AARP Medicare Advantage Patriot (HMO) - H0543-121-0
Benefit Details
|
San Diego |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,900 |
|
|
|
|
AARP Medicare Advantage SecureHorizons Plan 4 (HMO) - H0543-152-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,400 Browse Formulary |
|
|
|
|
Aetna Medicare Eagle Plan (HMO) - H4982-013-0
Benefit Details
|
San Diego |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare Plus Plan (HMO) - H4982-004-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
| $2,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Select Plan (HMO) - H0523-052-0
Benefit Details
|
San Diego |
$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%
| $3,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Align Connect (HMO C-SNP) - H3274-003-0
Benefit Details
|
San Diego |
$0.00 |
$480 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 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 |
Align Thrive (HMO I-SNP) - H3274-002-0
Benefit Details
|
San Diego |
$0.00 |
$480 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
new |
new |
new |
|
Anthem MediBlue Plus (HMO) - H0544-065-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $3,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Select (HMO) - H0544-091-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 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 |
Astiva Health Advantage (HMO) - H1993-003-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $32.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $0 copay | $845 Browse Formulary |
|
new |
new |
|
AVA (HMO) - H3815-027-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $3.00 Preferred Brand: $40.00 Non-Preferred Drug: $93.00 Specialty Tier: 33% Select Care Drugs: $3.00
| $999 Browse Formulary |
|
|
|
|
Blue Shield 65 Plus (HMO) - H0504-028-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $3.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
| $3,399 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 |
Blue Shield AdvantageOptimum Plan 1 (HMO) - H5928-010-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Blue Shield AdvantageOptimum Plan 2 (HMO) - H5928-053-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan) - H0148-001-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
All Generics, All Brands | Tier 1: 0%
| 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 |
Brand New Day Bridges Care Plan (HMO C-SNP) - H0838-028-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
Some Generics | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $45.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
-- |
|
|
Brand New Day Classic Care I Plan (HMO) - H0838-025-0
Benefit Details
|
San Diego |
$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 Care Drugs: $0.00
| $999 Browse Formulary |
|
-- |
|
|
Brand New Day Classic Care II Plan (HMO) - H0838-037-0
Benefit Details
|
San Diego |
$0.00 |
$50 Tier 1 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 32% Select Care Drugs: $0.00
| $999 Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Brand New Day Embrace Care Plan (HMO C-SNP) - H0838-039-1
Benefit Details
|
San Diego |
$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 |
|
-- |
|
|
Brand New Day Harmony Care Plan (HMO C-SNP) - H0838-032-0
Benefit Details
|
San Diego |
$0.00 |
$100 Tier 1 and 6 exempt |
Some Generics | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Drug: $90.00 Specialty Tier: 30% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
-- |
|
|
Brand New Day Part B Savings Plan (HMO) - H0838-049-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $2,900 Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Brand New Day Select Care II Plan (HMO I-SNP) - H0838-043-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
Some Generics | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
-- |
|
|
Brand New Day Valor Care Plan (HMO) - H0838-048-0
Benefit Details
|
San Diego |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
-- |
|
|
CalPlus (HMO) - H3815-009-0
Benefit Details
|
San Diego |
$0.00 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Select Care Drugs: $5.00
| $4,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Clever Care Fortune Medicare Advantage Plan (HMO) - H7607-007-3
Benefit Details
|
San Diego |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Brand: $99.00 Specialty Tier: 33% Supplemental Drugs: $0.00
select insulin pay $0-$35 copay | $888 Browse Formulary |
|
new |
new |
|
Clever Care Longevity Medicare Advantage (HMO) - H7607-002-3
Benefit Details
|
San Diego |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Brand: $99.00 Specialty Tier: 33% Supplemental Drugs: $0.00
select insulin pay $0-$35 copay | $1,700 Browse Formulary |
|
new |
new |
|
Clever Care Value Medicare Advantage Plan (HMO) - H7607-008-3
Benefit Details
|
San Diego |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: $99.00 Specialty Tier: 33% Supplemental Drugs: $0.00
select insulin pay $0-$35 copay | $3,000 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 |
CommuniCare Advantage Cal MediConnect Plan (Medicare-Medicaid Plan) - H5172-002-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
All Generics, All Brands | Tier 1: 0%
| n/a Browse Formulary |
-- |
-- |
-- |
|
Connected Care (HMO) - H2241-017-0
Sanctioned Plan
|
San Diego |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin coverage $35 or less | $3,000 Browse Formulary |
|
|
|
|
