AARP MedicareComplete Plan 7 (HMO) - H5253-049-0
Benefit Details
|
Cuyahoga |
$0.00 |
$225 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
| $4,500 Browse Formulary |
|
|
|
|
Advantra Silver (PPO) - H1608-029-0
Benefit Details
|
Cuyahoga |
$0.00 |
$95 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
| $3,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Value Plan (HMO) - H3931-107-0
Benefit Details
|
Cuyahoga |
$0.00 |
$95 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
| $3,600 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 |
Allwell Medicare (HMO) - H0724-001-0
Benefit Details
|
Cuyahoga |
$0.00 |
$125 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 30% Select Care Drugs: $0.00
| $4,900 Browse Formulary |
new |
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Essential (HMO) - H3655-032-0
Benefit Details
|
Cuyahoga |
$0.00 |
$60 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 31% Select Care Drugs: $0.00
| $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Preferred (HMO) - H3655-040-0
Benefit Details
|
Cuyahoga |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $4,900 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 Prime Select (HMO) - H3655-038-0
Benefit Details
|
Cuyahoga |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $12.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Buckeye Health Plan - MyCare Ohio (Medicare-Medicaid Plan) - H0022-001-0
Benefit Details
|
Cuyahoga |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: 0% Brand Drugs: 0% Non-Medicare Rx/OTC Drugs: 0%
| n/a Browse Formulary |
-- |
-- |
-- |
|
CareSource Advantage Zero Premium (HMO) - H6396-004-0
Benefit Details
|
Cuyahoga |
$0.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 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 |
CareSource MyCare Ohio (Medicare-Medicaid Plan) - H8452-001-0
Benefit Details
|
Cuyahoga |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: 0% Brand Drugs: 0% Non-Medicare Rx/OTC Drugs: 0%
| n/a Browse Formulary |
-- |
-- |
-- |
|
Humana Cleveland Clinic Preferred (HMO) - H6622-023-0
Benefit Details
|
Cuyahoga |
$0.00 |
$0 |
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: 33%
| $3,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Plus H6622-022 (HMO) - H6622-022-0
Benefit Details
|
Cuyahoga |
$0.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30%
| $4,900 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 |
HumanaChoice H5525-042 (PPO) - H5525-042-0
Benefit Details
|
Cuyahoga |
$0.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5495-001 (Regional PPO) - R5495-001-0
Benefit Details
|
Cuyahoga |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
MedMutual Advantage Classic (HMO) - H6723-001-1
Benefit Details
|
Cuyahoga |
$0.00 |
$160 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 30%
| $4,300 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 |
MeridianCare Essential (HMO) - H5475-022-0
Benefit Details
|
Cuyahoga |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Supplemental Drugs: $60.00
| $4,400 Browse Formulary |
|
|
|
|
Paramount Elite - Standard Medical and Drug (HMO) - H3653-015-0
Benefit Details
|
Cuyahoga |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $4,900 Browse Formulary |
|
|
|
|
SummaCare Medicare Topaz (HMO) - H3660-050-0
Benefit Details
|
Cuyahoga |
$0.00 |
$150 Tier 1, 2, 5, and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 30% Vaccines: $0.00
| $3,800 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 Connected for MyCareOhio (Medicare-Medicaid Plan) - H2531-001-0
Benefit Details
|
Cuyahoga |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: 0% Brand Drugs: 0%
| n/a Browse Formulary |
-- |
-- |
-- |
|
Anthem MediBlue Access Core (Regional PPO) - R5941-013-0
Benefit Details
|
Cuyahoga |
$15.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-106 (PPO) - H5216-106-0
Benefit Details
|
Cuyahoga |
$15.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $8.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30%
| $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 |
AARP MedicareComplete Plan 1 (HMO) - H5253-050-0
Benefit Details
|
Cuyahoga |
$18.00 |
$170 Tier 1, 2, and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 29%
| $3,600 Browse Formulary |
|
|
|
|
UnitedHealthcare Dual Complete (HMO SNP) - H5253-059-0
Benefit Details
|
Cuyahoga |
$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% All Formulary Drugs: 15% All Formulary Drugs: 15% All Formulary Drugs: 15% All Formulary Drugs: 15%
| n/a Browse Formulary |
|
|
|
|
Humana Cleveland Clinic Preferred SNP-DE (HMO SNP) - H6622-024-0
Benefit Details
|
Cuyahoga |
$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: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 27%
| 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 |
Paramount Elite - Prime Medical and Drug (HMO) - H3653-022-0
Benefit Details
|
Cuyahoga |
$28.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $4,400 Browse Formulary |
|
|
|
|
Valor Health Plan (HMO SNP) - H1119-001-0
Benefit Details
|
Cuyahoga |
$30.90 |
$415 |
No additional gap coverage, only the Donut Hole Discount | All Formulary Drugs: 25%
| n/a Browse Formulary |
new |
new |
new |
|
Allwell Dual Medicare (HMO SNP) - H0908-001-0
Benefit Details
|
Cuyahoga |
$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: 32% 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 |
Anthem MediBlue Dual Advantage (HMO SNP) - H3655-033-0
Benefit Details
|
Cuyahoga |
$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: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) - H3655-041-0
Benefit Details
|
Cuyahoga |
$32.90 |
$415 Tier 1 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 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:
|
CareSource Advantage (HMO) - H6396-001-0
Benefit Details
|
Cuyahoga |
