Lasso Healthcare Growth (MSA) - H1924-001-0
Benefit Details
|
Bexar |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a |
|
|
|
|
Lasso Healthcare Growth Plus (MSA) - H1924-004-0
Benefit Details
|
Bexar |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a |
|
|
|
|
AARP Medicare Advantage Choice (PPO) - H1278-005-0
Benefit Details
|
Bexar |
$0.00 |
$345 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26%
select insulin pay $35 copay | $6,400 Browse Formulary |
|
new |
|
|
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 Patriot (HMO) - H4590-029-0
Benefit Details
|
Bexar |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
AARP Medicare Advantage SecureHorizons (HMO) - H4590-010-0
Benefit Details
|
Bexar |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,900 Browse Formulary |
|
|
|
|
Aetna Medicare Plus Plan (PPO) - H3288-013-0
Benefit Details
|
Bexar |
$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%
| $7,550 Browse Formulary |
new |
new |
new |
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 Plan (HMO) - H4523-001-0
Benefit Details
|
Bexar |
$0.00 |
$250 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: 28%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Prime Plan (HMO) - H4523-020-0
Benefit Details
|
Bexar |
$0.00 |
$250 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: 28%
| $5,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Value Plan (HMO) - H8332-001-0
Benefit Details
|
Bexar |
$0.00 |
$150 Tier 1, 2 and 3 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%
| $4,500 Browse Formulary |
new |
new |
new |
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) - H0062-001-0
Benefit Details
|
Bexar |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $12.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $7,550 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Allwell Medicare (HMO) - H5294-017-0
Benefit Details
|
Bexar |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $12.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $4,300 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Allwell Medicare Simple (HMO) - H5294-014-0
Benefit Details
|
Bexar |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Amerigroup Medicare-Medicaid Plan (Medicare-Medicaid Plan) - H8786-001-0
Benefit Details
|
Bexar |
$0.00 |
$0 |
All Generics, All Brands | Tier 1: 0% Tier 2: 0% Tier 3: 0% Tier 4: 0%
| n/a Browse Formulary |
-- |
-- |
-- |
|
Amerivantage Care To You Plus (HMO I-SNP) - H8849-002-0
Benefit Details
|
Bexar |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.50 Preferred Brand: $40.00 Non-Preferred Drug: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
Amerivantage Classic (HMO) - H2593-028-3
Benefit Details
|
Bexar |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $12.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $7,550 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 |
Amerivantage Classic Plus (HMO) - H8849-008-3
Benefit Details
|
Bexar |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $12.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $5,600 Browse Formulary |
new |
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Amerivantage Select (HMO) - H2593-026-0
Benefit Details
|
Bexar |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Amerivantage Select Plus (HMO) - H8849-006-0
Benefit Details
|
Bexar |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $3,500 Browse Formulary |
new |
new |
new |
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 Cross Medicare Advantage Choice Plus (PPO) - H1666-008-0
Benefit Details
|
Bexar |
$0.00 |
$350 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $13.00 Preferred Brand: $40.00 Non-Preferred Drug: $93.00 Specialty Tier: 26%
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Blue Cross Medicare Advantage Value (HMO) - H8554-001-0
Benefit Details
|
Bexar |
$0.00 |
$195 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $39.00 Non-Preferred Drug: $93.00 Specialty Tier: 29%
| $4,000 Browse Formulary |
-- |
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
CFHP Medicare Advantage with Part D Standard Plan (HMO) - H5447-001-0
Benefit Details
|
Bexar |
$0.00 |
$300 Tier Yes exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $30.00 Non-Preferred Brand: 30% Specialty Tier: 27%
| $7,550 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 |
Cigna Fundamental Medicare (HMO) - H4513-062-0
Benefit Details
|
Bexar |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,300 |
|
|
|
|
Cigna Preferred Medicare (HMO) - H4513-028-0
Benefit Details
|
Bexar |
$0.00 |
$190 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $4.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 29%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Cigna Preferred Medicare (HMO) - H4513-061-1
Benefit Details
|
Bexar |
$0.00 |
$190 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $4.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 29%
| $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 |
Clover Health Choice (PPO) - H5141-025-0
Benefit Details
|
Bexar |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clover Health Classic (HMO) - H8010-005-0
Benefit Details
|
Bexar |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Devoted Health Core San Antonio (HMO) - H7993-003-0
Benefit Details
|
Bexar |
$0.00 |
$195 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $40.00 Non-Preferred Drug: $99.00 Specialty Tier: 29%
