Lasso Healthcare Growth (MSA) - H1924-001-0
Benefit Details
|
Maricopa |
$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
|
Maricopa |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a |
|
|
|
|
AARP Medicare Advantage Patriot (PPO) - H2228-095-0
Benefit Details
|
Maricopa |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 |
|
|
|
|
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 Plan 1 (HMO) - H0609-026-0
Benefit Details
|
Maricopa |
$0.00 |
$150 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 30%
select insulin pay $35 copay | $3,900 Browse Formulary |
|
|
|
|
AARP Medicare Advantage Plan 2 (HMO) - H0609-027-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,000 Browse Formulary |
|
|
|
|
AARP Medicare Advantage Walgreens Plan 1 (PPO) - H2228-074-0
Benefit Details
|
Maricopa |
$0.00 |
$195 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin pay $35 copay | $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 |
AARP Medicare Advantage Walgreens Plan 2 (PPO) - H2228-077-0
Benefit Details
|
Maricopa |
$0.00 |
$195 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Eagle Plan (PPO) - H5521-329-0
Benefit Details
|
Maricopa |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,500 |
|
|
|
|
Aetna Medicare Freedom Plan (PPO) - H5521-100-0
Benefit Details
|
Maricopa |
$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%
| $7,350 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 Platinum Plan (HMO) - H3931-130-0
Benefit Details
|
Maricopa |
$0.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Premier Plan (HMO) - H4835-002-0
Benefit Details
|
Maricopa |
$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%
| $4,700 Browse Formulary |
new |
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Prime Plan (HMO) - H3931-092-0
Benefit Details
|
Maricopa |
$0.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
| $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 |
Aetna Medicare Prime Plus Plan (HMO) - H4835-001-0
Benefit Details
|
Maricopa |
$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%
| $3,600 Browse Formulary |
new |
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Allwell CHF/Diabetes Medicare (HMO C-SNP) - H0351-038-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Allwell Medicare Essentials (HMO) - H5590-005-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $3,450 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 Premier II (HMO) - H0351-052-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Amerivantage CareMore Care To You (HMO I-SNP) - H2593-019-0
Benefit Details
|
Maricopa |
$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 |
|
|
|
|
Amerivantage CareMore Care To You Plus (HMO I-SNP) - H1423-008-0
Benefit Details
|
Maricopa |
$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 |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Banner Medicare Advantage Prime (HMO) - H5843-001-0
Benefit Details
|
Maricopa |
$0.00 |
$150 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 30% Select Care Drugs: $0.00
| $4,450 Browse Formulary |
new |
new |
new |
|
Blue Medicare Advantage Classic (HMO) - H0302-006-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33%
| $4,250 Browse Formulary |
|
|
|
|
BluePathway Plan 1 (HMO) - H6936-006-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $2,900 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 |
BluePathway Plan 2 (HMO) - H6936-003-0
Benefit Details
|
Maricopa |
$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 Brand: $100.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
new |
new |
new |
|
Bright Advantage (HMO) - H4853-001-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $4,900 Browse Formulary |
|
|
|
|
Bright Advantage Choice (PPO) - H5841-003-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $6,500 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 Achieve Medicare (HMO C-SNP) - H0354-027-0
Benefit Details
|
Maricopa |
$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 Diabetic Drugs: $9.00
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Cigna Alliance Medicare (HMO) - H0354-028-0
Benefit Details
|
Maricopa |
$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%
| $3,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Cigna Preferred Medicare (HMO) - H0354-001-0
Benefit Details
|
Maricopa |
$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%
| $3,450 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 Core (HMO) - H8173-001-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,200 Browse Formulary |
new |
new |
new |
|
Humana Gold Plus H0028-027 (HMO) - H0028-027-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
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: 33%
select insulin pay $35 copay | $3,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Plus H0028-028 (HMO) - H0028-028-0
Benefit Details
|
Maricopa |
$0.00 |
$225 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin pay $35 copay | $5,500 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 |
Humana Honor (PPO) - H5216-213-0
Benefit Details
|
Maricopa |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,400 |
|
|
|
|
HumanaChoice R7220-001 (Regional PPO) - R7220-001-0
Benefit Details
|
Maricopa |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,000 |
|
new |
|
|
Imperial Insurance Company Traditional (HMO) - H2793-003-0
Sanctioned Plan
|
Maricopa |
$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 |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Imperial Insurance Value (HMO C-SNP) - H2793-005-0
Sanctioned Plan
|
Maricopa |
$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 |
|
|
WellCare Dividend (HMO) - H6439-004-0
Benefit Details
|
Maricopa |
$0.00 |
$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 |
|
new |
|
|
WellCare Patriot (PPO) - H8553-002-0
Benefit Details
|
Maricopa |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,400 |
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 Premier (PPO) - H8553-001-0
Benefit Details
|
Maricopa |
$0.00 |
$150 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: 30%
| $5,000 Browse Formulary |
new |
new |
new |
|
WellCare Rx Plus (PPO) - H8553-003-0
Benefit Details
|
Maricopa |
$0.00 |
$300 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | 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 Value (HMO) - H6439-002-0
Benefit Details
|
Maricopa |
$0.00 |
$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 |
|
new |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Compass (HMO) - H6439-003-0
Benefit Details
|
Maricopa |
$15.50 |
$445 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
| $3,400 Browse Formulary |