Harmony (HMO) - H3815-031-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $3.00 Preferred Brand: $40.00 Non-Preferred Drug: $93.00 Specialty Tier: 33% Select Care Drugs: $3.00
| $2,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Health Net Cal MediConnect Plan (Medicare-Medicaid Plan) - H3237-002-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
All Generics, All Brands | Tier 1: 0%
| n/a Browse Formulary |
-- |
-- |
-- |
|
Heart & Diabetes (HMO C-SNP) - H3815-010-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
Some Generics | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Drug: $75.00 Specialty Tier: 33% Select Care Drugs: $5.00
| n/a Browse Formulary |
|
|
|
|
Humana Gold Plus H5619-016 (HMO) - H5619-016-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
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: 33%
select insulin pay $35 copay | $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 |
Humana Honor (HMO) - H5619-120-0
Benefit Details
|
San Diego |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Imperial Dynamic Plan (HMO) - H5496-012-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $3.00 Preferred Brand: $30.00 Non-Preferred Drug: $75.00 Specialty Tier: 33%
select insulin pay $0 copay | $899 Browse Formulary |
|
-- |
|
|
Imperial Senior Value (HMO C-SNP) - H5496-005-0
Benefit Details
|
San Diego |
$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 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Imperial Strong (HMO) - H5496-014-0
Benefit Details
|
San Diego |
$0.00 |
$480 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| $7,550 Browse Formulary |
|
-- |
|
|
Imperial Traditional (HMO) - H5496-007-0
Benefit Details
|
San Diego |
$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 |
|
-- |
|
|
Kaiser Permanente Senior Advantage San Diego (HMO) - H0524-037-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $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 |
Molina Dual Options (Medicare-Medicaid Plan) - H8677-001-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
All Generics, All Brands | Tier 1: 0%
| n/a Browse Formulary |
-- |
-- |
-- |
|
Molina Medicare Choice Care (HMO) - H5810-014-0
Benefit Details
|
San Diego |
$0.00 |
$125 Tier 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31% Select Care Drugs: $0.00
select insulin pay $35 copay | $7,550 Browse Formulary |
|
-- |
|
|
Molina Medicare Choice Care Select (HMO) - H5810-015-0
Benefit Details
|
San Diego |
$0.00 |
$480 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $15.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25% Select Care Drugs: $5.00
| $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 |
Platinum (HMO) - H3815-016-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $3.00 Preferred Brand: $30.00 Non-Preferred Drug: $75.00 Specialty Tier: 33% Select Care Drugs: $5.00
| $998 Browse Formulary |
|
|
|
|
SCAN Alta (HMO) - H5425-082-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Scripps Classic offered by SCAN Health Plan (HMO) - H5425-005-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Select (HMO) - H3815-032-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $3.00 Preferred Brand: $40.00 Non-Preferred Drug: $93.00 Specialty Tier: 33% Select Care Drugs: $3.00
| $3,400 Browse Formulary |
|
|
|
|
Sharp Direct Advantage Gold Card (HMO) - H5386-003-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
select insulin pay $35 copay | $2,900 Browse Formulary |
|
|
|
|
Sharp Direct Advantage VIP Plan (HMO) - H5386-005-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
select insulin pay $35 copay | $2,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Sharp SecureHorizons Plan by UnitedHealthcare (HMO) - H0543-145-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,400 Browse Formulary |
|
|
|
|
Sharp Walgreens by UnitedHealthcare (HMO) - H0543-204-0
Benefit Details
|
San Diego |
$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 | $2,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
the ONE + Rite Aid (HMO) - H3815-034-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $1.00 Preferred Brand: $40.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $5.00
| $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 |
UC San Diego Health Humana (HMO) - H5619-131-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
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: 33%
select insulin pay $35 copay | $2,800 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
UnitedHealthcare Chronic Complete Focus (HMO C-SNP) - H0543-214-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
Some Generics | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
select insulin pay $25 copay | n/a Browse Formulary |
|
|
|
|
Wellcare No Premium (HMO) - H0562-012-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $10.00 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:
|
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) - H0562-114-0
Benefit Details
|
San Diego |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 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:
|
Anthem MediBlue Coordination Plus (HMO) - H0544-070-0
Benefit Details
|
San Diego |
$3.70 |
$480 Tier 1 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Plus Plan 2 (HMO) - H4982-015-0
Benefit Details
|
San Diego |
$19.30 |
$220 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: 35% Specialty Tier: 29%
| $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 |
AVA (PPO) - H4961-007-0
Benefit Details
|
San Diego |
$22.50 |
