AARP MedicareComplete SecureHorizons Essential (HMO) - H0543-121-0
Benefit Details
|
San Bernardino |
$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) - H0543-007-0
Benefit Details
|
San Bernardino |
$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%
| $4,900 Browse Formulary |
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AARP MedicareComplete SecureHorizons Plan 2 (HMO) - H0543-144-0
Benefit Details
|
San Bernardino |
$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) - H0523-063-0
Benefit Details
|
San Bernardino |
$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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Aetna Medicare Select Plan (HMO) - H0523-022-0
Benefit Details
|
San Bernardino |
$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: 50%
| $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Blue Cross Senior Secure Plan I (HMO) - H0564-067-1
Benefit Details
|
San Bernardino |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $17.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
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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) - H0504-017-0
Benefit Details
|
San Bernardino |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Injectable Drugs: 25% Specialty Tier: 33%
| $3,200 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Bridges Drug Savings (HMO SNP) - H0838-028-0
Benefit Details
|
San Bernardino |
$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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Care1st AdvantageOptimum Plan (HMO) - H5928-012-0
Benefit Details
|
San Bernardino |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 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 |
Service |
Exper. |
Cost Info |
CareMore Breathe (HMO SNP) - H0544-019-0
Benefit Details
|
San Bernardino |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $7.50 Preferred Brand: $40.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
CareMore ESRD (HMO SNP) - H0544-020-0
Benefit Details
|
San Bernardino |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $7.50 Preferred Brand: $40.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
CareMore Heart (HMO SNP) - H0544-038-0
Benefit Details
|
San Bernardino |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $7.50 Preferred Brand: $40.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
CareMore Reliance (HMO SNP) - H0544-010-0
Benefit Details
|
San Bernardino |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $7.50 Preferred Brand: $40.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
CareMore StartSmart Plus (HMO) - H0544-007-0
Benefit Details
|
San Bernardino |
$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 |
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CareMore Value Plus (HMO) - H0544-008-0
Benefit Details
|
San Bernardino |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $7.50 Preferred Brand: $40.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $3,400 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Central Health Focus Plan (HMO SNP) - H5649-005-0
Benefit Details
|
San Bernardino |
$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 |
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Central Health Medicare Plan (HMO) - H5649-001-0
Benefit Details
|
San Bernardino |
$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 |
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Citizens Choice Health Plan (HMO) - H3815-001-0
Benefit Details
|
San Bernardino |
$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 |
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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 |
Classic Care (HMO) - H0838-025-0
Benefit Details
|
San Bernardino |
$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 |
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Easy Choice Best Plan (HMO) - H5087-016-0
Benefit Details
|
San Bernardino |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $39.00 Non-Preferred Brand: $89.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Health Net Gold Select (HMO) - H0562-101-2
Benefit Details
|
San Bernardino |
$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 |
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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 |
Health Net Healthy Heart (HMO) - H0562-100-2
Benefit Details
|
San Bernardino |
$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 |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Health Net Seniority Plus Green (HMO) - H0562-044-0
Benefit Details
|
San Bernardino |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 |
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Healthy Heart Drug Savings (HMO SNP) - H0838-030-0
Benefit Details
|
San Bernardino |
$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 |
Heart First (HMO SNP) - H5425-033-0
Benefit Details
|
San Bernardino |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $10.00
| $3,400 Browse Formulary |
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Hope Drug Savings (HMO SNP) - H0838-032-0
Benefit Details
|
San Bernardino |
$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 |
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Humana Gold Plus H0108-005 (HMO) - H0108-005-0
Benefit Details
|
San Bernardino |
$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 |
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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 |
IEHP DualChoice (Medicare-Medicaid Plan) - H5355-001-0
Benefit Details
|
San Bernardino |
$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 |
|
In Control Drug Savings (HMO SNP) - H0838-026-0
Benefit Details
|
San Bernardino |
$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 |
