AARP Medicare Advantage Choice Plan 1 (PPO) - H1821-002-0
Benefit Details
|
Snohomish |
$0.00 |
$225 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 29%
select insulin pay $35 copay | $6,500 Browse Formulary |
|
new |
new |
|
AARP Medicare Advantage Patriot (PPO) - H1821-004-0
Benefit Details
|
Snohomish |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,500 |
|
new |
new |
|
AARP Medicare Advantage Plan 2 (HMO) - H3805-017-0
Benefit Details
|
Snohomish |
$0.00 |
$275 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
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 Walgreens (HMO-POS) - H3805-032-0
Benefit Details
|
Snohomish |
$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 | $6,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Eagle Plan (PPO) - H5521-330-0
Benefit Details
|
Snohomish |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,500 |
|
|
|
|
Aetna Medicare Elite Plan (HMO-POS) - H3748-009-0
Benefit Details
|
Snohomish |
$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%
| $5,700 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 |
Aetna Medicare Value Plan (HMO-POS) - H3931-126-0
Benefit Details
|
Snohomish |
$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%
| $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Value Plus Plan (HMO-POS) - H3748-003-0
Benefit Details
|
Snohomish |
$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%
| $6,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Amerivantage Classic (HMO) - H1894-001-0
Benefit Details
|
Snohomish |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $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 |
Amerivantage ESRD Care (HMO C-SNP) - H1894-008-0
Benefit Details
|
Snohomish |
$0.00 |
$0 |
Few Generics | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Community Health Plan of WA MA No Rx Plan (HMO) - H5826-006-0
Benefit Details
|
Snohomish |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Community Health Plan of WA MA Plan 1 (HMO) - H5826-016-0
Benefit Details
|
Snohomish |
$0.00 |
$230 Tier 1, 2, 3 and 4 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% 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 |
Humana Gold Plus H2486-006 (HMO) - H2486-006-0
Benefit Details
|
Snohomish |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $8.00 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:
|
Humana Gold Plus H5619-063 (HMO) - H5619-063-0
Benefit Details
|
Snohomish |
$0.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $8.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
select insulin pay $35 copay | $7,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Honor (PPO) - H5216-301-4
Benefit Details
|
Snohomish |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-247 (PPO) - H5216-247-0
Benefit Details
|
Snohomish |
$0.00 |
$400 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26%
select insulin pay $35 copay | $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Kaiser Permanente Medicare Advantage Key (HMO) - H5050-022-0
Benefit Details
|
Snohomish |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Brand: $99.00 Specialty Tier: 31% Vaccines: $0.00
| $6,600 Browse Formulary |
|
|
|
|
Molina Medicare Choice Care (HMO) - H5823-011-0
Benefit Details
|
Snohomish |
$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 |
Premera Blue Cross Medicare Advantage (HMO) - H7245-001-0
Benefit Details
|
Snohomish |
$0.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $42.00 Non-Preferred Drug: $100.00 Specialty Tier: 30%
select insulin pay $35 copay | $6,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Premera Blue Cross Medicare Advantage Peak + Rx (HMO) - H9302-011-0
Benefit Details
|
Snohomish |
$0.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $12.00 Preferred Brand: $42.00 Non-Preferred Drug: $100.00 Specialty Tier: 30%
select insulin pay $35 copay | $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Providence Medicare Harbor + RX (HMO) - H9047-049-0
Benefit Details
|
Snohomish |
$0.00 |
$270 Tier 1, 2 and 6 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: 28% Vaccines: $0.00
select insulin pay $20-$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 |
Regence BlueAdvantage HMO (HMO) - H1997-009-0
Benefit Details
|
Snohomish |
$0.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Drug: 40% Specialty Tier: 28%
select insulin pay $35 copay | $6,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Regence MedAdvantage + Rx Core (PPO) - H5009-010-0
Benefit Details
|
Snohomish |
$0.00 |
$325 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $13.00 Preferred Brand: $40.00 Non-Preferred Drug: 40% Specialty Tier: 27%
select insulin pay $35 copay | $7,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Regence Valiance (HMO) - H1997-008-0
Benefit Details
|
Snohomish |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,900 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Regence Valiance (PPO) - H5009-001-0
Benefit Details
|
Snohomish |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,200 |
|
|
|
|
Wellcare Giveback (HMO) - H1353-006-0
Benefit Details
|
Snohomish |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $90.00 Specialty Tier: 29% Select Care Drugs: $0.00
| $7,550 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) - H1353-005-0
