AARP MedicareComplete (HMO) - H1080-004-0
Benefit Details
|
Pasco |
$0.00 |
$220 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
-- |
|
|
|
AARP MedicareComplete Choice Essential (Regional PPO) - R5287-002-0
Benefit Details
|
Pasco |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
AARP MedicareComplete Choice Plan 2 (Regional PPO) - R5287-001-0
Benefit Details
|
Pasco |
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 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 |
Amerivantage Classic + Rx (HMO) - H8991-028-0
Benefit Details
|
Pasco |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
-- |
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Amerivantage Specialty + Rx (HMO SNP) - H8991-017-0
Benefit Details
|
Pasco |
$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
| $6,700 Browse Formulary |
-- |
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare HMO LifeTime (HMO) - H1026-040-0
Benefit Details
|
Pasco |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Non-Preferred Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $4,400 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 |
BlueMedicare HMO MyTime (HMO) - H1026-057-0
Benefit Details
|
Pasco |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Brand: $80.00 Specialty Tier: 33%
| $3,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
CareDirect (HMO SNP) - H1019-059-0
Benefit Details
|
Pasco |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
|
|
|
CareFree (HMO) - H1019-060-0
Benefit Details
|
Pasco |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $60.00 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 |
CareOne (HMO) - H1019-014-0
Benefit Details
|
Pasco |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
CareOne PLUS (HMO) - H1019-054-0
Benefit Details
|
Pasco |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $15.00 Non-Preferred Brand: $60.00 Specialty Tier: 33%
| $5,000 Browse Formulary |
|
|
|
|
Clear Skies (HMO SNP) - H4199-020-0
Sanctioned Plan
|
Pasco |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Brand: $65.00 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 |
Day Break (HMO) - H4199-018-0
Sanctioned Plan
|
Pasco |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
-- |
|
|
Freedom Medicare Plan Rx (HMO) - H5427-060-0
Benefit Details
|
Pasco |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
|
|
|
Freedom Savings Plan (HMO) - H5427-052-0
Benefit Details
|
Pasco |
$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 |
Freedom VIP Care (HMO SNP) - H5427-070-0
Benefit Details
|
Pasco |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Brand: $75.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
|
|
|
Freedom VIP Savings (HMO SNP) - H5427-072-0
Benefit Details
|
Pasco |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Brand: $80.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
|
|
|
Freedom VIP Savings COPD (HMO SNP) - H5427-077-0
Benefit Details
|
Pasco |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Brand: $80.00 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 |
Humana Gold Plus - Diabetes (HMO SNP) - H1036-160-0
Benefit Details
|
Pasco |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $15.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $5,000 Browse Formulary |
|
|
|
|
Humana Gold Plus H1036-040 (HMO) - H1036-040-0
Benefit Details
|
Pasco |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $10.00 Non-Preferred Brand: $55.00 Specialty Tier: 33%
| $5,000 Browse Formulary |
|
|
|
|
Humana Gold Plus H1036-119 (HMO) - H1036-119-0
Benefit Details
|
Pasco |
$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 |
Humana Gold Plus H1036-141 (HMO) - H1036-141-0
Benefit Details
|
Pasco |
$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%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-018 (Regional PPO) - R5826-018-0
Benefit Details
|
Pasco |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 |
|
|
|
|
HumanaChoice R5826-074 (Regional PPO) - R5826-074-0
Benefit Details
|
Pasco |
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $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 |
Optimum Diamond Rewards (HMO-POS SNP) - H5594-028-0
Benefit Details
|
Pasco |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Brand: $60.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
|
|
|
Optimum Diamond Rewards COPD (HMO-POS SNP) - H5594-029-0
Benefit Details
|
Pasco |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Brand: $69.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
|
|
|
Optimum Gold Rewards Plan (HMO-POS) - H5594-001-0
Benefit Details
|
Pasco |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Brand: $80.00 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 |
Optimum Platinum Plan (HMO-POS) - H5594-002-0
Benefit Details
|
Pasco |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Preferred Brand: $10.00 Non-Preferred Brand: $69.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
|
|
|
Preferred Secure Option (HMO) - H1045-023-0
Benefit Details
|
Pasco |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Sunrise (HMO) - H4199-017-0
Sanctioned Plan
|
Pasco |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Brand: $65.00 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 |
Ultimate Elite (HMO) - H2962-003-0
Benefit Details
|
Pasco |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Brand: $50.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
-- |
|
|
Ultimate Elite Plus (HMO) - H2962-004-0
Benefit Details
|
Pasco |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Preferred Brand: $10.00 Non-Preferred Brand: $45.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
