Lasso Healthcare Growth (MSA) - H1924-001-0
Benefit Details
|
Dawson |
$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
|
Dawson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a |
|
|
|
|
AARP Medicare Advantage Choice Rebate (PPO) - H6528-041-0
Benefit Details
|
Dawson |
$0.00 |
$395 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26%
all covered insulin pay $35 or less | $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 |
AARP Medicare Advantage Plus Plan 1 (HMO-POS) - H8748-008-0
Benefit Details
|
Dawson |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
|
|
|
Aetna Medicare Advantage Plus Plan (PPO) - H2293-010-0
Benefit Details
|
Dawson |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $8,300 Browse Formulary |
new |
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Choice Plan (PPO) - H5521-328-0
Benefit Details
|
Dawson |
$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%
all covered insulin pay $35 or less | $6,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare Eagle Plan (PPO) - H3288-034-0
Benefit Details
|
Dawson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,900 |
|
|
|
|
Aetna Medicare Eagle Plus Plan (PPO) - H2293-009-0
Benefit Details
|
Dawson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,900 |
new |
new |
new |
|
Aetna Medicare Essential Plan (PPO) - H5521-091-0
Benefit Details
|
Dawson |
$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%
all covered insulin pay $35 or less | $6,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare Freedom Plus Plan (PPO) - H2293-008-0
Benefit Details
|
Dawson |
$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%
all covered insulin pay $35 or less | $5,500 Browse Formulary |
new |
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Plus Plan (PPO) - H3288-045-0
Benefit Details
|
Dawson |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $8,300 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access Basic (PPO) - H7728-006-0
Benefit Details
|
Dawson |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $13.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $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 |
Anthem MediBlue Plus (HMO) - H5422-011-0
Benefit Details
|
Dawson |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $7,100 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Service (HMO) - H5422-014-0
Benefit Details
|
Dawson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $7,550 |
|
|
|
|
Cigna Preferred Medicare (HMO) - H0439-010-0
Benefit Details
|
Dawson |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $4.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $6,600 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 True Choice Medicare (PPO) - H7849-022-0
Benefit Details
|
Dawson |
$0.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Choice Plan (PPO) - H9589-003-0
Benefit Details
|
Dawson |
$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: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 28%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
-- |
-- |
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Select Plus (HMO) - H6672-005-0
Benefit Details
|
Dawson |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
|
-- |
-- |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Clear Spring Health Silver Plan (HMO C-SNP) - H6672-003-0
Benefit Details
|
Dawson |
$0.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 28%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
-- |
Higher cost-sharing at standard network pharmacies. Details:
|
Clover Health LiveHealthy (PPO) - H5141-026-0
Benefit Details
|
Dawson |
$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%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clover Health Valor (PPO) - H5141-056-0
Benefit Details
|
Dawson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $7,550 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Essence Advantage (HMO-POS) - H5372-001-0
Benefit Details
|
Dawson |
$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 Brand: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $6,350 Browse Formulary |
new |
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Essence Advantage Choice (PPO) - H8229-001-0
Benefit Details
|
Dawson |
$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 Brand: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
new |
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Honor (PPO) - H5216-217-0
Benefit Details
|
Dawson |
$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 |
Humana Honor (PPO) - H5216-286-0
Benefit Details
|
Dawson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice - Diabetes and Heart (PPO C-SNP) - H5216-246-0
Benefit Details
|
Dawson |
$0.00 |
$145 Tier 1, 2, 3 and 6 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% Select Care Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
HumanaChoice H5216-154 (PPO) - H5216-154-0
Benefit Details
|
Dawson |
$0.00 |
$400 Tier 1 and 2 exempt |
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: 26%
all covered insulin pay $35 or less | $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 |
HumanaChoice H5216-157 (PPO) - H5216-157-0
Benefit Details
|
Dawson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,100 |
|
|
|
|
HumanaChoice H5216-203 (PPO) - H5216-203-1
Benefit Details
|
Dawson |
$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%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice H5216-279 (PPO) - H5216-279-0
Benefit Details
|
Dawson |
$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%
all covered insulin pay $35 or less | $2,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-345 (PPO) - H5216-345-0
Benefit Details
|
Dawson |
$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%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R3392-001 (Regional PPO) - R3392-001-0
Benefit Details
|
Dawson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $7,550 |
|
|
|
|
HumanaChoice R3392-004 (Regional PPO) - R3392-004-0
Benefit Details
|
Dawson |
$0.00 |
$195 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $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 |
UnitedHealthcare Medicare Advantage Choice Plan 1 (PPO) - H6528-006-0
Benefit Details
|
Dawson |
$0.00 |
$275 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Advantage Patriot (Regional PPO) - R2604-005-0
Benefit Details
|
Dawson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Wellcare Giveback (HMO) - H1112-042-0
Benefit Details
|
Dawson |
$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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $8,300 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 (HMO) - H1112-038-0
Benefit Details
|
Dawson |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $34.00 Non-Preferred Drug: 48% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $8,300 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) - H0111-001-0
Benefit Details
|
Dawson |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Patriot No Premium (HMO-POS) - H1112-034-0
Benefit Details
|
Dawson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 |
|
|
|
|
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) - R2604-002-0
Benefit Details
|
Dawson |
$9.50 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
UnitedHealthcare Medicare Gold (Regional PPO C-SNP) - R2604-003-0
Benefit Details
|
Dawson |
$15.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Anthem MediBlue Enhanced Care (HMO D-SNP) - H5422-018-0
Benefit Details
|
Dawson |
