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 |
|
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AARP MedicareComplete SecureHorizons Plan 1 (HMO) - H0543-001-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | 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 |
|
|
|
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AARP MedicareComplete SecureHorizons Plan 2 (HMO) - H0543-151-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | 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 |
|
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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 |
Aetna Medicare Prime Plan (HMO) - H0523-061-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $45.00 Non-Preferred Brand: 50%
| $3,400 Browse Formulary |
-- |
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|
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Anthem Select Advantage (HMO) - H0564-062-0
Benefit Details
|
Los Angeles |
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $21.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $3,400 Browse Formulary |
-- |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Blue Cross Senior Secure Plan I (HMO) - H0564-068-0
Benefit Details
|
Los Angeles |
$0.00 |
$50 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $6,000 Browse Formulary |
-- |
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Blue Shield 65 Plus (HMO) - H0504-015-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Brand: $85.00 Injectable Drugs: 25% Specialty Tier: 33%
| $2,800 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Blue Shield 65 Plus Choice Plan (HMO) - H0504-021-0
Benefit Details
|
Los Angeles (Partial) |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $3.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Injectable Drugs: 25% Specialty Tier: 33%
| $2,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Bridges Drug Savings (HMO SNP) - H0838-028-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Select Diabetic Drugs: $9.00
| $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 |
Service |
Exper. |
Cost Info |
Care1st AdvantageOptimum Plan (HMO) - H5928-004-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $50.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
|
|
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Care1st Cal MediConnect Plan (Medicare-Medicaid Plan) - H0148-002-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx/OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
CareMore Breathe (HMO SNP) - H0544-014-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $7.50 Preferred Brand: $37.50 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $3,000 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 |
CareMore Cal MediConnect Medicare-Medicaid Plan (Medicare-Medicaid Plan) - H6229-005-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
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. |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: $0.00 Select Care Drugs: $0.00
| n/a Browse Formulary |
-- |
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CareMore ESRD (HMO SNP) - H0544-015-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $7.50 Preferred Brand: $37.50 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $3,000 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
CareMore Heart (HMO SNP) - H0544-013-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $7.50 Preferred Brand: $37.50 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $3,000 Browse Formulary |
-- |
|
|
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CareMore Reliance (HMO SNP) - H0544-004-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $7.50 Preferred Brand: $37.50 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $3,000 Browse Formulary |
-- |
|
|
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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: $12.50 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $10.00
| $5,000 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
CareMore Touch (HMO SNP) - H0544-005-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $7.50 Preferred Brand: $37.50 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $3,000 Browse Formulary |
-- |
|
|
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CareMore Value Plus (HMO) - H0544-002-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $7.50 Preferred Brand: $37.50 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $3,000 Browse Formulary |
-- |
|
|
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Central Health Focus Plan (HMO SNP) - H5649-005-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $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 |
Central Health Medicare Plan (HMO) - H5649-001-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% Select Care Drugs: $10.00
| $3,400 Browse Formulary |
|
|
|
|
Citizens Choice Health Plan (HMO) - H3815-001-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $75.00 Injectable Drugs: 25% Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
|
|
|
Classic Care (HMO) - H0838-025-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Select Diabetic Drugs: $9.00
| $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 |
Easy Choice Best Plan (HMO) - H5087-005-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $89.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
-- |
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Health Net Cal MediConnect (Medicare-Medicaid Plan) - H3237-001-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx/OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
Health Net Gold Select (HMO) - H0562-101-1
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | 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 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Health Net Healthy Heart (HMO) - H0562-100-1
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $3,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Health Net Jade (HMO SNP) - H0562-092-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | 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
| $3,400 Browse Formulary |
|
|
|
|
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 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Heart Drug Savings (HMO SNP) - H0838-030-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Select Diabetic Drugs: $9.00
| $3,400 Browse Formulary |
-- |
|
|
|
Heart First (HMO SNP) - H5425-028-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Non-Preferred Generic: $7.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $3,400 Browse Formulary |
|
|
|
|
Hope Drug Savings (HMO SNP) - H0838-032-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Select Diabetic Drugs: $9.00
| $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 |