select insulin pay $35 copay | $3,400 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 |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) - H0028-039-0
Benefit Details
|
Bexar |
$0.00 |
$200 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Drug: $99.00 Specialty Tier: 29%
select insulin pay $35 copay | n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Plus H0028-030 (HMO) - H0028-030-0
Benefit Details
|
Bexar |
$0.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $42.00 Non-Preferred Drug: $99.00 Specialty Tier: 29%
select insulin pay $35 copay | $3,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Honor (PPO) - H5216-128-0
Benefit Details
|
Bexar |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R4182-001 (Regional PPO) - R4182-001-0
Benefit Details
|
Bexar |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,700 |
|
|
|
|
Imperial Insurance Company Traditional (HMO) - H2793-003-0
Benefit Details
|
Bexar |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $45.00 Non-Preferred Drug: $90.00 Specialty Tier: 33%
| $2,999 Browse Formulary |
new |
new |
|
|
Imperial Insurance Value (HMO C-SNP) - H2793-005-0
Benefit Details
|
Bexar |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $45.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Select Care Drugs: $3.00
select insulin pay $0 copay | n/a 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 |
Molina Dual Options (Medicare-Medicaid Plan) - H8197-001-0
Benefit Details
|
Bexar |
$0.00 |
$0 |
All Generics, All Brands | Tier 1: 0% Tier 2: 0% Tier 3: 0%
| n/a Browse Formulary |
-- |
-- |
-- |
|
Superior HealthPlan STAR+PLUS Medicare-Medicaid (Medicare-Medicaid Plan) - H6870-001-0
Benefit Details
|
Bexar |
$0.00 |
$0 |
All Generics, All Brands | Tier 1: 0% Tier 2: 0% Tier 3: 0%
| n/a Browse Formulary |
-- |
-- |
-- |
|
UnitedHealthcare Chronic Complete (HMO C-SNP) - H4590-037-0
Benefit Details
|
Bexar |
$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%
select insulin pay $35 copay | 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 |
WellCare Dividend Prime (HMO) - H0174-007-0
Benefit Details
|
Bexar |
$0.00 |
$300 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $30.00 Non-Preferred Drug: $100.00 Specialty Tier: 27%
| $6,700 Browse Formulary |
|
-- |
|
|
WellCare Guardian (HMO C-SNP) - H0174-008-0
Benefit Details
|
Bexar |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $10.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $10.00
select insulin pay $10 copay | n/a Browse Formulary |
|
-- |
|
|
WellCare Prime (PPO) - H7323-004-0
Benefit Details
|
Bexar |
$0.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Drug: 45% Specialty Tier: 28%
| $3,400 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 |
WellCare Rx Plus (PPO) - H7323-006-0
Benefit Details
|
Bexar |
$0.00 |
$300 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $45.00 Non-Preferred Drug: 45% Specialty Tier: 27%
| $6,000 Browse Formulary |
new |
new |
new |
|
WellCare TexanPlus Classic (HMO) - H0174-003-0
Benefit Details
|
Bexar |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $35.00 Non-Preferred Drug: $90.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
|
-- |
|
|
WellCare Value (HMO-POS) - H0174-005-0
Benefit Details
|
Bexar |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Drug: $85.00 Specialty Tier: 33%
| $4,500 Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Medicare Silver (Regional PPO C-SNP) - R6801-008-0
Benefit Details
|
Bexar |
$4.90 |
$445 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25%
| n/a Browse Formulary |
|
|
|
|
Cigna TotalCare (HMO D-SNP) - H4513-060-1
Benefit Details
|
Bexar |
$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: 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
| n/a Browse Formulary |
|
|
|
|
Cigna TotalCare (HMO D-SNP) - H4513-029-0
Benefit Details
|
Bexar |
$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: 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 |
HumanaChoice H5216-043 (PPO) - H5216-043-1
Benefit Details
|
Bexar |
$10.00 |
$295 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 27%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Allwell Medicare Complement (HMO) - H5294-016-0
Benefit Details
|
Bexar |
$14.10 |
$445 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $19.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25%
| $3,450 Browse Formulary |
|
|
|
|
Aetna Medicare Choice Plan (PPO) - H3288-001-0
Benefit Details
|
Bexar |
$15.00 |
$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%
| $7,550 Browse Formulary |
new |
new |
new |
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 |
Amerivantage Choice (PPO) - H8343-003-0
Benefit Details
|
Bexar |
$15.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $10.00 Generic: $15.00 Preferred Brand: $37.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $6,500 Browse Formulary |
new |
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Compass (HMO) - H0174-009-0
Benefit Details
|
Bexar |
$16.20 |
$445 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: 50% Specialty Tier: 25%
| $3,450 Browse Formulary |
|
-- |
|
|
UnitedHealthcare Dual Complete (HMO D-SNP) - H4590-022-0
Benefit Details
|
Bexar |
$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: 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 |
WellCare Access (HMO D-SNP) - H0174-004-0
