AARP Medicare Advantage Open Plan 1 (PPO) - H0294-017-0
Benefit Details
|
Wayne |
$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 insulin pay $35 copay | $4,900 Browse Formulary |
|
|
|
|
AARP Medicare Advantage Patriot (PPO) - H0294-022-0
Benefit Details
|
Wayne |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,500 |
|
|
|
|
Aetna Better Health Premier Plan (Medicare-Medicaid Plan) - H8026-001-0
Benefit Details
|
Wayne |
$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
|
Wayne |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,500 |
|
|
|
|
Aetna Medicare Premier (HMO-POS) - H3192-003-0
Benefit Details
|
Wayne |
$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%
| $3,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Value (PPO) - H5521-214-0
Benefit Details
|
Wayne |
$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%
| $4,950 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 |
Align Connect (HMO C-SNP) - H6832-002-0
Benefit Details
|
Wayne |
$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 |
|
AmeriHealth Caritas VIP Care Plus (Medicare-Medicaid Plan) - H0192-001-0
Benefit Details
|
Wayne |
$0.00 |
$0 |
All Generics, All Brands | Tier 1: 0%
| n/a Browse Formulary |
-- |
-- |
-- |
|
Ascension Complete Michigan Access (PPO) - H7512-002-0
Benefit Details
|
Wayne |
$0.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $2,900 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 |
Ascension Complete Michigan Access Plus (PPO) - H7512-001-0
Benefit Details
|
Wayne |
$0.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
new |
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Ascension Complete Michigan Reward (HMO) - H0482-003-0
Benefit Details
|
Wayne |
$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 |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Ascension Complete Michigan Secure (HMO) - H0482-004-0
Benefit Details
|
Wayne |
$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
| $2,900 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 |
BCN Advantage HMO-POS Prime Value (HMO-POS) - H5883-014-5
Benefit Details
|
Wayne |
$0.00 |
$50 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $11.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
select insulin pay $35 copay | $4,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HAP Empowered MI Health Link (Medicare-Medicaid Plan) - H9712-001-0
Benefit Details
|
Wayne |
$0.00 |
$0 |
All Generics, All Brands | Tier 1: 0%
| n/a Browse Formulary |
-- |
-- |
-- |
|
HAP Primary Choice Medicare (HMO) - H2354-024-0
Benefit Details
|
Wayne |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 48% Specialty Tier: 33% Select Care Drugs: $0.00
select insulin pay $25 copay | $4,300 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HAP Senior Plus (HMO) - H2354-015-0
Benefit Details
|
Wayne |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 48% Specialty Tier: 33% Select Care Drugs: $0.00
select insulin pay $25 copay | $4,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HAP Senior Plus Medical Only (HMO) - H2354-019-0
Benefit Details
|
Wayne |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 |
|
|
|
|
HAP Senior Plus Option 1 (PPO) - H2322-011-0
Benefit Details
|
Wayne |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 48% Specialty Tier: 33% Select Care Drugs: $0.00
select insulin pay $25 copay | $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 |
Humana Gold Plus H8908-004 (HMO) - H8908-004-0
Benefit Details
|
Wayne |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | $4,900 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Honor (PPO) - H5216-190-0
Benefit Details
|
Wayne |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,500 |
|
|
|
|
HumanaChoice H5216-287 (PPO) - H5216-287-0
Benefit Details
|
Wayne |
$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: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30%
| $5,200 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 |
HumanaChoice R3887-001 (Regional PPO) - R3887-001-0
Benefit Details
|
Wayne |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,500 |
|
|
|
|
McLaren Medicare Inspire (HMO) - H6322-001-0
Benefit Details
|
Wayne |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.50 Generic: $12.50 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 31% Select Care Drugs: $0.00
select insulin pay $10-$35 copay | $5,200 Browse Formulary |
new |
new |
new |
|
Medicare Plus Blue PPO Essential (PPO) - H9572-004-6
Benefit Details
|
Wayne |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $11.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 33%
| $6,000 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 |
MeridianComplete (Medicare-Medicaid Plan) - H0480-001-0
Benefit Details
|
Wayne |
$0.00 |
$0 |
All Generics, All Brands | Tier 1: 0%
| n/a Browse Formulary |
-- |
-- |
-- |
|
Molina Dual Options (Medicare-Medicaid Plan) - H7844-001-0
Benefit Details
|
Wayne |
$0.00 |
$0 |
All Generics, All Brands | Tier 1: 0%
| n/a Browse Formulary |
-- |
-- |
-- |
|
Molina Medicare Choice Care (HMO) - H5926-006-0
Benefit Details
|
Wayne |
$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 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
PriorityMedicare Edge (PPO) - H4875-020-3
Benefit Details
|
Wayne |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $8.00 Preferred Brand: $38.00 Non-Preferred Drug: 40% Specialty Tier: 33%
| $5,300 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
PriorityMedicare Key (HMO-POS) - H2320-022-5
Benefit Details
|
Wayne |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: 45% Specialty Tier: 33%
select insulin pay $20-$35 copay | $5,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
PriorityMedicare Vital (PPO) - H4875-022-5
Benefit Details
|
Wayne |
$0.00 |