$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 |
|
|
Humana Value Plus H5619-037 (HMO) - H5619-037-0
Benefit Details
|
San Diego |
$22.60 |
$480 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $19.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
UnitedHealthcare Medicare Advantage Assure (HMO) - H0543-172-0
Benefit Details
|
San Diego |
$24.00 |
$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 |
AARP Medicare Advantage SecureHorizons Value (HMO) - H0543-013-0
Benefit Details
|
San Diego |
$25.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,300 Browse Formulary |
|
|
|
|
Anthem MediBlue Extra (HMO) - H0544-081-0
Benefit Details
|
San Diego |
$25.70 |
$480 Tier 1 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $2.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Scripps Heart First offered by SCAN Health Plan (HMO C-SNP) - H5425-055-0
Benefit Details
|
San Diego |
$26.00 |
$0 |
Some Generics | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | 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 |
Align Premier (HMO I-SNP) - H3274-001-0
Benefit Details
|
San Diego |
$26.70 |
$480 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| n/a Browse Formulary |
new |
new |
new |
|
Kaiser Permanente Sr Adv Medicare Medi-Cal (HMO D-SNP) - H0524-030-0
Benefit Details
|
San Diego |
$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 |
|
|
|
|
Brand New Day Classic Choice Plan (HMO) - H0838-033-0
Benefit Details
|
San Diego |
$32.20 |
$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
| $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 |
Anthem MediBlue ESRD Care (PPO C-SNP) - H8552-028-0
Benefit Details
|
San Diego |
$33.20 |
$130 Tier 1 and 6 exempt |
Few Generics | Preferred Generic: $1.00 Generic: $6.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Astiva Health Value (HMO) - H1993-004-0
Benefit Details
|
San Diego |
$33.20 |
$480 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
select insulin pay $0 copay | $7,550 Browse Formulary |
|
new |
new |
|
Blue Shield Coordinated Choice Plan (HMO) - H5928-037-0
Benefit Details
|
San Diego |
$33.20 |
$480 Tier 1 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $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 |
Blue Shield TotalDual Plan (HMO D-SNP) - H5928-005-0
Benefit Details
|
San Diego |
$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: $0.00 Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
|
Brand New Day Bridges Choice Plan (HMO C-SNP) - H0838-029-0
Benefit Details
|
San Diego |
$33.20 |
$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 |
|
-- |
|
|
Brand New Day Embrace Choice Plan (HMO C-SNP) - H0838-040-1
Benefit Details
|
San Diego |
$33.20 |
$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 |
Brand New Day Harmony Choice Plan (HMO C-SNP) - H0838-020-0
Benefit Details
|
San Diego |
$33.20 |
$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 |
|
-- |
|
|
Brand New Day Select Choice II Plan (HMO I-SNP) - H0838-045-0
Benefit Details
|
San Diego |
$33.20 |
$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 |
|
-- |
|
|
Clever Care Balance Medicare Advantage (HMO) - H7607-003-3
Benefit Details
|
San Diego |
$33.20 |
$480 Tier 1 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% Supplemental Drugs: $0.00
select insulin pay $0-$35 copay | $5,999 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 Traditional Plus (HMO) - H5496-009-0
Benefit Details
|
San Diego |
$33.20 |
$480 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 |
|
-- |
|
|
Molina Medicare Complete Care (HMO D-SNP) - H5810-001-0
Benefit Details
|
San Diego |
$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: $14.00 Preferred Brand: $40.00 Non-Preferred Drug: 30% Specialty Tier: 25%
| n/a Browse Formulary |
|
-- |
|
|
Scripps Plus offered by SCAN Health Plan (HMO) - H5425-040-0
Benefit Details
|
San Diego |
$33.20 |
$480 Tier 1 exempt |
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%
| $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 |
Wellcare Dual Liberty (HMO D-SNP) - H0562-121-0
Benefit Details
|
San Diego |
$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: 44% Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
|
|
|
Wellcare Plus Sapphire I (HMO) - H0562-122-0
Benefit Details
|
San Diego |
$33.20 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 46% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
|
|
|
Wellcare Plus Sapphire II (HMO) - H3561-002-0
Benefit Details
|
San Diego |
$33.20 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 44% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Sharp Direct Advantage Platinum Card (HMO) - H5386-004-0
Benefit Details
|
San Diego |
$58.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
select insulin pay $35 copay | $2,900 Browse Formulary |
|
|
|
|
AARP Medicare Advantage SecureHorizons Premier (HMO) - H0543-060-0
Benefit Details
|
San Diego |
$69.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | $4,300 Browse Formulary |
|
|
|
|
Scripps Signature offered by SCAN Health Plan (HMO) - H5425-004-0
Benefit Details
|
San Diego |
$74.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $3.00 Preferred Brand: $37.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $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 |
Aetna Medicare Choice Plan (PPO) - H5521-053-0
Benefit Details
|
San Diego |
$90.00 |
$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%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|