AARP Medicare Advantage (HMO-POS) - H1045-028-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
| $4,900 Browse Formulary |
|
|
|
|
AARP Medicare Advantage Choice (PPO) - H2406-011-0
Benefit Details
|
Hillsborough |
$0.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 30%
| $5,500 Browse Formulary |
|
|
|
|
AARP Medicare Advantage Choice Essential (Regional PPO) - R0759-002-0
Benefit Details
|
Hillsborough |
$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 |
AARP Medicare Advantage Choice Plan 2 (Regional PPO) - R0759-001-0
Benefit Details
|
Hillsborough |
$0.00 |
$395 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
AARP Medicare Advantage Focus (HMO-POS) - H1045-045-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
| $3,900 Browse Formulary |
|
|
|
|
Aetna Medicare Choice (HMO-POS) - H1609-028-0
Benefit Details
|
Hillsborough |
$0.00 |
$195 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare Premier (PPO) - H5521-033-0
Benefit Details
|
Hillsborough |
$0.00 |
$300 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 27%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Premier Plus (PPO) - H5521-270-0
Benefit Details
|
Hillsborough |
$0.00 |
$150 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30%
| $5,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Summit Select (HMO) - H1609-034-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $90.00 Specialty Tier: 33%
| $3,200 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 |
BayCarePlus Complete (HMO) - H2235-001-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $4.00 Preferred Brand: $35.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,700 Browse Formulary |
new |
new |
|
|
BayCarePlus Rewards (HMO) - H2235-002-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33%
| $5,300 Browse Formulary |
new |
new |
|
|
BlueMedicare Classic (HMO) - H1035-021-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Drug: $93.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $5,000 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 |
BlueMedicare Classic Plus (HMO) - H1035-023-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Brand: $80.00 Specialty Tier: 33%
| $2,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Saver (HMO) - H1035-037-0
Benefit Details
|
Hillsborough |
$0.00 |
$50 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 32% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
|
|
|
CareFree (HMO) - H1019-104-2
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $60.00 Specialty Tier: 33%
| $2,500 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 |
CareOne PLUS (HMO) - H1019-103-2
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $10.00 Non-Preferred Drug: $55.00 Specialty Tier: 33%
| $1,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Cigna-HealthSpring Preferred (HMO) - H5410-029-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Cigna-HealthSpring Preferred Part B Savings (HMO) - H5410-030-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $4.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
| $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 |
Devoted Health Essentials Greater Tampa Bay (HMO) - H1290-016-0
Benefit Details
|
Hillsborough |
$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: $95.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
new |
new |
|
|
Devoted Health Greater Tampa Bay (HMO) - H1290-004-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $5.00 Non-Preferred Drug: $75.00 Specialty Tier: 33%
| $2,400 Browse Formulary |
new |
new |
|
|
Freedom Medicare Plan Rx (HMO) - H5427-060-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $85.00 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 |
Freedom Savings Plan (HMO) - H5427-052-0
Benefit Details
|
Hillsborough |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 |
|
|
|
|
Freedom VIP Care (HMO C-SNP) - H5427-070-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Drug: $60.00 Specialty Tier: 33% Select Diabetic Drugs: $0.00
| n/a Browse Formulary |
|
|
|
|
Freedom VIP Savings (HMO C-SNP) - H5427-072-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Drug: $80.00 Specialty Tier: 33% Select Diabetic 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 |
Freedom VIP Savings COPD (HMO C-SNP) - H5427-077-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Drug: $60.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
|
|
|
Humana Gold Plus - Diabetes (HMO C-SNP) - H1036-160-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $5.00 Non-Preferred Drug: $35.00 Specialty Tier: 33% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Plus H1036-025 (HMO) - H1036-025-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $5.00 Non-Preferred Drug: $55.00 Specialty Tier: 33%
| $1,900 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 |
Humana Gold Plus H1036-119 (HMO) - H1036-119-0
Benefit Details
|
Hillsborough |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 |
|
|
|
|
Humana Gold Plus H1036-265 (HMO) - H1036-265-1
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
| $2,750 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice Florida H5216-072 (PPO) - H5216-072-0
Benefit Details
|
Hillsborough |
$0.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $10.00 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 R5826-018 (Regional PPO) - R5826-018-0
Benefit Details
|
Hillsborough |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice R5826-074 (Regional PPO) - R5826-074-0
Benefit Details
|
Hillsborough |
