AARP MedicareComplete SecureHorizons Essential (HMO) - H0543-121-0
Benefit Details
|
Orange |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,900 |
|
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AARP MedicareComplete SecureHorizons Focus (HMO) - H0543-169-0
Benefit Details
|
Orange |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $1,500 Browse Formulary |
|
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AARP MedicareComplete SecureHorizons Plan 2 (HMO) - H0543-138-0
Benefit Details
|
Orange |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $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 |
Aetna Medicare Prime Plan (HMO) - H0523-061-0
Benefit Details
|
Orange |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $2,200 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Select Plan (HMO) - H0523-002-0
Benefit Details
|
Orange |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $2,000 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Alignment Health Plan Heart & Diabetes (HMO SNP) - H3815-010-0
Benefit Details
|
Orange |
$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:
|
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 My Choice (HMO) - H3815-001-0
Benefit Details
|
Orange |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $1.00 Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% Select Care Drugs: $3.00
| $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Alignment Health Plan Platinum (HMO) - H3815-008-0
Benefit Details
|
Orange |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $3.00 Preferred Brand: $30.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% Select Care Drugs: $5.00
| $1,499 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Breathe (HMO SNP) - H0544-014-0
Benefit Details
|
Orange |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.50 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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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Care On Site (HMO SNP) - H0544-005-0
Benefit Details
|
Orange |
$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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Anthem Diabetes (HMO SNP) - H0544-004-0
Benefit Details
|
Orange |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.50 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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Anthem ESRD (HMO SNP) - H0544-015-0
Benefit Details
|
Orange |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.50 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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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Heart (HMO SNP) - H0544-013-0
Benefit Details
|
Orange |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.50 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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Anthem MediBlue Plus (HMO) - H0544-061-0
Benefit Details
|
Orange |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Select (HMO) - H0544-059-0
Benefit Details
|
Orange |
$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%
| $1,000 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 |
Anthem StartSmart Plus (HMO) - H0544-007-0
Benefit Details
|
Orange |
$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
| $3,000 Browse Formulary |
|
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Anthem Value Plus (HMO) - H0544-002-0
Benefit Details
|
Orange |
$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
| $1,500 Browse Formulary |
|
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Blue Shield 65 Plus (HMO) - H0504-015-0
Benefit Details
|
Orange |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Injectable Drugs: 25% Specialty Tier: 33%
| $999 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 Choice Plan (HMO) - H0504-021-0
Benefit Details
|
Orange |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Injectable Drugs: 31% Specialty Tier: 33%
| $1,899 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Blue Shield Promise AdvantageOptimum Plan (HMO) - H5928-004-0
Benefit Details
|
Orange |
$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%
| $999 Browse Formulary |
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Brand New Day Bridges Care Plan (HMO SNP) - H0838-028-0
Benefit Details
|
Orange |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Drug: $75.00 Specialty Tier: 33% 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 |
Brand New Day Classic Care I Plan (HMO) - H0838-025-0
Benefit Details
|
Orange |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Drug: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $3,400 Browse Formulary |
|
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Brand New Day Classic Care II Plan (HMO) - H0838-037-0
Benefit Details
|
Orange |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $3,400 Browse Formulary |
|
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Brand New Day Embrace Care Plan (HMO SNP) - H0838-039-1
Benefit Details
|
Orange |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Drug: $85.00 Specialty Tier: 33% 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 |
Brand New Day Harmony Care Plan (HMO SNP) - H0838-032-0
Benefit Details
|
Orange |
$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 Care Drugs: $0.00
| n/a Browse Formulary |
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Central Health Focus Plan (HMO SNP) - H5649-006-0
Benefit Details
|
Orange |
$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 |
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-- |
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Central Health Medicare Plan (HMO) - H5649-001-0
Benefit Details
|
Orange |
$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 |
|
-- |
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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 Best Plan (HMO) - H5087-005-0
Benefit Details
|
Orange |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
| $2,500 Browse Formulary |
|
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Golden State (HMO) - H2241-007-1
Benefit Details
|
Orange |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
| $1,499 Browse Formulary |
|
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Health Net Gold Select (HMO) - H0562-101-1
Benefit Details
|
Orange |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $2,000 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 |
Health Net Jade (HMO SNP) - H0562-092-0
Benefit Details
|
Orange |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Heart First (HMO SNP) - H5425-028-0
Benefit Details
|
Orange |
$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%
| n/a Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Plus H5619-021 (HMO) - H5619-021-0
Benefit Details
|
Orange |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $1,300 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 |
Inter Valley Health Plan Service To Seniors (HMO) - H0545-001-0
Benefit Details
|
Orange |
$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 |
|
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|
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) - H0524-003-0
Benefit Details
|
Orange |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $0.00
| $4,900 Browse Formulary |
|
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OneCare Connect (Medicare-Medicaid Plan) - H8016-001-0
Benefit Details
|
Orange |
$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 |
SCAN Balance (HMO SNP) - H5425-034-0
Benefit Details
|
