Exemplar Health Freedom 1 (MSA) - H9295-001-0
Benefit Details
 |
Williamson |
$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
 |
Williamson |
$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
 |
Williamson |
$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
 |
Williamson |
$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
 |
Williamson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a |
|
|
|
|
AARP Medicare Advantage (HMO) - H4527-002-0
Benefit Details
 |
Williamson |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,500 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-POS) - H4527-024-0
Benefit Details
 |
Williamson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,500 |
 |
 |
 |
|
AARP Medicare Advantage Walgreens (PPO) - H1278-004-0
Benefit Details
 |
Williamson |
$0.00 |
$345 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: 27%
select insulin pay $35 copay | $6,400 Browse Formulary |
 |
 |
 |
Higher cost-sharing at standard network pharmacies. Details:
 |
Aetna Medicare Plus Plan (PPO) - H3288-022-0
Benefit Details
 |
Williamson |
$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:
 |
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 Plan (HMO) - H4523-001-0
Benefit Details
 |
Williamson |
$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:
 |
Amerivantage Classic (HMO) - H2593-029-0
Benefit Details
 |
Williamson |
$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) - H8849-008-6
Benefit Details
 |
Williamson |
$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
| $6,700 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 |
Ascension Complete Seton Access (PPO) - H9357-002-0
Benefit Details
 |
Williamson |
$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:
 |
Ascension Complete Seton Access Plus (PPO) - H9357-001-0
Benefit Details
 |
Williamson |
$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 Seton Reward (HMO) - H6678-001-0
Benefit Details
 |
Williamson |
$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 |
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 Seton Secure (HMO) - H6678-002-0
Benefit Details
 |
Williamson |
$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 |
new |
Higher cost-sharing at standard network pharmacies. Details:
 |
Blue Cross Medicare Advantage Choice Plus (PPO) - H1666-004-0
Benefit Details
 |
Williamson |
$0.00 |
$480 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: 25%
| $7,550 Browse Formulary |
 |
 |
 |
Higher cost-sharing at standard network pharmacies. Details:
 |
Blue Cross Medicare Advantage Classic (PPO) - H4801-003-0
Benefit Details
 |
Williamson |
$0.00 |
$480 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: 25%
| $6,400 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 |
Blue Cross Medicare Advantage Value (HMO) - H9706-003-0
Benefit Details
 |
Williamson |
$0.00 |
$100 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: 31%
| $6,700 Browse Formulary |
 |
new |
 |
Higher cost-sharing at standard network pharmacies. Details:
 |
BSW SeniorCare Advantage Select (HMO) - H8142-004-0
Benefit Details
 |
Williamson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,900 |
 |
 |
 |
|
BSW SeniorCare Advantage Select Rx (HMO) - H8142-001-0
Benefit Details
 |
Williamson |
$0.00 |
$300 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 27%
select insulin pay $35 copay | $6,300 Browse Formulary |
 |
 |
 |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Plus H0028-037 (HMO) - H0028-037-0
Benefit Details
 |
Williamson |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $4,900 Browse Formulary |
 |
 |
 |
Higher cost-sharing at standard network pharmacies. Details:
 |
Humana Honor (PPO) - H5216-128-0
Benefit Details
 |
Williamson |
$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
 |
Williamson |
$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 |
Imperial Insurance Company Traditional (HMO) - H2793-003-0
Benefit Details
 |
Williamson |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $45.00 Non-Preferred Drug: $90.00 Specialty Tier: 33%
select insulin pay $0 copay | $2,999 Browse Formulary |
 |
-- |
 |
|
Imperial Insurance Traditional Plus (HMO) - H2793-007-0
Benefit Details
 |
Williamson |
$0.00 |
$480 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| $7,550 Browse Formulary |
 |
-- |
 |
|
Imperial Insurance Value (HMO C-SNP) - H2793-005-0
Benefit Details
 |
Williamson |
$0.00 |
$0 |
Many Generics, Some Brands | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $45.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Select Care Drugs: $3.00
select insulin pay $0 copay | n/a Browse Formulary |
 |
-- |
 |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare Chronic Complete (HMO C-SNP) - H4527-039-0
Benefit Details
 |
Williamson |
$0.00 |
$0 |
Some Generics, Few Brands | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | n/a Browse Formulary |
 |
 |
 |
|
Wellcare Giveback (HMO) - H0174-013-1
Benefit Details
 |
Williamson |
$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) - H0174-012-1
Benefit Details
 |
Williamson |
$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:
 |
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 Rx Plus Open (PPO) - H7323-006-0
Benefit Details
 |
Williamson |
$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
 |
Williamson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
 |
-- |
 |
|
Wellcare TexanPlus No Premium (HMO) - H0174-002-0
Benefit Details
 |
Williamson |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Drug: $90.00 Specialty Tier: 29% Select Care Drugs: $0.00
| $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 |
UnitedHealthcare Medicare Silver (Regional PPO C-SNP) - R6801-008-0
Benefit Details
 |
Williamson |
$3.70 |
$480 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| n/a Browse Formulary |