$0.00 |
$395 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
Optimum Diamond Rewards (HMO C-SNP) - H5594-028-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Drug: $60.00 Specialty Tier: 33% Select Diabetic 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 |
Optimum Diamond Rewards COPD (HMO C-SNP) - H5594-029-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Drug: $60.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
|
|
|
Optimum Gold Rewards Plan (HMO) - H5594-001-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $85.00 Specialty Tier: 33%
| $2,500 Browse Formulary |
|
|
|
|
Optimum Platinum Plan (HMO) - H5594-002-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Preferred Brand: $10.00 Non-Preferred Drug: $65.00 Specialty Tier: 33%
| $1,500 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Simply Level (HMO C-SNP) - H5471-075-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Brand: $75.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
|
|
|
Simply More (HMO) - H5471-078-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Brand: $75.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
|
|
|
|
SOLIS SPF 009 (HMO) - H0982-009-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% Supplemental Brand and Generic Drugs: $0.00
| $3,400 Browse Formulary |
new |
new |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP) - H1045-048-3
Benefit Details
|
Hillsborough |
$0.00 |
$150 Tier 1, 2 and 3 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: 30%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Champion (HMO C-SNP) - H1032-203-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $10.00 Non-Preferred Drug: $80.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
|
|
|
WellCare Dividend (HMO) - H1032-032-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Drug: $75.00 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 |
WellCare Dividend Prime (HMO) - H1032-200-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $80.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
|
|
|
|
WellCare Elite (HMO) - H1032-201-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $15.00 Non-Preferred Drug: $75.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
|
|
|
|
WellCare Essential (HMO-POS) - H1032-174-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $15.00 Non-Preferred Drug: $75.00 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 |
WellCare Guardian (HMO C-SNP) - H1032-184-0
Benefit Details
|
Hillsborough |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $10.00 Non-Preferred Drug: $75.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
|
|
|
WellCare Premier (PPO) - H5199-012-0
Benefit Details
|
Hillsborough |
$0.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
| $3,400 Browse Formulary |
-- |
-- |
|
|
CareNeeds PLUS (HMO D-SNP) - H1019-026-0
Benefit Details
|
Hillsborough |
$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: $6.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| 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 |
CareNeeds (HMO D-SNP) - H1019-079-0
Benefit Details
|
Hillsborough |
$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: $3.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Cigna-HealthSpring Primary (HMO) - H5410-035-0
Benefit Details
|
Hillsborough |
$10.30 |
$435 |
No additional gap coverage, only the Donut Hole Discount | : 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25%
| $3,400 Browse Formulary |
|
|
|
|
Cigna-HealthSpring TotalCare (HMO D-SNP) - H5410-032-0
Benefit Details
|
Hillsborough |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| 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 |
UnitedHealthcare Assisted Living Plan (PPO I-SNP) - H0710-012-0
Benefit Details
|
Hillsborough |
$16.30 |
$200 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| n/a Browse Formulary |
|
-- |
|
|
Humana Gold Plus SNP-DE H1036-251 (HMO D-SNP) - H1036-251-0
Benefit Details
|
Hillsborough |
$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: $2.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Fully Integrated H1036-283 (HMO D-SNP) - H1036-283-0
Benefit Details
|
Hillsborough |
$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: $3.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| 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 |
UnitedHealthcare Dual Complete LP (HMO D-SNP) - H1045-039-0
Benefit Details
|
Hillsborough |
$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: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| n/a Browse Formulary |
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WellCare Reserve (HMO D-SNP) - H1032-202-0
Benefit Details
|
Hillsborough |
$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: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
| n/a Browse Formulary |
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WellCare Select (HMO D-SNP) - H1032-061-0
Benefit Details
|
Hillsborough |
$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: 47% Specialty Tier: 25%
| 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 |
WellCare Access (HMO D-SNP) - H1032-124-0
Benefit Details
|
Hillsborough |
$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 |
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Simply Complete (HMO D-SNP) - H5471-082-0
Benefit Details
|
Hillsborough |
$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: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Humana Gold Plus SNP-DE H1036-102 (HMO D-SNP) - H1036-102-0
Benefit Details
