Exemplar Health Freedom 1 (MSA) - H9295-001-0
Benefit Details
|
Guadalupe |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a |
|
|
|
|
Exemplar Health Freedom 2 (MSA) - H9295-002-0
Benefit Details
|
Guadalupe |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a |
|
|
|
|
Exemplar Health Freedom 3 (MSA) - H9295-003-0
Benefit Details
|
Guadalupe |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Lasso Healthcare Growth (MSA) - H1924-001-0
Benefit Details
|
Guadalupe |
$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
|
Guadalupe |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a |
|
|
|
|
AARP Medicare Advantage (HMO) - H4590-045-0
Benefit Details
|
Guadalupe |
$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 | $3,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
AARP Medicare Advantage Choice (PPO) - H1278-005-0
Benefit Details
|
Guadalupe |
$0.00 |
$270 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
select insulin pay $35 copay | $6,400 Browse Formulary |
|
|
|
|
AARP Medicare Advantage Patriot (HMO) - H4590-029-0
Benefit Details
|
Guadalupe |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
AARP Medicare Advantage SecureHorizons (HMO) - H4590-010-0
Benefit Details
|
Guadalupe |
$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 | $3,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare Choice Plan (PPO) - H3288-046-0
Benefit Details
|
Guadalupe |
$0.00 |
$300 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%
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Premier Plan (HMO) - H4523-001-0
Benefit Details
|
Guadalupe |
$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%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Value Plan (HMO) - H8332-001-0
Benefit Details
|
Guadalupe |
$0.00 |
$150 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30%
| $4,500 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 |
Amerivantage Classic (HMO) - H2593-029-0
Benefit Details
|
Guadalupe |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $7,550 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Amerivantage Classic Plus (HMO) - H8849-008-3
Benefit Details
|
Guadalupe |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $12.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $5,600 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Amerivantage Diabetes Care Plus (HMO C-SNP) - H8849-001-0
Benefit Details
|
Guadalupe |
$0.00 |
$0 |
Many Generics, Some Brands | Preferred Generic: $0.00 Generic: $7.50 Preferred Brand: $35.00 Non-Preferred Drug: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
select insulin pay $0-$35 copay | n/a 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 |
Amerivantage Heart Care Plus (HMO C-SNP) - H8849-012-0
Benefit Details
|
Guadalupe |
$0.00 |
$0 |
Many Generics, Some Brands | Preferred Generic: $0.00 Generic: $7.50 Preferred Brand: $40.00 Non-Preferred Drug: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Amerivantage Lung Care Plus (HMO C-SNP) - H8849-013-0
Benefit Details
|
Guadalupe |
$0.00 |
$0 |
Many Generics, Some Brands | Preferred Generic: $0.00 Generic: $7.50 Preferred Brand: $40.00 Non-Preferred Drug: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Blue Cross Medicare Advantage Choice Plus (PPO) - H1666-008-0
Benefit Details
|
Guadalupe |
$0.00 |
$350 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 27%
| $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 |
Cigna Fundamental Medicare (HMO) - H4513-062-0
Benefit Details
|
Guadalupe |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,300 |
|
|
|
|
Cigna Preferred Medicare (HMO) - H4513-061-1
Benefit Details
|
Guadalupe |
$0.00 |
$190 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $4.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 29%
| $3,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Cigna Preferred Savings Medicare (HMO) - H4513-066-0
Benefit Details
|
Guadalupe |
$0.00 |
$190 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $4.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 29%
| $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 |
Clover Health Choice (PPO) - H5141-025-0
Benefit Details
|
Guadalupe |
$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:
|
Devoted Health BeWell San Antonio (HMO C-SNP) - H7993-005-0
Benefit Details
|
Guadalupe |
$0.00 |
$0 |
Few Generics | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $40.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | n/a Browse Formulary |
|
|
|
|
Devoted Health Core San Antonio (HMO) - H7993-003-0
Benefit Details
|
Guadalupe |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $40.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Plus H0028-030 (HMO) - H0028-030-0
Benefit Details
|
Guadalupe |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $42.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Honor (PPO) - H5216-128-0
Benefit Details
|
Guadalupe |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice R4182-001 (Regional PPO) - R4182-001-0
Benefit Details
|
Guadalupe |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Molina Medicare Choice Care (HMO) - H7678-004-0
Benefit Details
|
Guadalupe |
$0.00 |
$125 Tier 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31% Select Care Drugs: $0.00
select insulin pay $35 copay | $7,550 Browse Formulary |
|
-- |
|
|
Molina Medicare Choice Care Select (HMO) - H7678-005-0
Benefit Details
|
Guadalupe |
$0.00 |
$480 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $15.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25% Select Care Drugs: $5.00
| $7,550 Browse Formulary |
|
-- |
|
|
UnitedHealthcare Chronic Complete (HMO C-SNP) - H4590-037-0
Benefit Details
|
Guadalupe |
$0.00 |
$0 |
Some Generics, Few Brands | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Giveback (HMO) - H0174-013-4
Benefit Details
|
Guadalupe |
$0.00 |
$300 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $2.00 Preferred Brand: $20.00 Non-Preferred Drug: $90.00 Specialty Tier: 28% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO-POS) - H0174-012-4
Benefit Details
|
Guadalupe |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Drug: $75.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $4,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) - H5294-017-0
Benefit Details
|
Guadalupe |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $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 |
Wellcare No Premium Medicare (HMO) - H0062-002-0
Benefit Details
|
Guadalupe |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $7,550 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Rx Plus Open (PPO) - H7323-006-0
Benefit Details
|
Guadalupe |
$0.00 |
