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 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,900 Browse Formulary |
|
|
|
|
AARP Medicare Advantage Plan 2 (HMO) - H0609-027-0
Benefit Details
|
Maricopa |
$0.00 |
$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%
select insulin pay $35 copay | $3,000 Browse Formulary |
|
|
|
|
AARP Medicare Advantage Plan 4 (HMO) - H0609-046-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,900 Browse Formulary |
|
|
|
|
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 1 (PPO) - H2228-074-0
Benefit Details
|
Maricopa |
$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%
select insulin pay $35 copay | $5,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AARP Medicare Advantage Walgreens Plan 2 (PPO) - H2228-077-0
Benefit Details
|
Maricopa |
$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%
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 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
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%
| $5,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Platinum Plan (HMO-POS) - H3931-129-0
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%
| $6,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Premier Plan (HMO-POS) - 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 |
|
|
|
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 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:
|
Aetna Medicare Prime Plus Plan (HMO-POS) - 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%
| $3,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Alignment Health Plan Heart & Diabetes (HMO C-SNP) - H3443-003-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Few Generics | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $40.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $5.00
| 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 |
Alignment Health Plan the ONE (HMO) - H3443-001-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $40.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $5.00
| $2,499 Browse Formulary |
new |
new |
new |
|
Amerivantage Comfort (HMO I-SNP) - H2593-019-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Many Generics, Some Brands | 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 Comfort Plus (HMO I-SNP) - H1423-008-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Many Generics, Some Brands | 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 |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Amerivantage Plus (HMO) - H1423-009-0
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%
| $3,000 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
AVA (PPO) - H9614-001-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $5.00
| $3,900 Browse Formulary |
new |
new |
new |
|
Banner Medicare Advantage Prime (HMO) - H5843-001-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | $2,775 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 |
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: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33%
| $2,900 Browse Formulary |
|
|
|
|
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 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Bright Advantage Classic Care Plan (HMO) - H4853-001-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $2,800 Browse Formulary |
|
|
|
|
Bright Advantage Embrace Care Plan (HMO C-SNP) - H4853-016-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Some Generics | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00
select insulin pay $0-$35 copay | n/a Browse Formulary |
|
|
|
|
Cigna Achieve Medicare (HMO C-SNP) - H0354-027-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Some Generics, Few Brands | Preferred Generic: $0.00 Generic: $5.00 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:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Cigna Alliance Medicare (HMO) - H0354-028-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | $2,500 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: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,100 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Devoted Health Advance (HMO C-SNP) - H8173-004-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Few Generics | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 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 |
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%
| $3,200 Browse Formulary |
|
new |
new |
|
Devoted Health Essence (HMO C-SNP) - H8173-006-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Few Generics | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | n/a Browse Formulary |
|
new |
new |
|
Devoted Health Liberty (HMO) - H8173-005-0
Benefit Details
|
Maricopa |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,400 |
|
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Global Classic (HMO) - H9078-001-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $90.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
new |
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Global Special Care (HMO C-SNP) - H9078-007-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Some Generics, Few Brands | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $90.00 Specialty Tier: 33%
select insulin pay $35 copay | n/a Browse Formulary |
new |
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Global Special Care Savings (HMO C-SNP) - H9078-008-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Some Generics, Few Brands | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $90.00 Specialty Tier: 33%
select insulin pay $35 copay | n/a 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 |
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:
|
Humana Gold Plus H0028-052 (HMO) - H0028-052-0
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 | $2,900 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 Honor (PPO) - H5216-213-0
Benefit Details
|
Maricopa |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,400 |
|
|
|
|
HumanaChoice H5216-137 (PPO) - H5216-137-0
Benefit Details
|
Maricopa |
$0.00 |
$445 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: $99.00 Specialty Tier: 25%
select insulin pay $35 copay | $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-265 (PPO) - H5216-265-0
Benefit Details
|
Maricopa |
$0.00 |
$250 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: 28%
select insulin pay $35 copay | $4,700 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 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 |
|
|
|
|
Imperial Insurance Company Traditional (HMO) - H2793-003-0
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: $90.00 Specialty Tier: 33%
select insulin pay $0 copay | $2,999 Browse Formulary |
|
-- |
|
|
Imperial Insurance Traditional Plus (HMO) - H2793-007-0
Benefit Details
|
Maricopa |
$0.00 |
$480 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| $7,550 Browse Formulary |
|
-- |
|
|
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
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Many Generics, Some Brands | 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 |
|
-- |
|
|
