Lasso Healthcare Growth (MSA) - H1924-001-0
Benefit Details
|
Cook |
$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
|
Cook |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a |
|
|
|
|
AARP Medicare Advantage Access (HMO) - H2802-024-0
Benefit Details
|
Cook |
$0.00 |
$100 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
select insulin pay $35 copay | $2,950 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 Patriot (PPO) - H8768-019-0
Benefit Details
|
Cook |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,900 |
|
|
|
|
AARP Medicare Advantage Walgreens (PPO) - H8768-010-0
Benefit Details
|
Cook |
$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%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Better Health Premier Plan MMAI (Medicare-Medicaid Plan) - H2506-001-0
Benefit Details
|
Cook |
$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 |
Aetna Medicare Eagle (PPO) - H5521-286-0
Benefit Details
|
Cook |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,500 |
|
|
|
|
Aetna Medicare Prime (HMO-POS) - H3192-001-0
Benefit Details
|
Cook |
$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 | $3,950 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Value (PPO) - H5521-086-0
Benefit Details
|
Cook |
$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%
| $3,950 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 |
Ascension Complete AMITA Health Reward (HMO) - H7399-001-0
Benefit Details
|
Cook |
$0.00 |
$480 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $0.00
| $2,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Ascension Complete AMITA Health Secure (HMO) - H7399-002-0
Benefit Details
|
Cook |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $1.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $2,400 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Blue Cross Community MMAI (Medicare-Medicaid Plan) - H0927-001-0
Benefit Details
|
Cook |
$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 |
Blue Cross Medicare Advantage Basic (HMO) - H3822-001-0
Benefit Details
|
Cook |
$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%
| $2,950 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Blue Cross Medicare Advantage Basic Plus (HMO-POS) - H3822-007-0
Benefit Details
|
Cook |
$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%
| $3,450 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Blue Cross Medicare Advantage Classic (PPO) - H8634-008-0
Benefit Details
|
Cook |
$0.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
| $6,900 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 |
Blue Medicare Advocate Health (HMO) - H8547-001-0
Benefit Details
|
Cook |
$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%
| $2,950 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Bright Advantage Classic Care Plan (HMO) - H6121-008-0
Benefit Details
|
Cook |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $39.00 Non-Preferred Drug: $92.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $3,400 Browse Formulary |
|
new |
new |
|
Cigna Fundamental Medicare (HMO) - H1415-013-0
Benefit Details
|
Cook |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Cigna Preferred Medicare (HMO) - H1415-024-0
Benefit Details
|
Cook |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $4.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 33%
| $3,150 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Cigna Premier Medicare (HMO-POS) - H1415-021-0
Benefit Details
|
Cook |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $4.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 33%
| $4,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Cigna True Choice Medicare (PPO) - H7849-002-0
Benefit Details
|
Cook |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $4.00 Preferred Brand: $42.00 Non-Preferred Drug: 45% Specialty Tier: 33%
| $4,400 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 |
Clear Spring Health Community Advantage Plan (HMO) - H3071-002-0
Benefit Details
|
Cook |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,000 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) - H5454-002-0
Benefit Details
|
Cook |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $2,900 Browse Formulary |
|
-- |
-- |
Higher cost-sharing at standard network pharmacies. Details:
|
Devoted Health Core (HMO) - H7151-001-0
Benefit Details
|
Cook |
$0.00 |
$0 |
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: 33%
select insulin pay $35 copay | $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 |
Devoted Health Essentials (HMO) - H7151-003-0
Benefit Details
|
Cook |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | $4,500 Browse Formulary |
new |
new |
new |
|