$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: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $5.00
all covered insulin pay $35 or less | 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 |
Cigna Preferred GA Medicare (HMO) - H0439-003-2
Benefit Details
|
Dawson |
$20.00 |
$280 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $12.00 Preferred Brand: $42.00 Non-Preferred Drug: 38% Specialty Tier: 28%
all covered insulin pay $35 or less | $7,100 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) - H5422-013-0
Benefit Details
|
Dawson |
$24.50 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $5.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Cigna Preferred Plus Medicare (HMO) - H0439-006-0
Benefit Details
|
Dawson |
$25.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $4.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $5,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Cigna TotalCare Plus (HMO D-SNP) - H0439-012-0
Benefit Details
|
Dawson |
$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
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Cigna TotalCare (HMO D-SNP) - H0439-002-0
Benefit Details
|
Dawson |
$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%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Aetna Medicare Value Plus Plan (PPO) - H2293-001-0
Benefit Details
|
Dawson |
$28.00 |
$505 Tier 1 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: 25%
all covered insulin pay $35 or less | $8,300 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 Assist (HMO) - H1112-043-0
Benefit Details
|
Dawson |
$28.10 |
$475 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
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AARP Medicare Advantage Plus Plan 2 (HMO-POS) - H8748-009-0
Benefit Details
|
Dawson |
$32.00 |
$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%
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
|
UnitedHealthcare Dual Complete Choice Select LP (PPO D-SNP) - H3256-002-0
Benefit Details
|
Dawson |
$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%
all covered insulin pay $35 or less | 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 |
Humana Together in Health (PPO I-SNP) - H5216-242-0
Benefit Details
|
Dawson |
$34.80 |
$505 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
UnitedHealthcare Dual Complete (HMO-POS D-SNP) - H5322-030-0
Benefit Details
|
Dawson |
$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%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Wellcare Dual Liberty (HMO D-SNP) - H1112-033-0
Benefit Details
|
Dawson |
$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
all covered insulin pay $35 or less | 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 |
HumanaChoice H5216-280 (PPO) - H5216-280-1
Benefit Details
|
Dawson |
$36.70 |
$505 Tier 1 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
|
Wellcare Dual Access (HMO D-SNP) - H1112-006-0
Benefit Details
|
Dawson |
$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
all covered insulin pay $35 or less | n/a Browse Formulary |
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Anthem MediBlue Dual Access (PPO D-SNP) - H7728-011-0
Benefit Details
|
Dawson |
$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: 26% Select Care Drugs: $10.00
all covered insulin pay $35 or less | n/a 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 |
Anthem MediBlue Dual Advantage (HMO D-SNP) - H5422-007-0
Benefit Details
|
Dawson |
$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
all covered insulin pay $35 or less | n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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CareSource Dual Advantage (HMO D-SNP) - H8390-015-0
Benefit Details
|
Dawson |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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new |
new |
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Clear Spring Health Deluxe Plan (HMO D-SNP) - H6672-001-0
Benefit Details
|
Dawson |
$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
all covered insulin pay $35 or less | 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 LiveHealthy Value (PPO) - H5141-045-0
Benefit Details
|
Dawson |
$37.30 |
$395 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%
all covered insulin pay $35 or less | $6,600 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Georgia Health Advantage (HMO I-SNP) - H8093-001-0
Benefit Details
|
Dawson |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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-- |
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Georgia Health Advantage Choice (HMO I-SNP) - H8093-002-0
Benefit Details
|
Dawson |
$37.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | 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 |
Humana Gold Plus SNP-DE H4141-003 (HMO D-SNP) - H4141-003-0
Benefit Details
|
Dawson |
$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
all covered insulin pay $35 or less | n/a Browse Formulary |
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HumanaChoice SNP-DE H5216-205 (PPO D-SNP) - H5216-205-0
Benefit Details
|
Dawson |
$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
all covered insulin pay $35 or less | n/a Browse Formulary |
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HumanaChoice SNP-DE H5216-206 (PPO D-SNP) - H5216-206-0
Benefit Details
|
Dawson |
$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%
all covered insulin pay $35 or less | 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 |
UnitedHealthcare Dual Complete Choice LP (PPO D-SNP) - H3256-001-0
Benefit Details
|
Dawson |
$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
all covered insulin pay $35 or less | n/a Browse Formulary |
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Wellcare Dual Access Open (PPO D-SNP) - H0111-004-0
Benefit Details
|
Dawson |
$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
all covered insulin pay $35 or less | n/a Browse Formulary |
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Anthem MediBlue Essential (HMO) - H5422-008-0
Benefit Details
|
Dawson |
$38.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,450 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 |
HumanaChoice H5216-073 (PPO) - H5216-073-0
Benefit Details
|
Dawson |
$43.00 |
$360 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 27%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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UnitedHealthcare Medicare Advantage Choice (Regional PPO) - R2604-001-0
Benefit Details
|
Dawson |
$49.00 |
$295 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Wellcare Low Premium Open (PPO) - H0111-002-0
Benefit Details
|
Dawson |
$55.00 |
$150 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: 45% Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $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 |
Anthem MediBlue Access (PPO) - H7728-005-0
Benefit Details
|
Dawson |
$59.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $13.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $6,050 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Premium Enhanced Open (PPO) - H0111-003-0
Benefit Details
|
Dawson |
$85.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $6,000 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R3392-002 (Regional PPO) - R3392-002-0
Benefit Details
|
Dawson |
$103.00 |
$340 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 27%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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