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 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $8.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $4,600 Browse Formulary |
|
|
|
|
AARP MedicareComplete SecureHorizons Plan 2 (HMO) - H0543-151-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $2,000 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare Prime Plan (HMO) - H0523-061-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $2,800 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Alignment Health Plan Heart & Diabetes (HMO SNP) - H3815-010-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% Select Care Drugs: $5.00
| n/a Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Alignment Health Plan My Choice (HMO) - H3815-001-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% Select Care Drugs: $3.00
| $3,400 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 |
Alignment Health Plan Platinum (HMO) - H3815-008-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% Select Care Drugs: $5.00
| $2,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Alignment Health Plan smartHMO (HMO) - H3815-013-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $10.00 Preferred Brand: $30.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% Select Care Drugs: $5.00
| $3,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Plus (HMO) - H0564-068-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $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 |
Anthem MediBlue Select (HMO) - H0564-062-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $1,900 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 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Brand: $88.00 Injectable Drugs: 33% 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 Generic: $3.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Injectable Drugs: 33% Specialty Tier: 33%
| $2,000 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 |
Bridges Drug Savings (HMO SNP) - H0838-028-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Diabetic Drugs: $11.00
| n/a Browse Formulary |
|
-- |
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Care1st AdvantageOptimum Plan (HMO) - H5928-004-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Drug: $80.00 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 |
Yes, some additional gap coverage. | Generic Drugs: 0% Brand Drugs: 0% Non-Medicare Rx/OTC Drugs: 0%
| 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 |
CareMore Breathe (HMO SNP) - H0544-014-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.50 Preferred Brand: $37.50 Non-Preferred Drug: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
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|
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CareMore Cal MediConnect Medicare-Medicaid Plan (Medicare-Medicaid Plan) - H6229-005-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: 0% Brand Drugs: 0% Non-Medicare Rx Drugs: 0% Non-Medicare OTC Drugs: 0%
| 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. |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 25% Non-Preferred Drug: 25% 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 |
Service |
Exper. |
Cost Info |
CareMore ESRD (HMO SNP) - H0544-015-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.50 Preferred Brand: $37.50 Non-Preferred Drug: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
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CareMore Heart (HMO SNP) - H0544-013-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.50 Preferred Brand: $37.50 Non-Preferred Drug: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
| n/a 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 Generic: $9.50 Preferred Brand: $37.50 Non-Preferred Drug: $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 |
Service |
Exper. |
Cost Info |
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 Generic: $14.50 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $10.00
| $5,000 Browse Formulary |
|
|
|
|
CareMore Touch (HMO SNP) - H0544-005-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.50 Preferred Brand: $37.50 Non-Preferred Drug: $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 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.50 Preferred Brand: $37.50 Non-Preferred Drug: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $1,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Central Health Focus Plan (HMO SNP) - H5649-006-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Drug: $75.00 Specialty Tier: 33% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
|
|
|
Central Health Medicare Plan (HMO) - H5649-001-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Drug: $75.00 Specialty Tier: 33% Select Care Drugs: $10.00
| $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 Generic: $5.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Select Diabetic Drugs: $11.00
| $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 |
Easy Choice Best Plan (HMO) - H5087-005-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
|
|
|
|
Health Net Cal MediConnect Plan (Medicare-Medicaid Plan) - H3237-001-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: 0% Brand Drugs: 0% Non-Medicare Rx/OTC Drugs: 0%
| n/a Browse Formulary |
-- |
-- |
-- |
|
Health Net Gold Select (HMO) - H0562-101-1
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $2,800 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 |
Health Net Jade (HMO SNP) - H0562-092-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
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 |
|
|
|
|
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 Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Diabetic Drugs: $11.00
| 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 |
Hope Drug Savings (HMO SNP) - H0838-032-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Select Diabetic Drugs: $11.00
| n/a Browse Formulary |
|
-- |
|
|
Humana Gold Plus H5619-021 (HMO) - H5619-021-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $2,200 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
In Control Drug Savings (HMO SNP) - H0838-026-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Select Diabetic Drugs: $11.00
| 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 |
Inter Valley Health Plan Service To Seniors (HMO) - H0545-001-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: 25% Specialty Tier: 33% Select Care Drugs: $0.00
| $2,000 Browse Formulary |
|
|
|
|
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 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 |
Yes, some additional gap coverage. | Generic Drugs: 0% Brand Drugs: 0% Non-Medicare Rx Drugs: 0% Non-Medicare OTC Drugs: 0%
| 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 |
Molina Dual Options (Medicare-Medicaid Plan) - H8677-002-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: 0% Brand Drugs: 0% Non-Medicare Rx/OTC Drugs: 0%
| n/a Browse Formulary |
-- |
-- |
-- |
|
PHP (HMO SNP) - H5852-001-0
Benefit Details
|
Los Angeles |
$0.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25%
| n/a Browse Formulary |
|
-- |
|