SCAN Balance (HMO C-SNP) - H1822-002-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Many Generics, Some Brands | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $0 copay | n/a Browse Formulary |
new |
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
SCAN Classic (HMO) - H1822-001-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $2,800 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 |
SCAN Heart First (HMO C-SNP) - H1822-003-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Many Generics, Some Brands | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | n/a Browse Formulary |
new |
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
SCAN Venture (HMO) - H1822-004-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $2,999 Browse Formulary |
new |
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
UnitedHealthcare Chronic Complete (HMO C-SNP) - H0609-042-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Some Generics | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 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 Giveback (HMO) - H0351-056-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $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:
|
Wellcare No Premium (HMO) - H0351-052-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $3,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium 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 |
Wellcare No Premium Open (PPO) - H8553-001-0
Benefit Details
|
Maricopa |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 29% Select Care Drugs: $0.00
| $5,000 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Rx Plus Open (PPO) - H8553-003-0
Benefit Details
|
Maricopa |
$0.00 |
$300 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: 43% Specialty Tier: 28% Select Care Drugs: $0.00
| $6,000 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Patriot Giveback Open (PPO) - H8553-002-0
Benefit Details
|
Maricopa |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,400 |
|
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 Specialty No Premium (HMO C-SNP) - H0351-038-0
Benefit Details
|
Maricopa |
$0.00 |
$0 |
Many Generics, Some Brands | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Select Diabetic Drugs: $0.00
select insulin pay $0 copay | n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-224 (PPO) - H5216-224-0
Benefit Details
|
Maricopa |
$17.00 |
$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%
select insulin pay $35 copay | $4,500 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 |
$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 | $4,000 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 |
Banner Medicare Advantage Plus (PPO) - H7273-001-0
Benefit Details
|
Maricopa |
$25.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | $4,500 Browse Formulary |
|
new |
new |
|
Banner Medicare Advantage Dual (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. |
Few Generics | Preferred Generic: 25% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
-- |
|
|
Humana Value Plus H5216-197 (PPO) - H5216-197-0
Benefit Details
|
Maricopa |
$29.60 |
$450 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $18.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
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 3 (HMO) - H0609-044-0
Benefit Details
|
Maricopa |
$30.00 |
$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%
select insulin pay $35 copay | $2,500 Browse Formulary |
|
|
|
|
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: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33%
| $2,900 Browse Formulary |
|
|
|
|
Wellcare Assist (HMO) - H0351-055-0
Benefit Details
|
Maricopa |
$35.00 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Drug: 44% Specialty Tier: 25% Select Care Drugs: $0.00
| $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 |
Banner Medicare Advantage Dual (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. |
Few Generics | Preferred Generic: 25% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
-- |
|
|
Bright Advantage Classic Choice Plan (HMO) - H4853-002-0
Benefit Details
|
Maricopa |
$39.20 |
$480 Tier 1 and 6 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 |
|
|
|
|
Devoted Health Select (HMO) - H8173-002-0
Benefit Details
|
Maricopa |
$39.70 |
$480 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%
| $3,200 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 |
Bright Advantage Embrace Assist Plan (HMO C-SNP) - H4853-020-0
Benefit Details
|
Maricopa |
$40.00 |
$480 Tier 1 and 6 exempt |
Some Generics | Preferred Generic: $0.00 Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
|
|
|
Bright Advantage Embrace Choice Plan (HMO C-SNP) - H4853-017-0
Benefit Details
|
Maricopa |
$40.00 |
$480 Tier 1 and 6 exempt |
Some Generics | Preferred Generic: $0.00 Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
|
|
|
Bright Advantage Harmony Choice Plan (HMO C-SNP) - H4853-018-0
Benefit Details
|
Maricopa |
$40.00 |
$480 Tier 1 and 6 exempt |
Some Generics | Preferred Generic: $0.00 Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Health 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 |
|
|
|
|
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 |
|
|
|
|
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 |
|
|
|
|
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) - H5580-005-0
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 |
|
|
|
|
Molina Medicare Complete Care (HMO D-SNP) - H8845-001-0
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 |
|
new |
new |
|
UnitedHealthcare Dual Complete LP (HMO D-SNP) - H0321-002-0
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 |
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%
| n/a Browse Formulary |
|
-- |
|
|
UnitedHealthcare Nursing Home Plan (PPO I-SNP) - H0710-005-0
Benefit Details
|
Maricopa |
$40.00 |
$480 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| n/a Browse Formulary |
|
-- |
|
|
Wellcare Dual Liberty (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% 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 |
Devoted Health Flex (HMO) - H8173-003-0
Benefit Details
|
Maricopa |
$45.00 |
$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%
| $4,200 Browse Formulary |
|
new |
new |
|
Blue Medicare Advantage Plus (HMO) - H0302-001-0
Benefit Details
|
Maricopa |
$48.00 |
$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 |
|
|
|
|
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 |
|
|
|
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 |
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 |
|
|
HumanaChoice R7220-002 (Regional PPO) - R7220-002-0
Benefit Details
|
Maricopa |
$60.00 |
$440 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: 24% Non-Preferred Drug: 24% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
Aetna Medicare Platinum Plan (PPO) - H5521-184-0
Benefit Details
|
Maricopa |
$85.00 |
$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 |
|
|
|
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 H5216-034 (PPO) - H5216-034-0
Benefit Details
|
Maricopa |
$119.00 |
$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 | $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|