$300 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: 42% Specialty Tier: 28% Select Care Drugs: $0.00
| $6,000 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Patriot No Premium (HMO) - H5294-014-0
Benefit Details
|
Guadalupe |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Specialty No Premium (HMO C-SNP) - H0174-008-0
Benefit Details
|
Guadalupe |
$0.00 |
$0 |
Many Generics, Some Brands | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Select Diabetic Drugs: $10.00
select insulin pay $10 copay | n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare TexanPlus No Premium (HMO) - H0174-011-1
Benefit Details
|
Guadalupe |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $3.00 Preferred Brand: $25.00 Non-Preferred Drug: $80.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $3,400 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
UnitedHealthcare Medicare Silver (Regional PPO C-SNP) - R6801-008-0
Benefit Details
|
Guadalupe |
$3.70 |
$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 |
Cigna TotalCare (HMO D-SNP) - H4513-060-1
Benefit Details
|
Guadalupe |
$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 |
|
|
|
|
HumanaChoice H5216-043 (PPO) - H5216-043-1
Benefit Details
|
Guadalupe |
$10.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 28%
select insulin pay $35 copay | $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Complement Assist (HMO) - H5294-016-0
Benefit Details
|
Guadalupe |
$14.90 |
$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
| $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 |
Aetna Medicare Dual Complete Plan (HMO D-SNP) - H8597-001-0
Benefit Details
|
Guadalupe |
$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: 30% Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) - H9706-002-0
Benefit Details
|
Guadalupe |
$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 |
|
|
Humana Gold Plus SNP-DE H0028-036 (HMO D-SNP) - H0028-036-0
Benefit Details
|
Guadalupe |
$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: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
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) - H4590-022-0
Benefit Details
|
Guadalupe |
$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 |
|
|
|
|
Aetna Medicare Choice II Plan (PPO) - H3288-048-0
Benefit Details
|
Guadalupe |
$19.00 |
$300 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%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) - H0174-009-0
Benefit Details
|
Guadalupe |
$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: 42% 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 |
Amerivantage Dual Coordination (HMO D-SNP) - H2593-032-0
Benefit Details
|
Guadalupe |
$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: $10.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $10.00
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Amerivantage Dual Coordination Plus (HMO D-SNP) - H8849-010-3
Benefit Details
|
Guadalupe |
$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: $10.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $10.00
| n/a Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Amerivantage Dual Secure Plus (HMO D-SNP) - H8849-011-3
Benefit Details
|
Guadalupe |
$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: $10.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $10.00
| n/a 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 |
Community First Medicare Advantage D-SNP (HMO D-SNP) - H5447-002-0
Benefit Details
|
Guadalupe |
$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: 25% Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25%
| n/a Browse Formulary |
|
new |
new |
|
Devoted Health Prime San Antonio (HMO) - H7993-004-0
Benefit Details
|
Guadalupe |
$25.10 |
$480 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $3,400 Browse Formulary |
|
|
|
|
Molina Medicare Complete Care (HMO D-SNP) - H7678-001-0
Benefit Details
|
Guadalupe |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Some Generics | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 30% 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 |
Provider Partners Texas Advantage Plan (HMO I-SNP) - H4054-001-0
Benefit Details
|
Guadalupe |
$25.10 |
$480 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| n/a Browse Formulary |
new |
new |
new |
|
Provider Partners Texas Community Plan (HMO I-SNP) - H4054-002-0
Benefit Details
|
Guadalupe |
$25.10 |
$480 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| n/a Browse Formulary |
new |
new |
new |
|
Texas Independence Health Plan, Inc. (HMO I-SNP) - H5015-001-0
Benefit Details
|
Guadalupe |
$25.10 |
$480 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| 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 Choice (Regional PPO D-SNP) - R6801-011-0
Benefit Details
|
Guadalupe |
$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 Dual Access (HMO D-SNP) - H0174-004-0
Benefit Details
|
Guadalupe |
$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: $15.00 Preferred Brand: $45.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
-- |
|
|
Wellcare Dual Access Harmony (HMO D-SNP) - H5294-015-0
Benefit Details
|
Guadalupe |
$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: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 47% 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 |
Wellcare Dual Access Open (PPO D-SNP) - H7323-005-0
Benefit Details
|
Guadalupe |
$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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
|
|
Wellcare Dual Liberty (HMO D-SNP) - H0174-006-0
Benefit Details
|
Guadalupe |
$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: 46% Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
-- |
|
|
Wellcare Dual Liberty Nurture (HMO D-SNP) - H5294-010-0
Benefit Details
|
Guadalupe |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Medicare Gold (Regional PPO C-SNP) - R6801-009-0
Benefit Details
|
Guadalupe |
$29.00 |
$295 Tier 1, 2 and 3 exempt |
Some Generics | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
select insulin coverage $35 or less | n/a Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Choice (Regional PPO) - R6801-012-0
Benefit Details
|
Guadalupe |
$49.00 |
$395 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R4182-004 (Regional PPO) - R4182-004-0
Benefit Details
|
Guadalupe |
$54.00 |
$175 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| $7,200 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 R4182-003 (Regional PPO) - R4182-003-0
Benefit Details
|
Guadalupe |
$92.00 |
$175 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| $7,200 Browse Formulary |
|
|
|
|
HumanaChoice H5216-042 (PPO) - H5216-042-0
Benefit Details
|
Guadalupe |
$94.00 |
$200 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|