Orange |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $2.00 Preferred Brand: $30.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
SCAN Classic (HMO) - H5425-007-0
Benefit Details
|
Orange |
$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%
| $1,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
SCAN Healthy at Home (HMO SNP) - H9104-006-0
Benefit Details
|
Orange |
$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%
| 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 |
Easy Choice Rx (HMO) - H5087-023-0
Benefit Details
|
Orange |
$12.00 |
$415 Tier 1 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $2,000 Browse Formulary |
|
|
|
|
Health Net Healthy Heart (HMO) - H0562-100-1
Benefit Details
|
Orange |
$16.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $2,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
UnitedHealthcare MedicareComplete Assure (HMO) - H0543-153-0
Benefit Details
|
Orange |
$16.10 |
$415 |
No additional gap coverage, only the Donut Hole Discount | All Formulary Drugs: 25% All Formulary Drugs: 25% All Formulary Drugs: 25% All Formulary Drugs: 25% All Formulary Drugs: 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 |
Easy Choice Plus Plan (HMO) - H5087-002-0
Benefit Details
|
Orange |
$25.00 |
$415 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%
| $2,500 Browse Formulary |
|
|
|
|
AARP MedicareComplete SecureHorizons Premier (HMO) - H0543-165-0
Benefit Details
|
Orange |
$25.20 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $1,500 Browse Formulary |
|
|
|
|
SCAN Prime (HMO) - H5425-066-0
Benefit Details
|
Orange |
$26.00 |
$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%
| $1,500 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 CalPlus (HMO) - H3815-009-0
Benefit Details
|
Orange |
$30.50 |
$415 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $10.00 Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% Select Care Drugs: $5.00
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5619-037 (HMO) - H5619-037-0
Benefit Details
|
Orange |
$33.30 |
$415 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $19.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
OneCare (HMO SNP) - H5433-001-0
Benefit Details
|
Orange |
$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 Brand: $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 |
Anthem Connect Plus (HMO) - H0544-049-0
Benefit Details
|
Orange |
$34.70 |
$415 |
No additional gap coverage, only the Donut Hole Discount | All Formulary Drugs: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% Tier 6: 25%
| $6,700 Browse Formulary |
|
|
|
|
Anthem MediBlue Coordination Plus (HMO) - H0544-072-0
Benefit Details
|
Orange |
$34.80 |
$415 Tier 1 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Blue Shield Promise Coordinated Choice Plan (HMO) - H5928-037-0
Benefit Details
|
Orange |
$34.80 |
$415 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 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Blue Shield Promise TotalDual Plan (HMO SNP) - H5928-005-0
Benefit Details
|
Orange |
$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 | All Formulary Drugs: 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
|
|
|
Brand New Day Bridges Choice Medi-Medi Plan (HMO SNP) - H0838-029-0
Benefit Details
|
Orange |
$34.80 |
$415 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 0% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Select Care Drugs: 0%
| n/a Browse Formulary |
|
|
|
|
Brand New Day Classic Choice Medi-Medi Plan (HMO) - H0838-033-0
Benefit Details
|
Orange |
$34.80 |
$415 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 0% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Select Care Drugs: 0%
| $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 |
Brand New Day Dual Access Plan (HMO SNP) - H0838-024-0
Benefit Details
|
Orange |
$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: 0% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Select Care Drugs: 0%
| n/a Browse Formulary |
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Brand New Day Embrace Choice Medi-Medi Plan (HMO SNP) - H0838-040-1
Benefit Details
|
Orange |
$34.80 |
$415 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 0% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Select Care Drugs: 0%
| n/a Browse Formulary |
|
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|
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Brand New Day Harmony Choice Plan (HMO SNP) - H0838-020-0
Benefit Details
|
Orange |
$34.80 |
$415 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 0% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Select Care Drugs: 0%
| 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 |
Brand New Day Select Care Plan (HMO SNP) - H0838-041-0
Benefit Details
|
Orange |
$34.80 |
$415 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 0% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Select Care Drugs: 0%
| n/a Browse Formulary |
|
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|
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Central Health Premier Plan (HMO) - H5649-004-0
Benefit Details
|
Orange |
$34.80 |
$415 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 |
|
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|
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Health Net Seniority Plus Amber I (HMO SNP) - H0562-055-0
Benefit Details
|
Orange |
$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: $100.00 Specialty Tier: 26% 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
|
Orange |
$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: $100.00 Specialty Tier: 27% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
|
|
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Health Net Seniority Plus Sapphire (HMO) - H0562-111-1
Benefit Details
|
Orange |
$34.80 |
$340 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 Drug: $100.00 Specialty Tier: 26% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
|
|
|
Health Net Seniority Plus Sapphire Premier (HMO) - H3561-002-0
Benefit Details
|
Orange |
$34.80 |
$285 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 Drug: $100.00 Specialty Tier: 27% 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 Sapphire Premier II (HMO) - H3561-005-0
Benefit Details
|
Orange |
$34.80 |
$280 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 Drug: $100.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
|
|
|
Inter Valley Health Plan Value Preferred Choice (HMO) - H0545-014-0
Benefit Details
|
Orange |
$34.80 |
$415 |
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%
| $5,900 Browse Formulary |
|
|
|
|
SCAN Plus (HMO) - H5425-045-0
Benefit Details
|
Orange |
$34.80 |
$415 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%
| $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 |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP) - H0524-029-0
Benefit Details
|
Orange |
$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: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $0.00
| n/a Browse Formulary |
|
|
|
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VillageHealth (HMO-POS SNP) - H5943-002-0
Benefit Details
|
Orange |
$34.80 |
$415 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%
| n/a Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Choice Plan (PPO) - H5521-056-0
Benefit Details
|
Orange |
$73.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem MediBlue Access (PPO) - H8552-020-0
Benefit Details
|
Orange |
$159.00 |
$370 Tier 1 and 6 exempt |
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: 25% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|