Benefit Details
|
Bexar |
$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 |
|
-- |
|
|
Allwell Dual Medicare Harmony (HMO D-SNP) - H5294-015-0
Benefit Details
|
Bexar |
$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: $1.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: 49% Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
|
WellCare Liberty (HMO D-SNP) - H0174-006-0
Benefit Details
|
Bexar |
$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 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare Dual Complete Plan (HMO D-SNP) - H8597-001-0
Benefit Details
|
Bexar |
$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: 25% Non-Preferred Drug: 35% Specialty Tier: 29%
| n/a Browse Formulary |
new |
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Amerivantage Dual Secure Plus (HMO D-SNP) - H8849-011-3
Benefit Details
|
Bexar |
$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: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Allwell Medicare Nurture (HMO D-SNP) - H5294-010-0
Benefit Details
|
Bexar |
$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: 49% Specialty Tier: 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 |
Amerivantage Dual Coordination (HMO D-SNP) - H2593-030-3
Benefit Details
|
Bexar |
$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: $14.00 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:
|
Amerivantage Dual Coordination Plus (HMO D-SNP) - H8849-010-3
Benefit Details
|
Bexar |
$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: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Amerivantage Dual Secure (HMO D-SNP) - H2593-034-0
Benefit Details
|
Bexar |
$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: $15.00 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:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Amerivantage ESRD Care (HMO-POS C-SNP) - H2593-031-0
Benefit Details
|
Bexar |
$22.50 |
$100 Tier 1 exempt |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Drug: $93.00 Specialty Tier: 31% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
CFHP Medicare Advantage D-SNP Standard Plan (HMO D-SNP) - H5447-002-0
Benefit Details
|
Bexar |
$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%
| n/a Browse Formulary |
new |
new |
new |
|
Devoted Health Prime San Antonio (HMO) - H7993-004-0
Benefit Details
|
Bexar |
$22.50 |
$195 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Drug: $99.00 Specialty Tier: 29%
select insulin pay $30 copay | $3,400 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 |
Humana Gold Plus SNP-DE H0028-036 (HMO D-SNP) - H0028-036-0
Benefit Details
|
Bexar |
$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: $2.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Imperial Insurance Company Dual (HMO D-SNP) - H2793-004-0
Benefit Details
|
Bexar |
$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: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| n/a Browse Formulary |
new |
new |
|
|
Molina Medicare Complete Care (HMO D-SNP) - H7678-001-0
Benefit Details
|
Bexar |
$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: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 32% Specialty Tier: 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 |
ProCare Advantage (HMO I-SNP) - H3467-001-0
Benefit Details
|
Bexar |
$22.50 |
$445 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| n/a Browse Formulary |
new |
new |
new |
|
UnitedHealthcare Dual Complete Choice (Regional PPO D-SNP) - R6801-011-0
Benefit Details
|
Bexar |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $0.00 Tier 3: $0.00 Tier 4: $0.00 Tier 5: $0.00
| n/a Browse Formulary |
|
|
|
|
WellCare Imperial (PPO D-SNP) - H7323-005-0
Benefit Details
|
Bexar |
$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: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: 46% Specialty Tier: 25%
| n/a 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 |
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) - H9706-002-0
Benefit Details
|
Bexar |
$0.80 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
UnitedHealthcare Medicare Gold (Regional PPO C-SNP) - R6801-009-0
Benefit Details
|
Bexar |
$29.00 |
$295 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 27%
select insulin coverage $35 or less | n/a Browse Formulary |
|
|
|
|
Humana Gold Choice H8145-126 (PFFS) - H8145-126-0
Benefit Details
|
Bexar |
$30.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a |
|
-- |
|
|
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 Choice (Regional PPO) - R6801-012-0
Benefit Details
|
Bexar |
$49.00 |
$395 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R4182-004 (Regional PPO) - R4182-004-0
Benefit Details
|
Bexar |
$55.00 |
$175 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| $7,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-042 (PPO) - H5216-042-0
Benefit Details
|
Bexar |
$93.00 |
$175 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| $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 |
HumanaChoice R4182-003 (Regional PPO) - R4182-003-0
Benefit Details
|
Bexar |
$93.00 |
$175 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| $7,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-084 (PFFS) - H8145-084-0
Benefit Details
|
Bexar |
$96.00 |
$250 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 28%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|