Humana Gold Plus H0108-011 (HMO) - H0108-011-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $30.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
|
|
|
In Control Drug Savings (HMO SNP) - H0838-026-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Select Diabetic Drugs: $9.00
| $3,400 Browse Formulary |
-- |
|
|
|
Inter Valley Health Plan Service To Seniors (HMO) - H0545-001-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | 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 |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) - H0524-003-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Vaccines: $0.00
| $4,400 Browse Formulary |
|
|
|
|
L.A Care Cal MediConnect Plan (Medicare-Medicaid Plan) - H8258-001-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
Molina Dual Options (Medicare-Medicaid Plan) - H8677-002-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx/OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
PHP (HMO SNP) - H5852-001-0
Benefit Details
|
Los Angeles |
$0.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25%
| $3,400 Browse Formulary |
-- |
|
|
|
Platinum Plan (HMO) - H3815-008-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $75.00 Injectable Drugs: 25% Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
|
|
|
SCAN Balance (HMO SNP) - H5425-034-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Non-Preferred Generic: $7.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $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 |
SCAN Classic (HMO) - H5425-006-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $10.00
| $3,000 Browse Formulary |
|
|
|
|
SCAN Healthy at Home (HMO SNP) - H9104-006-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 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 |
-- |
|
|
|
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: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: $0.00 Vaccines: $0.00
| $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 |
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: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: $0.00
| $6,700 Browse Formulary |
-- |
|
|
|
Humana Gold Plus H0108-050 (HMO) - H0108-050-0
Benefit Details
|
Los Angeles |
$22.90 |
$320 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $2.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
-- |
|
|
|
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. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: $0.00
| $6,700 Browse Formulary |
-- |
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Easy Choice Plus Plan (HMO) - H5087-017-0
Benefit Details
|
Los Angeles |
$23.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $29.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
-- |
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
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. |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: $0.00
| $1 Browse Formulary |
|
|
|
|
Aetna Medicare Select Plan (HMO) - H0523-002-0
Benefit Details
|
Los Angeles |
$28.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: 50%
| $6,700 Browse Formulary |
-- |
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Plus H0108-047 (HMO) - H0108-047-0
Benefit Details
|
Los Angeles |
$28.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $2.00 Preferred Brand: $30.00 Non-Preferred Brand: $75.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
|
|
|
AARP MedicareComplete SecureHorizons Plan 3 (HMO) - H0543-153-0
Benefit Details
|
Los Angeles |
$28.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| $6,700 Browse Formulary |
|
|
|
|
Bridges Extra Care (HMO SNP) - H0838-029-0
Benefit Details
|
Los Angeles |
$28.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 0% Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% Select Diabetic Drugs: $10.00
| $6,700 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 |
CalPlus Plan (HMO) - H3815-009-0
Benefit Details
|
Los Angeles |
$28.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| $3,400 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. |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: $0.00 Select Care Drugs: $0.00
| n/a Browse Formulary |
|
|
|
|
Central Health Premier Plan (HMO) - H5649-004-0
Benefit Details
|
Los Angeles |
$28.80 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% Select Care Drugs: 15%
| $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 |
Coordinated Choice Plan (HMO) - H5928-037-0
Benefit Details
|
Los Angeles |
$28.80 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
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 | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: $0.00 Select Diabetic Drugs: $0.00
| $6,700 Browse Formulary |
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|
|
|
Harmony (HMO SNP) - H0838-020-0
Benefit Details
|
Los Angeles |
$28.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| $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 |
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: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: $0.00 Select Care Drugs: $0.00
| $6,700 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: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: $0.00 Select Care Drugs: $0.00
| $825 Browse Formulary |
|
|
|
|
Health Net Seniority Plus Sapphire (HMO) - H0562-104-0
Benefit Details
|
Los Angeles |
$28.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $30.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| $5,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Healthy Heart Extra Care (HMO SNP) - H0838-031-0
Benefit Details
|
Los Angeles |
$28.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 0% Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% Select Diabetic Drugs: $10.00
| $6,700 Browse Formulary |
-- |
|
|
|
In Control Extra Care (HMO SNP) - H0838-027-0
Benefit Details
|
Los Angeles |
$28.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 0% Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% Select Diabetic Drugs: $0.00
| $6,700 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: $0.00
| 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 |
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: $0.00
| n/a Browse Formulary |
|
|
|
|
SCAN Plus (HMO) - H5425-045-0
Benefit Details
|
Los Angeles |
$28.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| $6,700 Browse Formulary |
|
|
|
|
VillageHealth (HMO SNP) - H5943-002-0
Benefit Details
|
Los Angeles |
$28.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| $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 |
Health Net Seniority Plus Complete (HMO) - H0562-106-0
Benefit Details
|
Los Angeles |
$176.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $2,500 Browse Formulary |
|
|
|
|