many Generics, Few Brands | Generic: $0.00 Preferred Brand: $40.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Preferred Select Care (HMO SNP) - H1045-022-0 Benefit Details |
Pinellas | $0.00 | $0 | Many Generics, Few Brands | Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
PUP PLUS (HMO) - H5696-038-0 Benefit Details |
Pinellas | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Preferred Brand: $35.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
PUP SIMPLE (HMO) - H5696-037-0 Benefit Details |
Pinellas | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $4,200 Browse Formulary | |||||
Simply Extra (HMO) - H5471-024-0 Benefit Details |
Pinellas | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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Simply Level (HMO SNP) - H5471-020-0 Benefit Details |
Pinellas | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $15.00 Non-Preferred Brand: $55.00 Specialty Tier: 33% | 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 | |||||||||
Simply More (HMO) - H5471-005-0 Benefit Details |
Pinellas | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $15.00 Non-Preferred Brand: $55.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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Sunrise (HMO) - H4199-017-0 Benefit Details |
Pinellas | $0.00 | $0 | All Generics | Generic: $0.00 Preferred Brand: $10.00 Non-Preferred Brand: $40.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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WellCare Advance (HMO) - H1032-037-0 Benefit Details |
Pinellas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
WellCare Dividend (HMO) - H1032-032-0 Benefit Details |
Pinellas | $0.00 | $0 | All Generics | Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Brand: $55.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
WellCare Essential (HMO) - H1032-174-0 Benefit Details |
Pinellas | $0.00 | $0 | All Generics | Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | $5,500 Browse Formulary | |||||
WellCare Value (HMO-POS) - H1032-035-0 Benefit Details |
Pinellas | $0.00 | $0 | All Generics | Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Brand: $55.00 Specialty Tier: 33% | $5,500 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
PUP EXTRA (HMO SNP) - H5696-021-0 Benefit Details |
PINELLAS | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Sunny Days (HMO SNP) - H4199-021-0 Benefit Details |
PINELLAS | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
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WellCare Select (HMO-POS SNP) - H1032-061-0 Benefit Details |
PINELLAS | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
WellCare Liberty (HMO SNP) - H1032-124-0 Benefit Details |
PINELLAS | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
WellCare Access (HMO SNP) - H1032-175-0 Benefit Details |
PINELLAS | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Plus SNP-DE H1036-102 (HMO SNP) - H1036-102-0 Benefit Details |
PINELLAS | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Coventry Advantra Maximum (HMO SNP) - H5850-021-0 Benefit Details |
PINELLAS | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Preferred Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $76.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Molina Medicare Options Plus (HMO SNP) - H8130-001-0 Benefit Details |
PINELLAS | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Plus SNP-DE H1036-161 (HMO SNP) - H1036-161-0 Benefit Details |
PINELLAS | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | 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 | |||||||||
CareNeeds PLUS (HMO SNP) - H1019-046-0 Benefit Details |
PINELLAS | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
UnitedHealthcare Dual Complete LP (HMO SNP) - H1080-036-0 Benefit Details |
PINELLAS | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | n/a Browse Formulary | |||||
Freedom Medi-Medi Full (HMO SNP) - H5427-087-0 Benefit Details |
PINELLAS | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Tier 1: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
UnitedHealthcare Nursing Home Plan (PPO SNP) - H5417-001-0 Benefit Details |
Pinellas | $23.80 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | n/a Browse Formulary | |||||
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Sunshine State Health Plan (HMO SNP) - H5190-001-0 Benefit Details |
PINELLAS | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Injectable Drugs: $95.00 | n/a Browse Formulary | |||||
CareNeeds (HMO SNP) - H1019-026-0 Benefit Details |
PINELLAS | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | 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 | |||||||||
Amerivantage Specialty + Rx (HMO SNP) - H8991-017-0 Benefit Details |
Pinellas | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | Some Generics | Preferred Generic: $0.00 Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% | n/a Browse Formulary | |||||
Freedom Medi-Medi Partial (HMO SNP) - H5427-078-0 Benefit Details |
PINELLAS | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Tier 1: 25% | n/a Browse Formulary | |||||
Optimum Emerald Full (HMO SNP) - H5594-017-0 Benefit Details |
PINELLAS | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Tier 1: 25% | 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 | |||||||||
Optimum Emerald Partial (HMO SNP) - H5594-016-0 Benefit Details |
PINELLAS | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Tier 1: 25% | n/a Browse Formulary | |||||
Simply Care (HMO SNP) - H5471-010-0 Benefit Details |
Pinellas | $24.80 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Simply Comfort (HMO SNP) - H5471-011-0 Benefit Details |
Pinellas | $24.80 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% | 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 | |||||||||
Simply Complete (HMO SNP) - H5471-007-0 Benefit Details |
PINELLAS | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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UnitedHealthcare Dual Complete EV (HMO SNP) - H5440-001-0 Benefit Details |
PINELLAS | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | n/a Browse Formulary | |||||
UnitedHealthcare Dual Complete RP (Regional PPO SNP) - R5287-003-0 Benefit Details |
Statewide | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Aetna Medicare Premier Plan (PPO) - H5521-033-0 Benefit Details |
Pinellas | $33.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Aetna Medicare Value Plan (HMO) - H5414-009-0 Benefit Details |
Pinellas | $39.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Day Break (HMO) - H4199-018-0 Benefit Details |
Pinellas | $77.50 | $0 | All Generics | Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-005 (Regional PPO) - R5826-005-0 Benefit Details |
Pinellas | $85.00 | $0 | Few Generics, Few Brands | Preferred Generic: $3.00 Non-Preferred Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% | $4,750 Browse Formulary | |||||
Humana Gold Choice H8145-061 (PFFS) - H8145-061-0 Benefit Details |
Pinellas | $102.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
BlueMedicare PPO (PPO) - H5434-002-0 Benefit Details |
Pinellas | $152.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Non-Preferred Generic: $17.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
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