Lasso Healthcare Growth (MSA) - H1924-001-0
Benefit Details
|
Lebanon |
$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
|
Lebanon |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a |
|
|
|
|
AARP Medicare Advantage Choice Plan 3 (PPO) - H2228-086-0
Benefit Details
|
Lebanon |
$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 | $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 Choice Rebate (PPO) - H2228-130-0
Benefit Details
|
Lebanon |
$0.00 |
$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 | $7,550 Browse Formulary |
|
|
|
|
AARP Medicare Advantage Flex (HMO-POS) - H1944-024-0
Benefit Details
|
Lebanon |
$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%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
|
|
|
AARP Medicare Advantage Patriot (HMO-POS) - H1944-030-0
Benefit Details
|
Lebanon |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,500 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare Advantra Credit Value (PPO) - H5522-017-0
Benefit Details
|
Lebanon |
$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 | $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Advantra Eagle (HMO) - H3959-041-0
Benefit Details
|
Lebanon |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 |
|
|
|
|
Aetna Medicare Advantra Silver (PPO) - H5522-004-0
Benefit Details
|
Lebanon |
$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 |
|
|
|
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 Silver Back (PPO) - H5522-022-0
Benefit Details
|
Lebanon |
$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%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Value (PPO) - H5521-263-0
Benefit Details
|
Lebanon |
$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 | $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueJourney Essential (HMO) - H3962-007-0
Benefit Details
|
Lebanon |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Drug: $93.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $5,500 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 |
Capital Blue Cross | WellSpan Health Advantage (PPO) - H3923-029-0
Benefit Details
|
Lebanon |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Drug: $93.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $6,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Capital Blue Cross | WellSpan Health Inspire (HMO) - H3962-021-0
Benefit Details
|
Lebanon |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Drug: $93.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Capital Blue Cross | WellSpan Health Value (PPO) - H3923-031-0
Benefit Details
|
Lebanon |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Drug: $93.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $8,000 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 |
Capital Blue Cross Select (PPO) - H3923-028-0
Benefit Details
|
Lebanon |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Drug: $93.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $7,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Cigna Preferred Medicare (HMO) - H3949-035-0
Benefit Details
|
Lebanon |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $6,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Cigna True Choice Savings Medicare (PPO) - H7849-031-0
Benefit Details
|
Lebanon |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $6,100 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Community Blue Medicare HMO Signature (HMO) - H3957-042-2
Benefit Details
|
Lebanon |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Community Blue Medicare PPO Signature (PPO) - H3916-037-2
Benefit Details
|
Lebanon |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $8,300 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Freedom Blue PPO Valor (PPO) - H3916-043-0
Benefit Details
|
Lebanon |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,000 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Geisinger Gold Classic 360 Rx (HMO) - H3954-160-0
Benefit Details
|
Lebanon |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $0.00
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
|
Geisinger Gold Classic Essential Rx (HMO) - H3954-161-0
Benefit Details
|
Lebanon |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $0.00
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
|
Geisinger Gold Heritage (HMO) - H3954-162-0
Benefit Details
|
Lebanon |
$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 |
Geisinger Gold Preferred Complete Rx (PPO) - H3924-065-0
Benefit Details
|
Lebanon |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $0.00
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
|
|
|
Health Partners Medicare Complete (HMO-POS) - H9207-012-0
Benefit Details
|
Lebanon |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $7,900 Browse Formulary |
|
|
|
|
Humana Gold Choice H8145-052 (PFFS) - H8145-052-0
Benefit Details
|
Lebanon |
$0.00 |
$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 | 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 Gold Choice H8145-055 (PFFS) - H8145-055-0
Benefit Details
|
Lebanon |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a |
|
|
|
|
Humana Gold Plus H6622-035 (HMO) - H6622-035-0
Benefit Details
|
Lebanon |
$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 | $6,700 Browse Formulary |
|
|
|
|
Humana Honor (PPO) - H5216-116-0
Benefit Details
|
Lebanon |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,900 |
|
|
|
|
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) - H5216-221-0
Benefit Details
|
Lebanon |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Humana USAA Honor with Rx (PPO) - H5525-059-0
Benefit Details
|
Lebanon |
$0.00 |
$250 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice H5525-051 (PPO) - H5525-051-1
Benefit Details
|
Lebanon |
$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 | $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 H5525-058 (PPO) - H5525-058-0
Benefit Details
|
Lebanon |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice H5525-060 (PPO) - H5525-060-0