Benefit Details
|
Snohomish |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $4.00 Preferred Brand: $35.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00
| $5,900 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 No Premium Open (PPO) - H5965-002-0
Benefit Details
|
Snohomish |
$0.00 |
$250 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: 28% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Patriot Giveback Open (PPO) - H5965-003-0
Benefit Details
|
Snohomish |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 |
|
new |
new |
|
Humana Gold Plus SNP-DE H5619-136 (HMO D-SNP) - H5619-136-2
Benefit Details
|
Snohomish |
$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: $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 |
Premera Blue Cross Medicare Advantage Alpine (HMO) - H9302-004-0
Benefit Details
|
Snohomish |
$24.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,500 |
|
|
|
|
Amerivantage Dual Coordination (HMO D-SNP) - H1894-002-0
Benefit Details
|
Snohomish |
$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: 27% Select Care Drugs: $10.00
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5619-134 (HMO) - H5619-134-0
Benefit Details
|
Snohomish |
$26.00 |
$440 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $15.00 Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $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 |
Kaiser Permanente Medicare Advantage Vital (HMO) - H5050-013-0
Benefit Details
|
Snohomish |
$29.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $99.00 Specialty Tier: 33% Vaccines: $0.00
| $5,800 Browse Formulary |
|
|
|
|
Regence MedAdvantage + Rx Primary (PPO) - H5009-009-0
Benefit Details
|
Snohomish |
$29.00 |
$300 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $13.00 Preferred Brand: $40.00 Non-Preferred Drug: 40% Specialty Tier: 27%
select insulin pay $35 copay | $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) - H1353-007-0
Benefit Details
|
Snohomish |
$29.10 |
$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: 43% Specialty Tier: 25% Select Care Drugs: $0.00
| $5,900 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 |
Wellcare Dual Access Open (PPO D-SNP) - H5965-004-0
Benefit Details
|
Snohomish |
$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: $8.00 Preferred Brand: $42.00 Non-Preferred Drug: 48% Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
new |
|
Humana Gold Plus H5619-059 (HMO) - H5619-059-0
Benefit Details
|
Snohomish |
$34.00 |
$50 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $8.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 32%
select insulin pay $35 copay | $5,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Premera Blue Cross Medicare Advantage Sound + Rx (HMO) - H9302-007-0
Benefit Details
|
Snohomish |
$35.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $12.00 Preferred Brand: $42.00 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:
|
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 2 (PPO) - H1821-005-0
Benefit Details
|
Snohomish |
$36.00 |
$225 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 29%
select insulin pay $35 copay | $6,000 Browse Formulary |
|
new |
new |
|
UnitedHealthcare Assisted Living Plan (PPO I-SNP) - H0710-030-0
Benefit Details
|
Snohomish |
$36.80 |
$200 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin pay $35 copay | n/a Browse Formulary |
|
-- |
|
|
Wellcare Dual Liberty (HMO D-SNP) - H1353-004-0
Benefit Details
|
Snohomish |
$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: $12.00 Preferred Brand: $42.00 Non-Preferred Drug: 48% Specialty Tier: 25% Select Care Drugs: $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 |
Kaiser Permanente Medicare Advantage Basic (HMO) - H5050-001-0
Benefit Details
|
Snohomish |
$40.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Community Health Plan of WA Dual Plan (HMO D-SNP) - H5826-014-0
Benefit Details
|
Snohomish |
$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 |
|
|
|
|
Community Health Plan of WA MA Plan 2 (HMO) - H5826-010-0
Benefit Details
|
Snohomish |
$40.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 33%
| $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 |
Molina Medicare Complete Care (HMO D-SNP) - H5823-006-0
Benefit Details
|
Snohomish |
$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: $29.00 Non-Preferred Drug: 41% Specialty Tier: 28%
| n/a Browse Formulary |
|
-- |
|
|
Molina Medicare Complete Care Select (HMO D-SNP) - H5823-010-0
Benefit Details
|
Snohomish |
$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: $29.00 Non-Preferred Drug: 41% Specialty Tier: 28%
| n/a Browse Formulary |
|
-- |
|
|
UnitedHealthcare Dual Complete (HMO D-SNP) - H5008-002-0
Benefit Details
|
Snohomish |
$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 Select (HMO D-SNP) - H5008-015-0
Benefit Details
|
Snohomish |
$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 |
|
|
|
|
UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP) - H5008-001-0
Benefit Details
|
Snohomish |
$40.50 |
$480 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
| n/a Browse Formulary |
|
|
|
|
UnitedHealthcare Nursing Home Plan (PPO I-SNP) - H0710-031-0
Benefit Details
|
Snohomish |
$40.50 |