Humana Community HMO Diabetes and Heart (HMO C-SNP) - H1468-017-0
Benefit Details
|
Cook |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33% Select Care Drugs: $0.00
select insulin pay $35 copay | n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Plus H1468-013 (HMO) - H1468-013-0
Benefit Details
|
Cook |
$0.00 |
$0 |
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: 33%
select insulin pay $35 copay | $2,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan) - H0336-001-0
Benefit Details
|
Cook |
$0.00 |
$0 |
All Generics, All Brands | Tier 1: 0%
| n/a Browse Formulary |
-- |
-- |
-- |
|
Humana Honor (PPO) - H5216-258-0
Benefit Details
|
Cook |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,900 |
|
|
|
|
HumanaChoice H5216-251 (PPO) - H5216-251-0
Benefit Details
|
Cook |
$0.00 |
$200 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 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 |
HumanaChoice R5361-001 (Regional PPO) - R5361-001-0
Benefit Details
|
Cook |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
-- |
|
|
MeridianComplete (Medicare-Medicaid Plan) - H6080-001-0
Benefit Details
|
Cook |
$0.00 |
$0 |
All Generics, All Brands | Tier 1: 0%
| n/a Browse Formulary |
-- |
-- |
-- |
|
Molina Dual Options (Medicare-Medicaid Plan) - H8046-001-0
Benefit Details
|
Cook |
$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 |
MoreCare + (HMO C-SNP) - H2678-002-0
Benefit Details
|
Cook |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: 43% Specialty Tier: 33%
| n/a Browse Formulary |
|
new |
|
|
MoreCare At Home (HMO I-SNP) - H2678-004-0
Benefit Details
|
Cook |
$0.00 |
$480 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 25%
| n/a Browse Formulary |
|
new |
|
|
MoreCare For You (HMO) - H2678-001-0
Benefit Details
|
Cook |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33% Select Care Drugs: $0.00
select insulin pay $20-$35 copay | $3,450 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 |
MoreCare Home (HMO I-SNP) - H2678-003-0
Benefit Details
|
Cook |
$0.00 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 25%
| n/a Browse Formulary |
|
new |
|
|
Wellcare Giveback Open (PPO) - H6713-002-0
Benefit Details
|
Cook |
$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 |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO-POS) - H1416-009-0
Benefit Details
|
Cook |
$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: 39% 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 Essential (HMO) - H5779-005-0
Benefit Details
|
Cook |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 41% Specialty Tier: 33% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Exclusive (HMO) - H5779-007-0
Benefit Details
|
Cook |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: 38% Specialty Tier: 33% Select Care Drugs: $0.00
| $3,000 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) - H6713-001-0
Benefit Details
|
Cook |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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 |
Wellcare Patriot No Premium (HMO-POS) - H1416-053-0
Benefit Details
|
Cook |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Specialty No Premium (HMO C-SNP) - H1416-066-0
Benefit Details
|
Cook |
$0.00 |
$0 |
Many Generics, Some Brands | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Select Diabetic Drugs: $11.00
select insulin pay $11 copay | n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Zing Choice IL (HMO) - H7330-001-0
Benefit Details
|
Cook |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,450 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 |
Zing Essential Wellness IL (HMO C-SNP) - H4624-010-0
Benefit Details
|
Cook |
$0.00 |
$0 |
Some Generics, Few Brands | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | n/a Browse Formulary |
|
new |
new |
|
Zing Signature Care (HMO-POS) - H7330-004-0
Benefit Details
|
Cook |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,450 Browse Formulary |
|
new |
|
|
Wellcare Assist (HMO) - H5779-008-0
Benefit Details
|
Cook |
$12.30 |
$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: 41% 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 |
Wellcare Edge Plus (HMO) - H5779-006-0
Benefit Details
|
Cook |
$18.70 |
$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: 49% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
-- |
|
|
Clear Spring Health Community Flex Plan (HMO-POS) - H3071-003-0
Benefit Details
|
Cook |
$19.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
| $2,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Compass (HMO) - H1416-023-0
Benefit Details
|
Cook |
$19.00 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% 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 |
