AARP Medicare Advantage Choice (PPO) - H2577-013-0
Benefit Details
|
Richmond City |
$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 |
|
|
|
|
AARP Medicare Advantage Patriot (PPO) - H2577-015-0
Benefit Details
|
Richmond City |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
AARP Medicare Advantage Plan 1 (HMO-POS) - H5253-111-2
Benefit Details
|
Richmond City |
$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 | $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 |
AARP Medicare Advantage Rebate (HMO-POS) - H5253-119-0
Benefit Details
|
Richmond City |
$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 | $8,300 Browse Formulary |
|
|
|
|
Aetna Medicare Premier Plan (PPO) - H5521-345-0
Benefit Details
|
Richmond City |
$0.00 |
$150 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Select Plan (HMO-POS) - H3931-098-0
Benefit Details
|
Richmond City |
$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 | $6,400 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 |
Align Connect (HMO C-SNP) - H1277-002-0
Benefit Details
|
Richmond City |
$0.00 |
$505 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
-- |
|
Align Thrive (HMO I-SNP) - H1277-001-0
Benefit Details
|
Richmond City |
$0.00 |
$505 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
-- |
|
Anthem MediBlue + Kroger (HMO) - H3447-039-0
Benefit Details
|
Richmond City |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,900 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 |
Anthem MediBlue + Kroger Access (PPO) - H4909-026-0
Benefit Details
|
Richmond City |
$0.00 |
$95 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (PPO) - H4909-014-0
Benefit Details
|
Richmond City |
$0.00 |
$95 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Care on Site (HMO I-SNP) - H3447-010-0
Benefit Details
|
Richmond City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.50 Preferred Brand: $40.00 Non-Preferred Drug: $85.00 Specialty Tier: 33% Select Care Drugs: $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 |
Anthem MediBlue COPD (HMO C-SNP) - H3447-003-0
Benefit Details
|
Richmond City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.50 Preferred Brand: $40.00 Non-Preferred Drug: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Diabetes and Heart Care (HMO C-SNP) - H3447-004-0
Benefit Details
|
Richmond City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.50 Preferred Brand: $35.00 Non-Preferred Drug: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue ESRD Care (HMO C-SNP) - H3447-033-0
Benefit Details
|
Richmond City |
$0.00 |
$325 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 27% Select Care Drugs: $0.00
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 |
Anthem MediBlue Local (HMO) - H3447-001-0
Benefit Details
|
Richmond City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.50 Preferred Brand: $40.00 Non-Preferred Drug: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Service (PPO) - H4909-020-0
Benefit Details
|
Richmond City |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Anthem MediBlue Smart Fit (HMO) - H3447-005-0
Benefit Details
|
Richmond City |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $12.50 Preferred Brand: $40.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $3,650 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 Medicare (HMO) - H9725-010-0
Benefit Details
|
Richmond City |
$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 Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $3,150 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Cigna True Choice Medicare (PPO) - H7849-070-0
Benefit Details
|
Richmond City |
$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 | $6,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) - H8293-001-0
Benefit Details
|
Richmond City |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $3,250 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 Essential (PPO) - H8014-002-0
Benefit Details
|
Richmond City |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $4,950 Browse Formulary |
new |
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) - H5619-046-0
Benefit Details
|
Richmond City |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
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: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Humana Gold Plus H5619-139 (HMO) - H5619-139-2
Benefit Details
|
Richmond City |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | 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 | $6,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Plus H6622-004 (HMO) - H6622-004-0
Benefit Details
|
Richmond City |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $2,900 Browse Formulary |
|
|
|
|
Humana Honor (PPO) - H5216-310-0
Benefit Details
|
Richmond City |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,900 |
|
|
|
|
Humana Honor (Regional PPO) - R1390-003-0
Benefit Details
|
Richmond City |
$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 |
HumanaChoice H5216-152 (PPO) - H5216-152-0
Benefit Details
|