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Inter Valley Health Plan Service To Seniors (HMO) - H0545-001-0
Benefit Details
|
San Bernardino |
$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 |
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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 |
Kaiser Permanente Senior Advantage Inland Empire (HMO) - H0524-015-0
Benefit Details
|
San Bernardino |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Vaccines: $0.00
| $4,400 Browse Formulary |
|
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Molina Dual Options (Medicare-Medicaid Plan) - H8677-001-0
Benefit Details
|
San Bernardino |
$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 |
|
SCAN Classic (HMO) - H5425-009-0
Benefit Details
|
San Bernardino |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Care Drugs: $10.00
| $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 |
SCAN Healthy at Home (HMO SNP) - H9104-006-0
Benefit Details
|
San Bernardino |
$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 |
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Senior Advantage Medicare Medi-Cal Plan South (HMO SNP) - H0524-029-0
Benefit Details
|
San Bernardino |
$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 |
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Molina Medicare Options Plus (HMO SNP) - H5810-001-0
Benefit Details
|
San Bernardino |
$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 |
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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 |
Humana Gold Plus H0108-050 (HMO) - H0108-050-0
Benefit Details
|
San Bernardino |
$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 |
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Care1st TotalDual Plan (HMO SNP) - H5928-005-0
Benefit Details
|
San Bernardino |
$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 |
|
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|
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AARP MedicareComplete SecureHorizons Plan 3 (HMO) - H0543-153-0
Benefit Details
|
San Bernardino |
$28.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| $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 |
Bridges Extra Care (HMO SNP) - H0838-029-0
Benefit Details
|
San Bernardino |
$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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|
|
|
CalPlus Plan (HMO) - H3815-009-0
Benefit Details
|
San Bernardino |
$28.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| $3,400 Browse Formulary |
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|
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Central Health Medi-Medi Plan (HMO SNP) - H5649-002-0
Benefit Details
|
San Bernardino |
$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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|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Central Health Premier Plan (HMO) - H5649-004-0
Benefit Details
|
San Bernardino |
$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 |
|
|
|
|
Coordinated Choice Plan (HMO) - H5928-037-0
Benefit Details
|
San Bernardino |
$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
|
San Bernardino |
$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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|
|
|
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) - H5087-002-0
Benefit Details
|
San Bernardino |
$28.80 |
$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:
|
Harmony (HMO SNP) - H0838-020-0
Benefit Details
|
San Bernardino |
$28.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| $6,700 Browse Formulary |
-- |
|
|
|
Health Net Seniority Plus Amber I (HMO SNP) - H0562-055-0
Benefit Details
|
San Bernardino |
$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 |
|
|
|
|
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 II (HMO SNP) - H0562-070-0
Benefit Details
|
San Bernardino |
$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
|
San Bernardino |
$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 |
|
|
|
|
Healthy Heart Extra Care (HMO SNP) - H0838-031-0
Benefit Details
|
San Bernardino |
$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 |
IEHP Medicare DualChoice (HMO SNP) - H5640-001-0
Benefit Details
|
San Bernardino |
$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
| $6,700 Browse Formulary |
-- |
|
|
|
In Control Extra Care (HMO SNP) - H0838-027-0
Benefit Details
|
San Bernardino |
$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
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San Bernardino |
$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 |
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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 |
SCAN Connections at Home (HMO SNP) - H5425-031-0
Benefit Details
|
San Bernardino |
$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 |
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SCAN Plus (HMO) - H5425-045-0
Benefit Details
|
San Bernardino |
$28.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| $6,700 Browse Formulary |
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VillageHealth (HMO-POS SNP) - H5943-001-0
Benefit Details
|
San Bernardino |
$28.80 |
$310 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $18.00 Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% Select Care 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 |
Humana Gold Plus H0108-006 (HMO) - H0108-006-0
Benefit Details
|
San Bernardino |
$38.00 |
$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 |
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Health Net Seniority Plus Complete (HMO) - H0562-106-0
Benefit Details
|
San Bernardino |
$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 |
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