$32.90 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $4,600 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Gateway Health Medicare Assured Diamond (HMO SNP) - H9190-001-0
Benefit Details
|
Cuyahoga |
$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: 25%
| n/a Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Ruby (HMO SNP) - H9190-002-0
Benefit Details
|
Cuyahoga |
$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: 25%
| n/a Browse Formulary |
|
|
|
|
MeridianCare Extra (HMO SNP) - H5475-021-0
Benefit Details
|
Cuyahoga |
$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: 25% Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% Supplemental 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 |
Provider Partners Health Plan of Ohio (HMO SNP) - H7119-001-0
Benefit Details
|
Cuyahoga |
$32.90 |
$415 |
No additional gap coverage, only the Donut Hole Discount | All Formulary Drugs: 25%
| n/a Browse Formulary |
new |
new |
new |
|
UnitedHealthcare Nursing Home Plan 1 (PPO SNP) - H2406-001-0
Benefit Details
|
Cuyahoga |
$32.90 |
$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%
| n/a Browse Formulary |
|
|
|
|
UnitedHealthcare Nursing Home Plan 2 (PPO SNP) - H0710-027-0
Benefit Details
|
Cuyahoga |
$32.90 |
$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%
| 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 |
MedMutual Advantage Choice (HMO) - H6723-002-1
Benefit Details
|
Cuyahoga |
$38.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
| $3,950 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Select (PPO) - H4497-001-1
Benefit Details
|
Cuyahoga |
$38.00 |
$160 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 30%
| $6,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Paramount Elite - Enhanced Medical Only (HMO) - H3653-018-0
Benefit Details
|
Cuyahoga |
$40.00 |
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 |
SummaCare Medicare Ruby (HMO) - H3660-044-0
Benefit Details
|
Cuyahoga |
$43.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $0.00
| $3,600 Browse Formulary |
|
|
|
|
Humana Gold Plus H6622-011 (HMO) - H6622-011-0
Benefit Details
|
Cuyahoga |
$46.00 |
$195 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (PPO) - H4036-010-1
Benefit Details
|
Cuyahoga |
$56.00 |
$50 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 32% Select Care Drugs: $0.00
| $6,400 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 |
CareSource Advantage Plus (HMO) - H6396-002-0
Benefit Details
|
Cuyahoga |
$67.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $3,900 Browse Formulary |
|
|
|
|
Paramount Elite - Enhanced Medical and Drug (HMO) - H3653-004-0
Benefit Details
|
Cuyahoga |
$68.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
|
|
|
|
Anthem MediBlue Access Basic (Regional PPO) - R5941-014-0
Benefit Details
|
Cuyahoga |
$70.00 |
$200 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: 41% Specialty Tier: 29% Select Care Drugs: $0.00
| $6,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
MedMutual Advantage Preferred (PPO) - H4497-002-1
Benefit Details
|
Cuyahoga |
$74.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
| $5,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-024 (PPO) - H5216-024-0
Benefit Details
|
Cuyahoga |
$75.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
SummaCare Medicare Sapphire (HMO-POS) - H3660-029-0
Benefit Details
|
Cuyahoga |
$76.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $0.00
| $3,600 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 MediBlue Access Plus (PPO) - H4036-017-0
Benefit Details
|
Cuyahoga |
$87.00 |
$40 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 32% Select Care Drugs: $0.00
| $4,300 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Plus H6622-019 (HMO) - H6622-019-0
Benefit Details
|
Cuyahoga |
$87.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
| $3,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Choice Plan (PPO) - H5521-134-0
Benefit Details
|
Cuyahoga |
$98.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $4,100 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 |
MedMutual Advantage Plus (HMO) - H6723-003-1
Benefit Details
|
Cuyahoga |
$99.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
| $3,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5495-002 (Regional PPO) - R5495-002-0
Benefit Details
|
Cuyahoga |
$100.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $9.00 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:
|
AARP MedicareComplete Plan 3 (HMO) - H5253-051-0
Benefit Details
|
Cuyahoga |
$111.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
| $3,200 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
MedMutual Advantage Premium (PPO) - H4497-003-1
Benefit Details
|
Cuyahoga |
$119.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
| $3,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Standard Plan (PPO) - H5521-020-0
Benefit Details
|
Cuyahoga |
$120.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $4,750 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5525-030 (PPO) - H5525-030-0
Benefit Details
|
Cuyahoga |
$155.00 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
| $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 |
SummaCare Medicare Emerald (HMO-POS) - H3660-028-0
Benefit Details
|
Cuyahoga |
$180.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Vaccines: $0.00
| $3,400 Browse Formulary |
|
|
|
|
Aetna Medicare OH Connect Gold 2 (Regional PPO) - R6694-005-0
Benefit Details
|
Cuyahoga |
$190.00 |
$350 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26%
| $3,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare OH Connect Gold (Regional PPO) - R6694-003-0
Benefit Details
|
Cuyahoga |
$204.00 |
$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%
| $3,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|