$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 |
Wellcare Dual Access (HMO D-SNP) - H1353-002-0
Benefit Details
|
Snohomish |
$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: $8.00 Preferred Brand: $40.00 Non-Preferred Drug: 49% Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
new |
|
|
Aetna Medicare Platinum Plus Plan (HMO-POS) - H3748-004-0
Benefit Details
|
Snohomish |
$43.00 |
$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%
| $6,500 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
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AARP Medicare Advantage Plan 3 (HMO) - H3805-015-0
Benefit Details
|
Snohomish |
$45.00 |
$225 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 29%
select insulin pay $35 copay | $5,900 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 |
Regence BlueAdvantage HMO Plus (HMO) - H1997-002-0
Benefit Details
|
Snohomish |
$48.00 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Drug: 40% Specialty Tier: 31%
select insulin pay $35 copay | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Aetna Medicare Choice Plan (PPO) - H5521-127-0
Benefit Details
|
Snohomish |
$49.00 |
$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%
| $6,200 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Premera Blue Cross Medicare Advantage Classic (HMO) - H7245-002-0
Benefit Details
|
Snohomish |
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,000 Browse Formulary |
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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 |
Providence Medicare Summit + RX (HMO-POS) - H9047-047-0
Benefit Details
|
Snohomish |
$59.00 |
$240 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28% Vaccines: $0.00
select insulin pay $20-$35 copay | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Wellcare Premium Enhanced Open (PPO) - H5965-001-0
Benefit Details
|
Snohomish |
$65.00 |
$100 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: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
| $6,000 Browse Formulary |
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new |
new |
Higher cost-sharing at standard network pharmacies. Details:
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Community Health Plan of WA MA Plan 3 (HMO) - H5826-008-0
Benefit Details
|
Snohomish |
$68.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 33%
| $6,700 Browse Formulary |
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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 |
Regence MedAdvantage + Rx Classic (PPO) - H5009-008-0
Benefit Details
|
Snohomish |
$78.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $13.00 Preferred Brand: $40.00 Non-Preferred Drug: 40% Specialty Tier: 28%
select insulin pay $35 copay | $6,200 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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AARP Medicare Advantage Plan 1 (HMO) - H3805-037-0
Benefit Details
|
Snohomish |
$88.00 |
$185 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 30%
select insulin pay $35 copay | $4,200 Browse Formulary |
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Aetna Medicare Select Plan (PPO) - H5521-128-0
Benefit Details
|
Snohomish |
$99.00 |
$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%
| $5,900 Browse Formulary |
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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 |
Kaiser Permanente Medicare Advantage Essential (HMO) - H5050-009-0
Benefit Details
|
Snohomish |
$99.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $7.00 Preferred Brand: $45.00 Non-Preferred Brand: $99.00 Specialty Tier: 33% Vaccines: $0.00
| $4,800 Browse Formulary |
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HumanaChoice H5216-047 (PPO) - H5216-047-0
Benefit Details
|
Snohomish |
$100.00 |
$320 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 27%
select insulin pay $35 copay | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Premera Blue Cross Medicare Advantage Charter + Rx (HMO) - H9302-003-0
Benefit Details
|
Snohomish |
$110.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $12.00 Preferred Brand: $42.00 Non-Preferred Drug: $100.00 Specialty Tier: 30%
select insulin pay $35 copay | $4,900 Browse Formulary |
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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 |
Regence MedAdvantage + Rx Enhanced (PPO) - H5009-002-0
Benefit Details
|
Snohomish |
$158.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Drug: 40% Specialty Tier: 28%
select insulin pay $35 copay | $5,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Premera Blue Cross Medicare Advantage Classic Plus (HMO) - H7245-003-0
Benefit Details
|
Snohomish |
$170.00 |
$180 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $42.00 Non-Preferred Drug: $100.00 Specialty Tier: 30%
select insulin pay $35 copay | $5,000 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Kaiser Permanente Medicare Advantage Optimal (HMO) - H5050-004-0
Benefit Details
|
Snohomish |
$296.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $7.00 Preferred Brand: $45.00 Non-Preferred Brand: $99.00 Specialty Tier: 33% Vaccines: $0.00
| $3,450 Browse Formulary |
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