 |
 |
 |
|
Wellcare Complement Assist (HMO) - H5294-016-0
Benefit Details
 |
Williamson |
$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 |
 |
-- |
 |
|
Aetna Medicare Choice Plan (PPO) - H3288-004-0
Benefit Details
 |
Williamson |
$15.00 |
$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%
| $6,500 Browse Formulary |
 |
 |
 |
Higher cost-sharing at standard network pharmacies. Details:
 |
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare Dual Complete Plan (HMO D-SNP) - H8597-001-0
Benefit Details
 |
Williamson |
$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
 |
Williamson |
$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 |
 |
|
Wellcare Low Premium Open (PPO) - H7323-001-0
Benefit Details
 |
Williamson |
$20.00 |
$200 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $1.00 Preferred Brand: $35.00 Non-Preferred Drug: 42% Specialty Tier: 29% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
 |
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 Assist (HMO) - H0174-009-0
Benefit Details
 |
Williamson |
$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 |
 |
-- |
 |
|
UnitedHealthcare Dual Complete Focus (HMO D-SNP) - H4527-003-0
Benefit Details
 |
Williamson |
$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 |
 |
 |
 |
|
Amerivantage Dual Coordination (HMO D-SNP) - H2593-032-0
Benefit Details
 |
Williamson |
$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:
 |
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 Plus (HMO D-SNP) - H8849-010-6
Benefit Details
 |
Williamson |
$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) - H8849-011-6
Benefit Details
 |
Williamson |
$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 ESRD Care (HMO-POS C-SNP) - H2593-031-0
Benefit Details
 |
Williamson |
$25.10 |
$100 Tier 1 and 6 exempt |
Few Generics | Preferred Generic: $2.00 Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Drug: $93.00 Specialty Tier: 31% 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 |
Humana Gold Plus SNP-DE H0028-044 (HMO D-SNP) - H0028-044-0
Benefit Details
 |
Williamson |
$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: $4.00 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:
 |
Imperial Insurance Company Dual (HMO D-SNP) - H2793-004-0
Benefit Details
 |
Williamson |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Many Generics, Some Brands | Preferred Generic: 0% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| n/a Browse Formulary |
 |
-- |
 |
|
UnitedHealthcare Dual Complete (HMO D-SNP) - H4514-013-2
Benefit Details
 |
Williamson |
$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 |
 |
 |
 |
|
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
 |
Williamson |
$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 Nursing Home Plan (PPO I-SNP) - H0710-020-0
Benefit Details
 |
Williamson |
$25.10 |
$480 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| n/a Browse Formulary |
 |
-- |
 |
|
Wellcare Dual Access Harmony (HMO D-SNP) - H5294-015-0
Benefit Details
 |
Williamson |
$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
 |
Williamson |
$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 |
 |
|
UnitedHealthcare Medicare Gold (Regional PPO C-SNP) - R6801-009-0
Benefit Details
 |
Williamson |
$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 |
 |
 |
 |
|
BSW SeniorCare Advantage Basic (PPO) - H2032-002-0
Benefit Details
 |
Williamson |
$37.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 28%
select insulin pay $35 copay | $7,000 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 H0473-003 (PPO) - H0473-003-0
Benefit Details
 |
Williamson |
$38.00 |
$200 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 29%
select insulin pay $35 copay | $6,700 Browse Formulary |
 |
 |
 |
Higher cost-sharing at standard network pharmacies. Details:
 |
UnitedHealthcare Medicare Advantage Choice (Regional PPO) - R6801-012-0
Benefit Details
 |
Williamson |
$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
 |
Williamson |
$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 |
BSW SeniorCare Advantage Preferred (HMO) - H8142-005-0
Benefit Details
 |
Williamson |
$83.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
 |
 |
 |
|
Blue Cross Medicare Advantage Choice Premier (PPO) - H1666-001-0
Benefit Details
 |
Williamson |
$90.00 |
$300 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: 28%
| $5,900 Browse Formulary |
 |
 |
 |
Higher cost-sharing at standard network pharmacies. Details:
 |
HumanaChoice R4182-003 (Regional PPO) - R4182-003-0
Benefit Details
 |
Williamson |
$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 |
 |
 |
 |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
BSW SeniorCare Advantage Platinum (PPO) - H2032-003-0
Benefit Details
 |
Williamson |
$140.00 |
$50 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 32%
select insulin pay $35 copay | $4,700 Browse Formulary |
 |
 |
 |
|
BSW SeniorCare Advantage Preferred Rx (HMO) - H8142-002-0
Benefit Details
 |
Williamson |
$145.00 |
$100 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 31%
select insulin pay $35 copay | $4,900 Browse Formulary |
 |
 |
 |
|
BSW SeniorCare Advantage Premium (HMO) - H8142-006-0
Benefit Details
 |
Williamson |
$199.00 |
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 |
Blue Cross Medicare Advantage Flex (PPO) - H4801-014-0
Benefit Details
 |
Williamson |
$215.40 |
$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: 33% Specialty Tier: 25%
| n/a Browse Formulary |
new |
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
 |
BSW SeniorCare Advantage Premium Rx (HMO) - H8142-003-0
Benefit Details
 |
Williamson |
$255.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $4,800 Browse Formulary |
 |
 |
 |
|