-- |
|
|
WellCare Advance (HMO) - H1032-037-0
Benefit Details
|
Pasco |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Dividend (HMO) - H1032-179-0
Benefit Details
|
Pasco |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $75.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Essential (HMO) - H1032-174-0
Benefit Details
|
Pasco |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $20.00 Non-Preferred Brand: $60.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Value (HMO-POS) - H1032-035-0
Benefit Details
|
Pasco |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $20.00 Non-Preferred Brand: $55.00 Specialty Tier: 33%
| $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 |
Coventry Summit Maximum (HMO SNP) - H1013-034-0
Benefit Details
|
Pasco |
$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
| $3,400 Browse Formulary |
-- |
|
|
|
Humana Gold Plus SNP-DE H1036-102 (HMO SNP) - H1036-102-0
Benefit Details
|
Pasco |
$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 |
|
|
|
|
WellCare Access (HMO SNP) - H1032-124-0
Benefit Details
|
Pasco |
$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 |
CareNeeds (HMO SNP) - H1019-026-0
Benefit Details
|
Pasco |
$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 |
|
|
|
|
WellCare Liberty (HMO SNP) - H1032-175-0
Benefit Details
|
Pasco |
$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:
|
WellCare Select (HMO SNP) - H1032-061-0
Benefit Details
|
Pasco |
$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 |
UnitedHealthcare Dual Complete LP (HMO SNP) - H1080-036-0
Benefit Details
|
Pasco |
$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: tbd
| $6,700 Browse Formulary |
-- |
|
|
|
UnitedHealthcare Nursing Home Plan (PPO SNP) - H5417-001-0
Benefit Details
|
Pasco |
$24.30 |
$320 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| $6,700 Browse Formulary |
-- |
-- |
|
|
Molina Medicare Options Plus (HMO SNP) - H8130-001-0
Benefit Details
|
Pasco |
$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. | Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: $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 |
Freedom Medi-Medi Full (HMO SNP) - H5427-087-0
Benefit Details
|
Pasco |
$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
| $3,400 Browse Formulary |
-- |
|
|
|
Freedom Medi-Medi Partial (HMO SNP) - H5427-078-0
Benefit Details
|
Pasco |
$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: tbd
| $3,400 Browse Formulary |
-- |
|
|
|
Optimum Emerald Full (HMO SNP) - H5594-017-0
Benefit Details
|
Pasco |
$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 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: $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 |
Optimum Emerald Partial (HMO SNP) - H5594-016-0
Benefit Details
|
Pasco |
$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 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: $0.00
| $3,400 Browse Formulary |
-- |
|
|
|
Sunny Days (HMO SNP) - H4199-021-0
Sanctioned Plan
|
Pasco |
$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. | Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: $0.00
| $3,400 Browse Formulary |
-- |
-- |
|
|
Sunshine Health Advantage (HMO SNP) - H5190-002-0
Benefit Details
|
Pasco |
$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 Injectable 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 |
UnitedHealthcare Dual Complete RP (Regional PPO SNP) - R5287-003-0
Benefit Details
|
Pasco |
$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: tbd
| $6,700 Browse Formulary |
|
|
|
|
AARP MedicareComplete Choice (PPO) - H5532-001-0
Benefit Details
|
Pasco |
$29.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
-- |
|
|
|
Aetna Medicare Premier Plan (PPO) - H5521-033-0
Benefit Details
|
Pasco |
$35.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $3.00 Preferred Brand: $45.00 Non-Preferred Brand: 50% 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 |
BlueMedicare Regional PPO (Regional PPO) - R3332-001-0
Benefit Details
|
Pasco |
$36.10 |
$100 |
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: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-005 (Regional PPO) - R5826-005-0
Benefit Details
|
Pasco |
$95.00 |
$100 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Non-Preferred Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Brand: $85.00 Specialty Tier: 30%
| $6,700 Browse Formulary |
|
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Humana Gold Choice H8145-061 (PFFS) - H8145-061-0
Benefit Details
|
Pasco |
$101.00 |
$0 |
Yes, some additional gap coverage. | 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 |
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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 |
BlueMedicare PPO (PPO) - H5434-002-0
Benefit Details
|
Pasco |
$127.10 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Non-Preferred Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $75.00 Specialty Tier: 33%
| $3,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Select Plus Plan (HMO) - H5414-025-0
Benefit Details
|
Pasco |
$139.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $3.00 Preferred Brand: $45.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $3,300 Browse Formulary |
-- |
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Select Plus Plan (PPO) - H5521-052-0
Benefit Details
|
Pasco |
$139.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Non-Preferred Generic: $3.00 Preferred Brand: $45.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $3,300 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|