Humana Together in Health IE-SNP (HMO I-SNP) - H1468-020-0
Benefit Details
|
Cook |
$23.70 |
$460 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Together in Health I-SNP (HMO I-SNP) - H1468-019-0
Benefit Details
|
Cook |
$23.90 |
$480 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Zing Open Access IL (HMO-POS) - H7330-002-0
Benefit Details
|
Cook |
$25.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,450 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 (HMO) - H2802-025-0
Benefit Details
|
Cook |
$26.00 |
$195 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin pay $35 copay | $3,900 Browse Formulary |
|
|
|
|
Wellcare Plus (HMO) - H1416-048-0
Benefit Details
|
Cook |
$26.60 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $43.00 Non-Preferred Drug: 49% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
-- |
|
|
UnitedHealthcare Chronic Complete Assure (PPO C-SNP) - H0271-027-0
Benefit Details
|
Cook |
$26.70 |
$480 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Bright Advantage Classic Choice Plan (HMO) - H6121-003-0
Benefit Details
|
Cook |
$29.10 |
$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
| $6,700 Browse Formulary |
|
new |
new |
|
Devoted Health Prime (HMO) - H7151-002-0
Benefit Details
|
Cook |
$29.10 |
$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%
| $2,900 Browse Formulary |
new |
new |
new |
|
Longevity Health Plan (HMO I-SNP) - H9590-001-0
Benefit Details
|
Cook |
$29.10 |
$480 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Provider Partners Illinois Advantage Plan (HMO I-SNP) - H3800-001-0
Benefit Details
|
Cook |
$29.10 |
$480 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| n/a Browse Formulary |
|
new |
|
|
Provider Partners Illinois Community Plan (HMO I-SNP) - H3800-002-0
Benefit Details
|
Cook |
$29.10 |
$480 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| n/a Browse Formulary |
|
new |
|
|
UnitedHealthcare Assisted Living Plan (PPO I-SNP) - H0710-055-0
Benefit Details
|
Cook |
$29.10 |
$200 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
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 |
UnitedHealthcare Medicare Advantage Assure (PPO) - H0271-004-0
Benefit Details
|
Cook |
$29.10 |
$480 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| $7,550 Browse Formulary |
|
|
|
|
UnitedHealthcare Nursing Home Plan 1 (HMO-POS I-SNP) - H2802-027-0
Benefit Details
|
Cook |
$29.10 |
$480 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| n/a Browse Formulary |
|
|
|
|
UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP) - H0710-039-0
Benefit Details
|
Cook |
$29.10 |
$480 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
HumanaChoice H5216-283 (PPO) - H5216-283-0
Benefit Details
|
Cook |
$35.00 |
$150 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: $100.00 Specialty Tier: 30%
select insulin pay $35 copay | $3,750 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AARP Medicare Advantage Choice (PPO) - H8768-005-0
Benefit Details
|
Cook |
$38.00 |
$195 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 29%
select insulin pay $35 copay | $3,900 Browse Formulary |
|
|
|
|
Aetna Medicare Premier Plus (PPO) - H5521-016-0
Benefit Details
|
Cook |
$39.00 |
$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%
| $3,475 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 Cross Medicare Advantage Choice Plus (PPO) - H8634-003-0
Benefit Details
|
Cook |
$79.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
| $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Blue Cross Medicare Advantage Premier Plus (HMO-POS) - H3822-008-0
Benefit Details
|
Cook |
$83.00 |
$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%
| $2,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-013 (PPO) - H5216-013-0
Benefit Details
|
Cook |
$88.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | $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 |
HumanaChoice R5361-002 (Regional PPO) - R5361-002-0
Benefit Details
|
Cook |
$120.00 |
$480 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
-- |
|
|
Blue Cross Medicare Advantage Choice Premier (PPO) - H8634-004-0
Benefit Details
|
Cook |
$142.00 |
$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%
| $3,460 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-008 (PFFS) - H8145-008-0
Benefit Details
|
Cook |
$146.00 |
$380 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26%
| 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 |
Blue Cross Medicare Advantage Flex (PPO) - H8634-014-0
Benefit Details
|
Cook |
$189.20 |
$480 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $44.00 Non-Preferred Drug: 32% Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|