2014 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 SecureHorizons Essential (HMO) - H0543-121-0 Benefit Details |
Los Angeles | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,900 | ||||||
AARP MedicareComplete SecureHorizons Plan 1 (HMO) - H0543-001-0 Benefit Details |
Los Angeles | $0.00 | $0 | Some Generics | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,400 Browse Formulary | |||||
AARP MedicareComplete SecureHorizons Plan 2 (HMO) - H0543-151-0 Benefit Details |
Los Angeles | $0.00 | $0 | Some Generics | Preferred Generic: $0.00 Non-Preferred Generic: $7.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 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 | |||||||||
Aetna Medicare Select Plan (HMO) - H0523-002-0 Benefit Details |
Los Angeles | $0.00 | $0 | Few Generics | Generic: $10.00 Preferred Brand: 25% Non-Preferred Brand: 50% Specialty Tier: 33% Select Care Drugs: $0.00 | $6,700 Browse Formulary | |||||
Blue Cross Senior Secure Plan I (HMO) - H0564-006-0 Benefit Details |
Los Angeles | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $14.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Injectable Drugs: 33% Specialty Tier: 33% | $5,000 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Blue Shield 65 Plus (HMO) - H0504-015-0 Benefit Details |
Los Angeles | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Injectable Drugs: 25% Specialty Tier: 33% | $2,800 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 | |||||||||
Blue Shield 65 Plus Choice Plan (HMO) - H0504-021-0 Benefit Details |
Los Angeles (Partial) | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Brand: $70.00 Injectable Drugs: 25% Specialty Tier: 33% | $2,000 Browse Formulary | |||||
Brand New Day Dementia with Enhanced Drug Benefits (HMO SNP) - H0838-028-0 Benefit Details |
Los Angeles | $0.00 | $0 | Many Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Brand New Day Diabetes with Enhanced Drug Benefits (HMO SNP) - H0838-026-0 Benefit Details |
Los Angeles | $0.00 | $0 | Many Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 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 | |||||||||
Brand New Day Enhanced Drug Savings for So Cal (HMO) - H0838-022-0 Benefit Details |
Los Angeles | $0.00 | $0 | Many Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Care1st AdvantageOptimum Plan (HMO) - H5928-004-0 Benefit Details |
Los Angeles | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $50.00 Specialty Tier: 30% | $3,400 Browse Formulary | |||||
Care1st AdvantageOptimum Plan (HMO) - H5928-010-0 Benefit Details |
Los Angeles | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $60.00 Specialty Tier: 30% | $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 | |||||||||
CareMore Breathe (HMO SNP) - H0544-014-0 Benefit Details |
Los Angeles | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
CareMore Connect (HMO SNP) - H0544-003-0 Benefit Details |
Los Angeles | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
CareMore ESRD (HMO SNP) - H0544-015-0 Benefit Details |
Los Angeles | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00 | 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 | |||||||||
CareMore Heart (HMO SNP) - H0544-013-0 Benefit Details |
Los Angeles | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
CareMore Reliance (HMO SNP) - H0544-004-0 Benefit Details |
Los Angeles | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
CareMore StartSmart Plus (HMO) - H0544-007-0 Benefit Details |
Los Angeles | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $10.00 | $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 | |||||||||
CareMore Touch (HMO SNP) - H0544-005-0 Benefit Details |
Los Angeles | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
CareMore Value Plus (HMO) - H0544-002-0 Benefit Details |
Los Angeles | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $3,400 Browse Formulary | |||||
Central Health Medicare Plan (HMO) - H5649-001-0 Benefit Details |
Los Angeles | $0.00 | $0 | All Generics | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 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 | |||||||||
Citizens Choice Healthplan (HMO) - H3815-001-0 Benefit Details |
Los Angeles | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $75.00 Injectable Drugs: 33% Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Easy Choice Best Plan (HMO) - H5087-005-0 Benefit Details |
Los Angeles | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
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Golden State Medicare Health Plan, Golden (HMO) - H2241-001-0 Benefit Details |
Los Angeles | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $4.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 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 | |||||||||
Health Net Gold Select (HMO) - H0562-101-1 Benefit Details |
Los Angeles | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $2,200 Browse Formulary | |||||
Health Net Healthy Heart (HMO) - H0562-100-1 Benefit Details |
Los Angeles | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $3,400 Browse Formulary | |||||
Health Net Jade (HMO SNP) - H0562-092-0 Benefit Details |
Los Angeles | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00 | 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 | |||||||||
Health Net Seniority Plus Green (HMO) - H0562-044-0 Benefit Details |
Los Angeles | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Health Net Seniority Plus Ruby (HMO) - H0562-099-1 Benefit Details |
Los Angeles | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $3,400 Browse Formulary | |||||
Heart First (HMO SNP) - H5425-028-0 Benefit Details |
Los Angeles | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $3.00 Non-Preferred Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00 | 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 Gold Plus H0108-011 (HMO) - H0108-011-0 Benefit Details |
Los Angeles | $0.00 | $0 | Some Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Inter Valley Health Plan Service To Seniors (HMO) - H0545-001-0 Benefit Details |
Los Angeles | $0.00 | $0 | Some Generics | Preferred Generic: $5.00 Non-Preferred Generic: $15.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) - H0524-003-0 Benefit Details |
