Lasso Healthcare Growth (MSA) - H1924-001-0
Benefit Details
|
Bucks |
$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
|
Bucks |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a |
|
|
|
|
AARP Medicare Advantage Choice Plan 2 (PPO) - H2228-085-0
Benefit Details
|
Bucks |
$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%
select insulin pay $35 copay | $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 |
AARP Medicare Advantage Patriot (HMO) - H1944-030-0
Benefit Details
|
Bucks |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,500 |
|
|
|
|
AARP Medicare Advantage Plan 1 (HMO) - H1944-033-0
Benefit Details
|
Bucks |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | $6,900 Browse Formulary |
|
|
|
|
Aetna Medicare Advantra Credit Value (PPO) - H5522-017-0
Benefit Details
|
Bucks |
$0.00 |
$250 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare Advantra Eagle (HMO) - H3959-057-0
Benefit Details
|
Bucks |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 |
|
|
|
|
Aetna Medicare Advantra Value (HMO) - H3959-052-0
Benefit Details
|
Bucks |
$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%
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Elite (HMO) - H3931-112-0
Benefit Details
|
Bucks |
$0.00 |
$150 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30%
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare Value (PPO) - H5521-263-0
Benefit Details
|
Bucks |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Cigna Achieve Medicare (HMO C-SNP) - H3949-024-0
Benefit Details
|
Bucks |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Diabetic Drugs: $5.00
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Cigna Alliance Medicare (HMO) - H3949-031-0
Benefit Details
|
Bucks |
$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%
| $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 |
Cigna Fundamental Medicare (HMO) - H3949-026-0
Benefit Details
|
Bucks |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,900 |
|
|
|
|
Cigna True Choice Medicare (PPO) - H7849-006-0
Benefit Details
|
Bucks |
$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%
| $7,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clover Health Choice (PPO) - H5141-038-0
Benefit Details
|
Bucks |
$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 insulin pay $35 copay | $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 |
Erickson Advantage Liberty with Drugs (HMO-POS) - H5652-008-0
Benefit Details
|
Bucks |
$0.00 |
$400 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Drug: $100.00 Specialty Tier: 26%
select insulin pay $35 copay | $6,700 Browse Formulary |
|
|
|
|
Erickson Advantage Liberty without Drugs (HMO-POS) - H5652-002-0
Benefit Details
|
Bucks |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Geisinger Gold Classic 360 Rx (HMO) - H3954-160-0
Benefit Details
|
Bucks |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $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 |
Geisinger Gold Classic Advantage (HMO) - H3954-156-22
Benefit Details
|
Bucks |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
|
|
|
Geisinger Gold Classic Essential Rx (HMO) - H3954-161-0
Benefit Details
|
Bucks |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $0.00
select insulin pay $35 copay | $7,550 Browse Formulary |
|
|
|
|
Geisinger Gold Preferred Complete Rx (PPO) - H3924-065-0
Benefit Details
|
Bucks |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $0.00
select insulin pay $35 copay | $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 |
Health Partners Medicare Complete (HMO-POS) - H9207-012-0
Benefit Details
|
Bucks |
$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%
| $7,550 Browse Formulary |
|
-- |
|
|
Humana Gold Plus H6622-037 (HMO) - H6622-037-0
Benefit Details
|
Bucks |
$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 | $6,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Honor (PPO) - H5216-221-0
Benefit Details
|
Bucks |
$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 |
HumanaChoice H5216-116 (PPO) - H5216-116-0
Benefit Details
|
Bucks |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,900 |
|
|
|
|
HumanaChoice H5525-051 (PPO) - H5525-051-2
Benefit Details
|
Bucks |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | $7,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R0923-001 (Regional PPO) - R0923-001-0
Benefit Details
|
Bucks |
$0.00 |
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 |
Keystone 65 Basic Rx (HMO) - H3952-055-0
Benefit Details
|
Bucks |
$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%
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Keystone 65 Focus Rx (HMO-POS) - H3952-053-0
Benefit Details
|
Bucks |
$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 | $6,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Personal Choice 65 Prime Rx (PPO) - H3909-014-0
Benefit Details
|
Bucks |
$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%
| $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 |
Personal Choice 65 Saver Rx (PPO) - H3909-016-0
Benefit Details
|
Bucks |
$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%
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) - H2915-012-0
Benefit Details
|
Bucks |