|
new |
|
|
HumanaChoice H5216-224 (PPO) - H5216-224-0
Benefit Details
|
Maricopa |
$16.00 |
$195 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: 29%
| $4,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Liberty (HMO D-SNP) - H5430-001-0
Benefit Details
|
Maricopa |
$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: $7.00 Preferred Brand: $45.00 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 |
Humana Value Plus H5216-197 (PPO) - H5216-197-0
Benefit Details
|
Maricopa |
$20.90 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AARP Medicare Advantage Walgreens Plan 3 (PPO) - H2228-097-0
Benefit Details
|
Maricopa |
$25.00 |
$195 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin pay $35 copay | $4,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Health Choice Pathway (HMO D-SNP) - H5587-002-0
Benefit Details
|
Maricopa |
$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%
| 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 |
BluePathway Plan 3 (HMO) - H6936-004-0
Benefit Details
|
Maricopa |
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $2,900 Browse Formulary |
new |
new |
new |
|
Imperial Insurance Traditional Plus (HMO) - H2793-007-0
Sanctioned Plan
|
Maricopa |
$32.40 |
$445 Tier 1 exempt |
Yes, some additional gap coverage. | Preferred Generic: 0% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $2,999 Browse Formulary |
new |
new |
|
|
Mercy Care Advantage (HMO D-SNP) - H5580-004-0
Benefit Details
|
Maricopa |
$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
| 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 |
Mercy Care Advantage (HMO D-SNP) - H5580-001-0
Benefit Details
|
Maricopa |
$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
| n/a Browse Formulary |
|
-- |
|
|
Mercy Care Advantage (HMO D-SNP) - H5580-005-0
Benefit Details
|
Maricopa |
$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
| n/a Browse Formulary |
|
-- |
|
|
Allwell Dual Medicare (HMO D-SNP) - H5590-008-0
Benefit Details
|
Maricopa |
$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 |
Banner - University Care Advantage (HMO D-SNP) - H4931-015-0
Benefit Details
|
Maricopa |
$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%
| n/a Browse Formulary |
|
|
|
|
Banner - University Care Advantage (HMO D-SNP) - H4931-007-0
Benefit Details
|
Maricopa |
$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%
| n/a Browse Formulary |
|
|
|
|
Bright Advantage Assist (HMO) - H4853-002-0
Benefit Details
|
Maricopa |
$36.10 |
$445 Tier 1 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Select Care Drugs: $0.00
| $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 |
Devoted Health Select (HMO) - H8173-002-0
Benefit Details
|
Maricopa |
$36.10 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,000 Browse Formulary |
new |
new |
new |
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Magellan Complete Care of Arizona (HMO D-SNP) - H8845-001-0
Benefit Details
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Maricopa |
$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%
| n/a Browse Formulary |
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new |
new |
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UnitedHealthcare Dual Complete LP (HMO D-SNP) - H0321-002-0
Benefit Details
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Maricopa |
$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 |
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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 |
UnitedHealthcare Dual Complete ONE (HMO D-SNP) - H0321-004-0
Benefit Details
|
Maricopa |
$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 |
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UnitedHealthcare Nursing Home Plan (PPO I-SNP) - H0710-005-0
Benefit Details
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Maricopa |
$36.10 |
$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 |
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Devoted Health Flex (HMO) - H8173-003-0
Benefit Details
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Maricopa |
$39.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $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 |
Banner Medicare Advantage Plus (PPO) - H7273-001-0
Benefit Details
|
Maricopa |
$40.00 |
$150 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 30% Select Care Drugs: $0.00
| $6,500 Browse Formulary |
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new |
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Blue Medicare Advantage Plus (HMO) - H0302-001-0
Benefit Details
|
Maricopa |
$43.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $4,250 Browse Formulary |
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Bright Advantage Choice Plus (PPO) - H5841-004-0
Benefit Details
|
Maricopa |
$49.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $5,000 Browse Formulary |
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new |
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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 |
Humana Gold Plus H0028-023 (HMO) - H0028-023-0
Benefit Details
|
Maricopa |
$50.00 |
$225 Tier 1 and 2 exempt |
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: 29%
select insulin pay $35 copay | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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HumanaChoice R7220-002 (Regional PPO) - R7220-002-0
Benefit Details
|
Maricopa |
$52.00 |
$420 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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new |
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Higher cost-sharing at standard network pharmacies. Details:
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Bright Advantage Plus (HMO) - H4853-014-0
Benefit Details
|
Maricopa |
$54.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $3,200 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 Platinum Plan (PPO) - H5521-184-0
Benefit Details
|
Maricopa |
$59.00 |
$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%
| $6,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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BlueJourney (PPO) - H5140-001-0
Benefit Details
|
Maricopa |
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33%
| $5,000 Browse Formulary |
new |
new |
new |
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HumanaChoice H5216-034 (PPO) - H5216-034-0
Benefit Details
|
Maricopa |
$120.00 |
$225 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $7,550 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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