|
SCAN Balance (HMO SNP) - H5425-034-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $2.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
| n/a 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 |
SCAN Classic (HMO) - H5425-006-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $11.00
| $2,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
SCAN Classic II (HMO) - H5425-064-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $11.00
| $3,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
SCAN Healthy at Home (HMO SNP) - H9104-006-0
Benefit Details
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $11.00
| n/a 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 |
Golden State Medicare Health Plan, Golden (HMO) - H2241-006-0
Benefit Details
|
Los Angeles |
$4.40 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $10.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33%
| $3,400 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 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
|
Humana Gold Plus H5619-037 (HMO) - H5619-037-0
Benefit Details
|
Los Angeles |
$16.50 |
$400 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $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 |
Health Net Healthy Heart (HMO) - H0562-100-1
Benefit Details
|
Los Angeles |
$20.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $2,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AARP MedicareComplete SecureHorizons Plan 3 (HMO) - H0543-153-0
Benefit Details
|
Los Angeles |
$26.70 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd
| $6,700 Browse Formulary |
|
|
|
|
Aetna Medicare Select Plan (HMO) - H0523-002-0
Benefit Details
|
Los Angeles |
$27.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $5,400 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 |
Central Health Advance Plan (HMO SNP) - H5649-007-0
Benefit Details
|
Los Angeles |
$29.70 |
$400 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Select Care Drugs: $10.00
| 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 | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $45.00 Non-Preferred Drug: 50% 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. |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Select Care Drugs: $11.00
| n/a 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 |
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: $8.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $0.00
| n/a Browse Formulary |
|
|
|
|
Easy Choice Plus Plan (HMO) - H5087-017-0
Benefit Details
|
Los Angeles |
$33.10 |
$400 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 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. |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Select Care Drugs: $11.00
| n/a 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 |
CareMore Connect Plus (HMO) - H0544-049-0
Benefit Details
|
Los Angeles |
$36.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd
| $6,700 Browse Formulary |
|
|
|
|
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. |
No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd
| 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. |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Select Care Drugs: $10.00
| 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 |
Central Health Premier Plan (HMO) - H5649-004-0
Benefit Details
|
Los Angeles |
$36.20 |
$400 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Select Care Drugs: $10.00
| $6,700 Browse Formulary |
|
|
|
|
Coordinated Choice Plan (HMO) - H5928-037-0
Benefit Details
|
Los Angeles |
$36.20 |
$400 Tier 1 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 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 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 29% 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 |
Service |
Exper. |
Cost Info |
Health Net Seniority Plus Amber II (HMO SNP) - H0562-110-1
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 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 30% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
|
|
|
Health Net Seniority Plus Sapphire (HMO) - H0562-111-1
Benefit Details
|
Los Angeles |
$36.20 |
$140 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 30% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
|
|
|
Health Net Seniority Plus Sapphire Premier (HMO) - H3561-002-0
Benefit Details
|
Los Angeles |
$36.20 |
$170 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 29% Select Care Drugs: $0.00
| $6,700 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 |
Inter Valley Health Plan Value Preferred Choice (HMO) - H0545-014-0
Benefit Details
|
Los Angeles |
$36.20 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd
| $5,900 Browse Formulary |
|
|
|
|
Alignment Health Plan CalPlus (HMO) - H3815-009-0
Benefit Details
|
Los Angeles |
$36.30 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd
| $3,400 Browse Formulary |
|
|
|
|
Anthem MediBlue Coordination Plus (HMO) - H0564-080-0
Benefit Details
|
Los Angeles |
$36.30 |
$400 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $92.00 Specialty Tier: 25% Select Care Drugs: $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 |
Bridges - Dual Access (HMO SNP) - H0838-029-0
Benefit Details
|
Los Angeles |
$36.30 |
$400 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 0% Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% Select Diabetic Drugs: 0%
| n/a Browse Formulary |
|
-- |
|
|
Classic Choice for Medi-Medi (HMO) - H0838-033-0
Benefit Details
|
Los Angeles |
$36.30 |
$400 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 0% Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% Select Diabetic Drugs: $11.00
| $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% Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% Select Diabetic Drugs: 0%
| 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 |
Harmony - Dual Access (HMO SNP) - H0838-020-0
Benefit Details
|
Los Angeles |
$36.30 |
$400 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 0% Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% Select Diabetic Drugs: $11.00
| n/a Browse Formulary |
|
-- |
|
|
Healthy Heart - Dual Access (HMO SNP) - H0838-031-0
Benefit Details
|
Los Angeles |
$36.30 |
$400 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 0% Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% Select Diabetic Drugs: 0%
| n/a Browse Formulary |
|
-- |
|
|
In Control - Dual Access (HMO SNP) - H0838-027-0
Benefit Details
|
Los Angeles |
$36.30 |
$400 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 0% Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% Select Diabetic Drugs: 0%
| 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 Plus (HMO) - H5425-045-0
Benefit Details
|
Los Angeles |
$36.30 |
$400 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Select Care Drugs: $11.00
| $4,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
VillageHealth (HMO-POS SNP) - H5943-002-0
Benefit Details
|
Los Angeles |
$36.30 |
$400 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Choice Plan (PPO) - H5521-125-0
Benefit Details
|
Los Angeles |
$73.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|