Benefit Details
|
Lebanon |
$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 R0923-001 (Regional PPO) - R0923-001-0
Benefit Details
|
Lebanon |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UPMC for Life HMO No Rx (HMO) - H3907-002-0
Benefit Details
|
Lebanon |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 |
|
|
|
|
UPMC for Life PPO Premier Rx (PPO) - H5533-011-0
Benefit Details
|
Lebanon |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
UPMC for Life PPO Salute (PPO) - H5533-012-0
Benefit Details
|
Lebanon |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,500 |
|
|
|
|
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) - H2915-012-0
Benefit Details
|
Lebanon |
$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: 44% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback Open (PPO) - H2128-004-0
Benefit Details
|
Lebanon |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 27% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) - H2915-016-0
Benefit Details
|
Lebanon |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: 46% Specialty Tier: 33% Select Care Drugs: $0.00
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 |
Wellcare No Premium Open (PPO) - H2128-002-0
Benefit Details
|
Lebanon |
$0.00 |
$160 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 43% Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Patriot Giveback (HMO) - H2915-013-0
Benefit Details
|
Lebanon |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $7,550 |
|
|
|
|
Wellcare Assist (HMO) - H2915-011-0
Benefit Details
|
Lebanon |
$13.50 |
$445 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: 45% Specialty Tier: 25% 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 |
Wellcare Assist Open (PPO) - H2128-001-0
Benefit Details
|
Lebanon |
$14.20 |
$395 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: 46% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Advantra Silver Plus (PPO) - H5522-013-0
Benefit Details
|
Lebanon |
$18.00 |
$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 | $7,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5525-017 (PPO) - H5525-017-0
Benefit Details
|
Lebanon |
$18.00 |
$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 | $4,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Capital Blue Cross | WellSpan Health AdvantagePlus (PPO) - H3923-030-0
Benefit Details
|
Lebanon |
$19.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $40.00 Non-Preferred Drug: $93.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AARP Medicare Advantage Choice Plan 1 (PPO) - H2228-035-0
Benefit Details
|
Lebanon |
$21.00 |
$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 | $5,900 Browse Formulary |
|
|
|
|
UPMC for Life HMO Deductible Rx (HMO) - H3907-037-0
Benefit Details
|
Lebanon |
$22.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
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 Advantra Premier (HMO-POS) - H3959-039-0
Benefit Details
|
Lebanon |
$23.00 |
$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 |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
UPMC for Life PPO Rx Choice (PPO) - H5533-009-0
Benefit Details
|
Lebanon |
$23.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Dual Access Open (PPO D-SNP) - H2128-005-0
Benefit Details
|
Lebanon |
$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 |
|
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare Advantra Cares (HMO D-SNP) - H3959-036-0
Benefit Details
|
Lebanon |
$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 Plus (HMO D-SNP) - H3949-009-0
Benefit Details
|
Lebanon |
$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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Community Blue Medicare PPO Distinct (PPO) - H3916-034-3
Benefit Details
|
Lebanon |
$25.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $42.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $6,000 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 |
Cigna True Choice Plus Medicare (PPO) - H7849-032-0
Benefit Details
|
Lebanon |
$28.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $6,100 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5525-006 (PPO) - H5525-006-0
Benefit Details
|
Lebanon |
$28.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Wellcare Low Premium Open (PPO) - H2128-003-0
Benefit Details
|
Lebanon |
$29.00 |
$100 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 43% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,000 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 |
Wellcare Dual Access (HMO D-SNP) - H2915-007-0
Benefit Details
|
Lebanon |
$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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UnitedHealthcare Dual Complete (HMO-POS D-SNP) - H3113-009-0
Benefit Details
|
Lebanon |
$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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Geisinger Gold Classic Complete Rx (HMO) - H3954-158-13
Benefit Details
|
Lebanon |
$34.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $0.00
all covered insulin pay $35 or less | $4,900 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 |
Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) - H6622-078-1
Benefit Details
|
Lebanon |
$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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UPMC for Life HMO Rx Choice (HMO) - H3907-049-0
Benefit Details
|
Lebanon |
$36.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
UnitedHealthcare Dual Complete Select (HMO-POS D-SNP) - H3113-014-0
Benefit Details
|
Lebanon |
$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 |
UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP) - H0710-017-0
Benefit Details
|
Lebanon |
$41.00 |
$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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AmeriHealth Caritas VIP Care (HMO D-SNP) - H4227-002-0
Benefit Details
|
Lebanon |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Generic: $8.00 Brand: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