$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: 48% Specialty Tier: 33% Select Care Drugs: $0.00
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback Open (PPO) - H2128-004-0
Benefit Details
|
Bucks |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 27% Select Care Drugs: $0.00
| $7,550 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 |
Wellcare No Premium (HMO) - H2915-016-0
Benefit Details
|
Bucks |
$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: 46% Specialty Tier: 33% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) - H2128-002-0
Benefit Details
|
Bucks |
$0.00 |
$160 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 43% Specialty Tier: 30% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
new |
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Patriot Giveback (HMO) - H2915-013-0
Benefit Details
|
Bucks |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,900 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare Advantra Premier (HMO) - H3959-033-0
Benefit Details
|
Bucks |
$16.00 |
$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%
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) - H6622-078-2
Benefit Details
|
Bucks |
$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: $2.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) - H2128-001-0
Benefit Details
|
Bucks |
$24.70 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $43.00 Non-Preferred Drug: 43% Specialty Tier: 25% Select Care Drugs: $0.00
| $6,700 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 |
AARP Medicare Advantage Plan 2 (HMO) - H1944-009-0
Benefit Details
|
Bucks |
$27.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | $6,700 Browse Formulary |
|
|
|
|
Aetna Medicare Advantra Cares (HMO D-SNP) - H3959-035-0
Benefit Details
|
Bucks |
$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: 27%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Low Premium Open (PPO) - H2128-003-0
Benefit Details
|
Bucks |
$29.00 |
$100 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 43% Specialty Tier: 31% 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 |
Cigna TotalCare (HMO D-SNP) - H3949-009-0
Benefit Details
|
Bucks |
$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 |
|
|
|
|
Cigna TotalCare Plus (HMO D-SNP) - H3949-037-0
Benefit Details
|
Bucks |
$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 |
|
|
|
|
Erickson Advantage Guardian (HMO-POS I-SNP) - H5652-003-0
Benefit Details
|
Bucks |
$32.30 |
$0 |
Some Generics | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $28.00 Non-Preferred Drug: $70.00 Specialty Tier: 33%
select insulin pay $28 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 Dual Complete (HMO D-SNP) - H3113-009-0
Benefit Details
|
Bucks |
$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 |
|
|
|
|
Keystone 65 Select Medical Only (HMO) - H3952-048-0
Benefit Details
|
Bucks |
$34.50 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,900 |
|
|
|
|
Cigna Preferred Medicare (HMO) - H3949-030-0
Benefit Details
|
Bucks |
$35.00 |
$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%
| $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 |
Wellcare Assist (HMO) - H2915-011-0
Benefit Details
|
Bucks |
$36.00 |
$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: 42% Specialty Tier: 25% Select Care Drugs: $0.00
| $7,550 Browse Formulary |
|
|
|
|
Geisinger Gold Classic Complete Rx (HMO) - H3954-158-13
Benefit Details
|
Bucks |
$38.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $0.00
select insulin pay $35 copay | $4,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP) - H0710-017-0
Benefit Details
|
Bucks |
$40.60 |
$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 |
Clover Health Choice Value (PPO) - H5141-039-0
Benefit Details
|
Bucks |
$40.70 |
$480 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: 22% Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25%
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Gateway Health Medicare Assured Diamond (HMO D-SNP) - H5932-012-0
Benefit Details
|
Bucks |
$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: $41.00 Non-Preferred Drug: 50% Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Ruby (HMO D-SNP) - H5932-013-0
Benefit Details
|
Bucks |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Geisinger Gold Secure Rx (HMO D-SNP) - H3954-097-0
Benefit Details
|
Bucks |
$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 |
|
|
|
|
Health Partners Medicare Prime (HMO-POS) - H9207-002-0
Benefit Details
|
Bucks |
$40.70 |
$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%
| $7,550 Browse Formulary |
|
-- |
|
|
Health Partners Medicare Special (HMO D-SNP) - H9207-004-0
Benefit Details
|
Bucks |
$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 |
|
-- |
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Keystone First VIP Choice (HMO D-SNP) - H4227-001-0
Benefit Details
|
Bucks |
$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 | Generic: $6.00 Brand: 25%
| n/a Browse Formulary |
|
|
|
|
Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) - H4093-001-0
Benefit Details
|
Bucks |
$40.70 |
$480 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| n/a Browse Formulary |
|
-- |
|
|