$350 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 45% Specialty Tier: 26%
| $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 |
Reliance Principle Plan (HMO) - H9861-001-0
Benefit Details
|
Wayne |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30%
select insulin pay $10 copay | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) - H5475-031-0
Benefit Details
|
Wayne |
$0.00 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO-POS) - H5475-026-0
Benefit Details
|
Wayne |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: 40% 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 Exclusive (HMO) - H5475-033-0
Benefit Details
|
Wayne |
$0.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) - H2117-001-0
Benefit Details
|
Wayne |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: 43% Specialty Tier: 33% Select Care Drugs: $0.00
| $5,000 Browse Formulary |
new |
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Patriot Giveback Open (PPO) - H2117-003-0
Benefit Details
|
Wayne |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 |
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 |
Zing Choice MI (HMO) - H4624-006-0
Benefit Details
|
Wayne |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | $4,200 Browse Formulary |
|
new |
new |
|
Zing Essential Wellness MI (HMO C-SNP) - H4624-012-0
Benefit Details
|
Wayne |
$0.00 |
$0 |
Some Generics, Few Brands | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | n/a Browse Formulary |
|
new |
new |
|
Wellcare Low Premium (HMO-POS) - H5475-024-0
Benefit Details
|
Wayne |
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Drug: 38% 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 |
Humana Gold Plus SNP-DE H8908-005 (HMO D-SNP) - H8908-005-0
Benefit Details
|
Wayne |
$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: $18.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
BCN Advantage HMO-POS Community Value (HMO-POS) - H5883-012-2
Benefit Details
|
Wayne |
$20.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Drug: 50% Specialty Tier: 33%
| $4,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) - H5475-038-0
Benefit Details
|
Wayne |
$20.60 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $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 |
HumanaChoice H5216-133 (PPO) - H5216-133-0
Benefit Details
|
Wayne |
$22.00 |
$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: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30%
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Assure Premier (HMO D-SNP) - H3192-007-0
Benefit Details
|
Wayne |
$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: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: 25% Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
PriorityMedicare Ideal (PPO) - H4875-018-5
Benefit Details
|
Wayne |
$24.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 30%
| $5,800 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 Thrive (HMO I-SNP) - H6832-001-0
Benefit Details
|
Wayne |
$24.80 |
$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 |
|
McLaren Medicare Inspire Plus (HMO) - H6322-002-0
Benefit Details
|
Wayne |
$25.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.50 Generic: $12.50 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Select Care Drugs: $0.00
select insulin pay $10-$35 copay | $3,800 Browse Formulary |
new |
new |
new |
|
Zing Open Access MI (HMO-POS) - H4624-007-0
Benefit Details
|
Wayne |
$25.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | $4,200 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 |
AARP Medicare Advantage Open Plan 2 (PPO) - H0294-018-0
Benefit Details
|
Wayne |
$28.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | $4,200 Browse Formulary |
|
|
|
|
Aetna Medicare Premier Plus (PPO) - H5521-217-0
Benefit Details
|
Wayne |
$29.00 |
$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%
| $5,100 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BCN Advantage HMO-POS Elements (HMO-POS) - H5883-001-5
Benefit Details
|
Wayne |
$30.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Dual Access (HMO-POS D-SNP) - H5475-001-0
Benefit Details
|
Wayne |
$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: $5.00 Preferred Brand: $36.00 Non-Preferred Drug: 42% Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
|
|
|
Wellcare Dual Access Open (PPO D-SNP) - H2117-002-0
Benefit Details
|
Wayne |
$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: $42.00 Non-Preferred Drug: 49% Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
HAP Empowered Duals (HMO D-SNP) - H2354-025-0
Benefit Details
|
Wayne |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Few Brands | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Longevity Health Plan (HMO I-SNP) - H7557-001-0
Benefit Details
|
Wayne |
$31.50 |
$480 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| n/a Browse Formulary |
|
new |
new |
|
McLaren Medicare Inspire Duals (HMO D-SNP) - H6322-004-0
Benefit Details
|
Wayne |
$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 |
new |
|
Molina Medicare Complete Care (HMO D-SNP) - H5926-001-0
Benefit Details
|
Wayne |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $42.00 Non-Preferred Drug: 33% 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 |
Molina Medicare Complete Care Select (HMO D-SNP) - H5926-005-0
Benefit Details
|
Wayne |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $42.00 Non-Preferred Drug: 33% Specialty Tier: 25%
| n/a Browse Formulary |
|
-- |
|
|
PriorityMedicare D-SNP (HMO D-SNP) - H8379-001-0
Benefit Details
|
Wayne |
$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: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
|
Reliance Dual Care Plus (HMO D-SNP) - H9861-003-0
Benefit Details
|
Wayne |
$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 |
|