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Geisinger Gold Secure Rx (HMO D-SNP) - H3954-097-0
Benefit Details
|
Lebanon |
$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 |
Health Partners Medicare Prime (HMO-POS) - H9207-002-0
Benefit Details
|
Lebanon |
$41.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $7,900 Browse Formulary |
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Health Partners Medicare Special (HMO D-SNP) - H9207-004-0
Benefit Details
|
Lebanon |
$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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Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) - H5932-001-0
Benefit Details
|
Lebanon |
$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: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 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 |
Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) - H5932-009-0
Benefit Details
|
Lebanon |
$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: $13.00 Preferred Brand: $42.00 Non-Preferred Drug: 45% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Value Plus H5216-117 (PPO) - H5216-117-0
Benefit Details
|
Lebanon |
$41.10 |
$505 Tier 1 and 2 exempt |
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%
all covered insulin pay $35 or less | $7,000 Browse Formulary |
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UnitedHealthcare Dual Complete Choice (PPO D-SNP) - H1889-007-0
Benefit Details
|
Lebanon |
$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 |
UPMC for Life Complete Care (HMO D-SNP) - H4279-001-0
Benefit Details
|
Lebanon |
$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: $6.00 Generic: $12.00 Preferred Brand: $30.00 Non-Preferred Drug: 49% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
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Higher cost-sharing at standard network pharmacies. Details:
|
AARP Medicare Advantage Choice Plan 2 (PPO) - H2228-036-0
Benefit Details
|
Lebanon |
$44.00 |
$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 | $5,500 Browse Formulary |
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Geisinger Gold Preferred Enhanced Rx (PPO) - H3924-062-22
Benefit Details
|
Lebanon |
$45.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $0.00
all covered insulin pay $35 or less | $7,550 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 |
Aetna Medicare Silver (HMO) - H3931-070-0
Benefit Details
|
Lebanon |
$47.00 |
$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 | $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueJourney Classic (PPO) - H3923-013-0
Benefit Details
|
Lebanon |
$51.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Drug: $93.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
UPMC for Life PPO Rx Enhanced (PPO) - H5533-008-0
Benefit Details
|
Lebanon |
$58.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $7,550 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 |
BlueJourney Value (HMO) - H3962-004-0
Benefit Details
|
Lebanon |
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Drug: $93.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Freedom Blue PPO Basic (PPO) - H3916-012-0
Benefit Details
|
Lebanon |
$62.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,900 |
|
|
|
|
Freedom Blue PPO ValueRx (PPO) - H3916-018-0
Benefit Details
|
Lebanon |
$66.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $13.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $5,500 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 |
HumanaChoice R0923-002 (Regional PPO) - R0923-002-0
Benefit Details
|
Lebanon |
$71.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
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|
Aetna Medicare Advantra Premier Plus (PPO) - H5522-002-0
Benefit Details
|
Lebanon |
$77.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $6,500 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
UPMC for Life HMO Rx (HMO) - H3907-029-0
Benefit Details
|
Lebanon |
$81.00 |
$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 | $5,500 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 |
Geisinger Gold Preferred Advantage Rx (PPO) - H3924-059-22
Benefit Details
|
Lebanon |
$84.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $0.00
all covered insulin pay $35 or less | $4,000 Browse Formulary |
|
|
|
|
BlueJourney Premier (HMO) - H3962-001-0
Benefit Details
|
Lebanon |
$115.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $40.00 Non-Preferred Drug: $93.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $3,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-120 (PPO) - H5216-120-0
Benefit Details
|
Lebanon |
$123.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $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 |
Geisinger Gold Classic Advantage Rx (HMO) - H3954-157-23
Benefit Details
|
Lebanon |
$144.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $0.00
all covered insulin pay $35 or less | $3,450 Browse Formulary |
|
|
|
|
Freedom Blue PPO Standard (PPO) - H3916-015-0
Benefit Details
|
Lebanon |
$171.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $13.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueJourney Prime (PPO) - H3923-017-0
Benefit Details
|
Lebanon |
$174.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Drug: $93.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $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 |
Aetna Medicare Gold Plan (PPO) - H5521-122-0
Benefit Details
|
Lebanon |
$176.00 |
$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 | $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Freedom Blue PPO Deluxe (PPO) - H3916-005-0
Benefit Details
|
Lebanon |
$285.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $13.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
UPMC for Life HMO Rx Enhanced (HMO) - H3907-006-0
Benefit Details
|
Lebanon |
$295.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|