Provider Partners Pennsylvania Community Plan (HMO I-SNP) - H4093-004-0
Benefit Details
|
Bucks |
$40.70 |
$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 |
UnitedHealthcare Dual Complete Select (HMO D-SNP) - H3113-014-0
Benefit Details
|
Bucks |
$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 |
|
|
|
|
UPMC for Life Complete Care (HMO D-SNP) - H7123-001-0
Benefit Details
|
Bucks |
$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: $5.00 Generic: $10.00 Preferred Brand: $19.00 Non-Preferred Drug: 49% Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Dual Access (HMO D-SNP) - H2915-002-0
Benefit Details
|
Bucks |
$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: $37.00 Non-Preferred Drug: 50% Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
AARP Medicare Advantage Choice Plan 1 (PPO) - H2228-037-0
Benefit Details
|
Bucks |
$45.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | $6,700 Browse Formulary |
|
|
|
|
Geisinger Gold Preferred Enhanced Rx (PPO) - H3924-062-22
Benefit Details
|
Bucks |
$45.00 |
$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% Vaccines: $0.00
select insulin pay $35 copay | $7,550 Browse Formulary |
|
|
|
|
Aetna Medicare Advantra Premier Plus (PPO) - H5522-014-0
Benefit Details
|
Bucks |
$50.00 |
$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 | $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Personal Choice 65 Elite Rx (PPO) - H3909-017-0
Benefit Details
|
Bucks |
$51.00 |
$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%
| $6,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Keystone 65 Select Rx (HMO) - H3952-049-0
Benefit Details
|
Bucks |
$57.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $9.00 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:
|
Cigna True Choice Plus Medicare (PPO) - H7849-007-0
Benefit Details
|
Bucks |
$60.00 |
$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%
| $6,100 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 H5525-005 (PPO) - H5525-005-0
Benefit Details
|
Bucks |
$62.00 |
$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 | $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Silver (HMO) - H3931-070-0
Benefit Details
|
Bucks |
$65.00 |
$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%
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Erickson Advantage Freedom (HMO-POS) - H5652-006-0
Benefit Details
|
Bucks |
$70.00 |
$200 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Drug: $85.00 Specialty Tier: 29%
select insulin pay $35 copay | $4,300 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 R0923-002 (Regional PPO) - R0923-002-0
Benefit Details
|
Bucks |
$72.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin coverage $35 or less | $6,700 Browse Formulary |
|
|
|
|
Geisinger Gold Preferred Advantage Rx (PPO) - H3924-059-22
Benefit Details
|
Bucks |
$86.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $0.00
select insulin pay $35 copay | $4,000 Browse Formulary |
|
|
|
|
Aetna Medicare Premier (HMO-POS) - H3931-064-0
Benefit Details
|
Bucks |
$96.00 |
$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%
| $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 |
Geisinger Gold Classic Advantage Rx (HMO) - H3954-157-22
Benefit Details
|
Bucks |
$122.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $0.00
select insulin pay $35 copay | $3,450 Browse Formulary |
|
|
|
|
HumanaChoice H5216-120 (PPO) - H5216-120-0
Benefit Details
|
Bucks |
$128.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Cigna Preferred Plus Medicare (HMO) - H3949-013-0
Benefit Details
|
Bucks |
$135.00 |
$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%
| $4,900 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 |
Aetna Medicare Premier Plus (HMO) - H3931-004-0
Benefit Details
|
Bucks |
$146.00 |
$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%
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Gold Plan (PPO) - H5521-122-0
Benefit Details
|
Bucks |
$170.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Keystone 65 Preferred Medical Only (HMO) - H3952-008-0
Benefit Details
|
Bucks |
$178.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,800 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Personal Choice 65 Medical Only (PPO) - H3909-007-0
Benefit Details
|
Bucks |
$179.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 |
|
|
|
|
Erickson Advantage Champion (HMO-POS C-SNP) - H5652-004-0
Benefit Details
|
Bucks |
$199.00 |
$0 |
Some Generics | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Drug: $85.00 Specialty Tier: 33%
select insulin pay $35 copay | n/a Browse Formulary |
|
|
|
|
Erickson Advantage Signature with Drugs (HMO-POS) - H5652-001-0
Benefit Details
|
Bucks |
$199.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Drug: $85.00 Specialty Tier: 33%
select insulin pay $35 copay | $2,600 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Keystone 65 Preferred Rx (HMO) - H3952-020-0
Benefit Details
|
Bucks |
$231.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,800 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Personal Choice 65 Rx (PPO) - H3909-001-0
Benefit Details
|
Bucks |
$294.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
| $5,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|