|
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 (HMO D-SNP) - H2247-001-0
Benefit Details
|
Wayne |
$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 |
|
|
|
|
UnitedHealthcare Dual Complete Choice (PPO D-SNP) - H0271-028-0
Benefit Details
|
Wayne |
$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 |
|
|
|
|
Wellcare Community Assist (PPO) - H2117-004-0
Benefit Details
|
Wayne |
$31.50 |
$480 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: 43% Specialty Tier: 25% Select Care Drugs: $0.00
| $5,000 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 |
Zing Complete Plus MI (HMO D-SNP) - H4624-019-0
Benefit Details
|
Wayne |
$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% Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25%
| n/a Browse Formulary |
|
new |
new |
|
Reliance Cardinal Plan (HMO) - H9861-002-0
Benefit Details
|
Wayne |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30%
select insulin pay $10 copay | $4,500 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Plus H8908-001 (HMO) - H8908-001-0
Benefit Details
|
Wayne |
$46.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,900 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 |
McLaren Medicare Inspire Flex (HMO-POS) - H6322-003-2
Benefit Details
|
Wayne |
$49.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.50 Generic: $12.50 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Select Care Drugs: $0.00
select insulin pay $10-$35 copay | $3,800 Browse Formulary |
new |
new |
new |
|
PriorityMedicare Value (HMO-POS) - H2320-029-5
Benefit Details
|
Wayne |
$50.00 |
$75 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31%
select insulin pay $15-$35 copay | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BCN Advantage HMO ConnectedCare (HMO) - H5883-007-0
Benefit Details
|
Wayne |
$58.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 48% Specialty Tier: 33%
select insulin pay $35 copay | $3,800 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 |
HAP Senior Plus Option 2 (PPO) - H2322-012-0
Benefit Details
|
Wayne |
$65.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 48% Specialty Tier: 33% Select Care Drugs: $0.00
select insulin pay $25 copay | $5,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Vitality (PPO) - H9572-002-6
Benefit Details
|
Wayne |
$77.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $11.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 33%
| $5,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HAP Senior Plus Option 1 (HMO-POS) - H2354-021-0
Benefit Details
|
Wayne |
$90.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 48% Specialty Tier: 33% Select Care Drugs: $0.00
select insulin pay $25 copay | $4,200 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 |
HAP Senior Plus Henry Ford Tiered Access (HMO) - H2354-018-0
Benefit Details
|
Wayne |
$95.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 48% Specialty Tier: 33% Select Care Drugs: $0.00
select insulin pay $25 copay | $4,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
PriorityMedicare Merit (PPO) - H4875-016-3
Benefit Details
|
Wayne |
$98.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 33%
| $4,100 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-011 (PPO) - H5216-011-0
Benefit Details
|
Wayne |
$100.00 |
$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%
| $5,900 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 |
HumanaChoice R3887-002 (Regional PPO) - R3887-002-0
Benefit Details
|
Wayne |
$112.00 |
$480 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $9.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $5,300 Browse Formulary |
|
|
|
|
PriorityMedicare (HMO-POS) - H2320-028-5
Benefit Details
|
Wayne |
$127.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $8.00 Preferred Brand: $38.00 Non-Preferred Drug: 45% Specialty Tier: 33%
| $4,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BCN Advantage HMO-POS Classic (HMO-POS) - H5883-002-7
Benefit Details
|
Wayne |
$129.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $38.00 Non-Preferred Drug: 45% Specialty Tier: 33%
select insulin pay $35 copay | $3,800 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 |
Medicare Plus Blue PPO Signature (PPO) - H9572-001-6
Benefit Details
|
Wayne |
$135.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 48% Specialty Tier: 33%
| $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HAP Senior Plus Option 3 (PPO) - H2322-008-0
Benefit Details
|
Wayne |
$165.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 48% Specialty Tier: 33% Select Care Drugs: $0.00
select insulin pay $25 copay | $4,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HAP Senior Plus Option 2 (HMO-POS) - H2354-022-0
Benefit Details
|
Wayne |
$190.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 48% Specialty Tier: 33% Select Care Drugs: $0.00
select insulin pay $25 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 |
HAP Senior Plus Option 4 (PPO) - H2322-004-0
Benefit Details
|
Wayne |
$200.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 48% Specialty Tier: 33% Select Care Drugs: $0.00
select insulin pay $25 copay | $4,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
PriorityMedicare Select (PPO) - H4875-017-5
Benefit Details
|
Wayne |
$214.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
| $3,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BCN Advantage HMO-POS Prestige (HMO-POS) - H5883-003-5
Benefit Details
|
Wayne |
$265.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $38.00 Non-Preferred Drug: 45% 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 |
Medicare Plus Blue PPO Assure (PPO) - H9572-003-6
Benefit Details
|
Wayne |
$300.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
| $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|