Los Angeles | $0.00 | $0 | All Generics, Few Brands | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Vaccines: $0.00 | $5,900 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 | |||||||||
PHP (HMO SNP) - H5852-001-0 Benefit Details |
Los Angeles | $0.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% | n/a Browse Formulary | |||||
SCAN Balance (HMO SNP) - H5425-034-0 Benefit Details |
Los Angeles | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $3.00 Non-Preferred Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
SCAN Classic (HMO) - H5425-006-0 Benefit Details |
Los Angeles | $0.00 | $0 | Many Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $10.00 | $3,000 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 | |||||||||
SCAN Healthy at Home (HMO SNP) - H9104-006-0 Benefit Details |
Los Angeles | $0.00 | $0 | Many Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Tier 6: $10.00 | n/a Browse Formulary | |||||
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP) - H0524-029-0 Benefit Details |
Los Angeles | $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: $7.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Vaccines: $0.00 | n/a Browse Formulary | |||||
AARP MedicareComplete SecureHorizons Plan 3 (HMO) - H0543-153-0 Benefit Details |
Los Angeles | $16.20 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | $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 | |||||||||
Care1st TotalDual Plan (HMO SNP) - H5928-001-0 Benefit Details |
Los Angeles | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | Few Generics | Preferred Generic: $0.00 Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% | n/a Browse Formulary | |||||
Molina Medicare Options Plus (HMO SNP) - H5810-001-0 Benefit Details |
Los Angeles | $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 | Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
SCAN Connections (HMO SNP) - H5425-010-0 Benefit Details |
Los Angeles | $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 | Tier 1: 0% Tier 2: 0% Tier 3: 0% Tier 4: 0% Tier 5: 0% Tier 6: 0% | 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 | |||||||||
Easy Choice Freedom Plan (HMO SNP) - H5087-001-0 Benefit Details |
Los Angeles | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | Call plan for details | Preferred Generic: $0.00 Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% | n/a Browse Formulary | |||||
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Coordinated Choice Plan (HMO) - H5928-037-0 Benefit Details |
Los Angeles | $26.30 | $310 | Few Generics | Preferred Generic: $0.00 Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% | $3,400 Browse Formulary | |||||
SCAN Plus (HMO) - H5425-045-0 Benefit Details |
Los Angeles | $28.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% Tier 6: 25% | $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 | |||||||||
Brand New Day Dementia with Extra Care (HMO SNP) - H0838-029-0 Benefit Details |
Los Angeles | $28.10 | $310 | 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 | |||||
Brand New Day Diabetes with Extra Care (HMO SNP) - H0838-027-0 Benefit Details |
Los Angeles | $28.10 | $310 | 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 | |||||
Brand New Day Dual Coverage (HMO SNP) - H0838-024-0 Benefit Details |
Los Angeles | $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 | Tier 1: 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15% | 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 | |||||||||
Brand New Day Extra Care (HMO) - H0838-023-0 Benefit Details |
Los Angeles | $28.10 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | $6,700 Browse Formulary | |||||
Brand New Day for Mental Illness (HMO SNP) - H0838-020-0 Benefit Details |
Los Angeles | $28.10 | $310 | 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 | |||||
Central Health Medi-Medi Plan (HMO SNP) - H5649-002-0 Benefit Details |
Los Angeles | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: 25% Non-Preferred Brand: 25% 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 | |||||||||
Central Health Premier Plan (HMO) - H5649-004-0 Benefit Details |
Los Angeles | $28.10 | $310 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% | $6,700 Browse Formulary | |||||
Health Net Seniority Plus Amber I (HMO SNP) - H0562-055-0 Benefit Details |
Los Angeles | $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: $0.00 Non-Preferred Generic: $12.00 Preferred Brand: $41.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00 | n/a Browse Formulary | |||||
Health Net Seniority Plus Amber II (HMO SNP) - H0562-070-0 Benefit Details |
Los Angeles | $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: $0.00 Non-Preferred Generic: $13.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00 | 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 | |||||||||
L.A. Care Health Plan Medicare Advantage (HMO SNP) - H2643-001-0 Benefit Details |
Los Angeles | $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 | Tier 1: 0% | n/a Browse Formulary | |||||
SCAN Connections at Home (HMO SNP) - H5425-029-0 Benefit Details |
Los Angeles | $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 | Tier 1: 0% Tier 2: 0% Tier 3: 0% Tier 4: 0% Tier 5: 0% Tier 6: 0% | n/a Browse Formulary | |||||
VillageHealth (HMO SNP) - H5943-002-0 Benefit Details |
Los Angeles | $28.10 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% Tier 6: 25% | 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 |
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Service | Exper. | Cost Info | |||||||||
Inter Valley Health Plan Total Fit (HMO) - H0545-011-0 Benefit Details |
Los Angeles | $30.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Anthem Medicare Preferred Standard (PPO) - H8552-001-0 Benefit Details |
Los Angeles | $80.00 | $149 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $16.00 Preferred Brand: $40.00 Non-Preferred Brand: $85.00 Injectable Drugs: $95.00 Specialty Tier: 33% | $4,500 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: |
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