|
Hillsborough |
$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: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| 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 |
WellCare Liberty (HMO D-SNP) - H1032-175-0
Benefit Details
|
Hillsborough |
$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 |
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UnitedHealthcare Dual Complete RP (Regional PPO D-SNP) - R0759-003-0
Benefit Details
|
Hillsborough |
$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 | : 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
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Aetna Medicare Assure (HMO D-SNP) - H1609-019-0
Benefit Details
|
Hillsborough |
$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: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
| 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 |
Aetna Medicare Assure Plus (HMO D-SNP) - H1609-044-0
Benefit Details
|
Hillsborough |
$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: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
| n/a Browse Formulary |
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Allwell Dual Medicare (HMO D-SNP) - H5190-002-0
Benefit Details
|
Hillsborough |
$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: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
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BlueMedicare Complete (HMO D-SNP) - H1035-030-0
Benefit Details
|
Hillsborough |
$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: $40.00 Non-Preferred Brand: $92.00 Specialty Tier: 25%
| 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 |
Devoted Health Prime Greater Tampa Bay (HMO) - H1290-009-0
Benefit Details
|
Hillsborough |
$28.50 |
$435 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $3,400 Browse Formulary |
new |
new |
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Freedom Medi-Medi Full (HMO D-SNP) - H5427-087-0
Benefit Details
|
Hillsborough |
$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: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Freedom Medi-Medi Partial (HMO D-SNP) - H5427-078-0
Benefit Details
|
Hillsborough |
$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: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| 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 |
Longevity Health Plan (HMO I-SNP) - H1644-001-0
Benefit Details
|
Hillsborough |
$28.50 |
$435 |
No additional gap coverage, only the Donut Hole Discount | : 25%
| n/a Browse Formulary |
new |
new |
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Molina Medicare Complete Care (HMO D-SNP) - H8130-001-0
Benefit Details
|
Hillsborough |
$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: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25%
| n/a Browse Formulary |
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Optimum Emerald Full (HMO D-SNP) - H5594-017-0
Benefit Details
|
Hillsborough |
$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: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| 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 |
Optimum Emerald Partial (HMO D-SNP) - H5594-016-0
Benefit Details
|
Hillsborough |
$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: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Simply Care (HMO I-SNP) - H5471-094-0
Benefit Details
|
Hillsborough |
$28.50 |
$435 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $5.00 Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25%
| n/a Browse Formulary |
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Simply Comfort (HMO I-SNP) - H5471-095-0
Benefit Details
|
Hillsborough |
$28.50 |
$435 Tier 1 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25%
| 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 |
Simply Select (HMO) - H5471-099-0
Benefit Details
|
Hillsborough |
$28.50 |
$435 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25%
| $3,400 Browse Formulary |
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SOLIS SPF 010 (HMO D-SNP) - H0982-010-0
Benefit Details
|
Hillsborough |
$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% Generic: 0% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% Supplemental Brand and Generic Drugs: 0%
| n/a Browse Formulary |
new |
new |
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UnitedHealthcare Nursing Home Plan (PPO I-SNP) - H0710-038-0
Benefit Details
|
Hillsborough |
$28.50 |
$435 |
No additional gap coverage, only the Donut Hole Discount | : 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25%
| 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 Choice (Regional PPO) - R3332-001-0
Benefit Details
|
Hillsborough |
$47.90 |
$250 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Drug: $93.00 Specialty Tier: 28% Select Care Drugs: $0.00
| $6,500 Browse Formulary |
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WellCare Prime (PPO) - H5199-010-0
Benefit Details
|
Hillsborough |
$75.00 |
$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%
| $2,000 Browse Formulary |
-- |
-- |
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HumanaChoice R5826-005 (Regional PPO) - R5826-005-0
Benefit Details
|
Hillsborough |
$101.00 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 31%
| $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 |
BlueMedicare Select (PPO) - H5434-002-0
Benefit Details
|
Hillsborough |
$145.50 |
$305 Tier 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $93.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|