Richmond City |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 |
|
|
|
|
HumanaChoice H5216-266 (PPO) - H5216-266-0
Benefit Details
|
Richmond City |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | 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 | $5,400 Browse Formulary |
|
|
|
|
HumanaChoice H5216-308 (PPO) - H5216-308-0
Benefit Details
|
Richmond City |
$0.00 |
$485 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $8,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-312 (PPO) - H5216-312-0
Benefit Details
|
Richmond City |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
|
HumanaChoice R1390-001 (Regional PPO) - R1390-001-0
Benefit Details
|
Richmond City |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,950 |
|
-- |
|
|
LifeWorks Freedom (HMO I-SNP) - H2185-003-0
Benefit Details
|
Richmond City |
$0.00 |
$505 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
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 |
Molina Medicare Choice Care (HMO) - H7559-003-0
Benefit Details
|
Richmond City |
$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
all covered insulin pay $35 or less | $8,300 Browse Formulary |
|
-- |
|
|
Optima Medicare Salute (HMO) - H2563-014-0
Benefit Details
|
Richmond City |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 |
|
|
|
|
Optima Medicare Value (HMO) - H2563-009-0
Benefit Details
|
Richmond City |
$0.00 |
$150 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30%
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 |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) - H5619-145-0
Benefit Details
|
Richmond City |
$4.10 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Humana Gold Plus H6622-074 (HMO) - H6622-074-2
Benefit Details
|
Richmond City |
$15.00 |
$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: $99.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
|
Aetna Medicare Assure Value (HMO D-SNP) - H1610-003-0
Benefit Details
|
Richmond City |
$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 |
Aetna Medicare Assure Premier (HMO D-SNP) - H1610-002-0
Benefit Details
|
Richmond City |
$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 |
|
|
|
|
Anthem MediBlue Dual Advantage (HMO D-SNP) - H3447-030-0
Benefit Details
|
Richmond City |
$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 |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AARP Medicare Advantage Plan 2 (HMO-POS) - H5253-112-2
Benefit Details
|
Richmond City |
$23.00 |
$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 | $3,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Virginia Premier Advantage Elite (HMO D-SNP) - H9877-001-0
Benefit Details
|
Richmond City |
$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 |
|
|
|
|
Optima Community Complete (HMO D-SNP) - H2563-004-0
Benefit Details
|
Richmond City |
$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 |
|
|
|
|
Anthem MediBlue Extra (HMO) - H3447-027-0
Benefit Details
|
Richmond City |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 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 |
Aetna Better Health of Virginia (HMO D-SNP) - H1610-001-0
Benefit Details
|
Richmond City |
$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 |
|
|
|
|
Humana Gold Choice H8145-042 (PFFS) - H8145-042-0
Benefit Details
|
Richmond City |
$28.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a |
|
|
|
|
Cigna Preferred Plus Medicare (HMO) - H9725-011-0
Benefit Details
|
Richmond City |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | 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 | $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 |
Cigna True Choice Plus Medicare (PPO) - H7849-071-0
Benefit Details
|
Richmond City |
$29.00 |
$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:
|
Anthem MediBlue Dual Access (PPO D-SNP) - H4909-018-0
Benefit Details
|
Richmond City |
$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 |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
UnitedHealthcare Dual Complete ONE (HMO-POS D-SNP) - H7464-005-0
Benefit Details
|
Richmond City |
$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 |
UnitedHealthcare Dual Complete ONE Plus (HMO-POS D-SNP) - H7464-007-0
Benefit Details
|
Richmond City |
$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 |
|
|
|
|
UnitedHealthcare Dual Complete (HMO-POS D-SNP) - H7464-001-0
Benefit Details
|
Richmond City |
$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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Align Kidney Care (HMO C-SNP) - H1277-004-0
Benefit Details
|
Richmond City |
$34.50 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
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 Balance (HMO-POS D-SNP) - H7464-006-0
Benefit Details
|
Richmond City |
$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 Full Dual Advantage (HMO D-SNP) - H3447-011-0
Benefit Details
|
Richmond City |
$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: $40.00 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:
|
LifeWorks Advantage I-SNP (HMO I-SNP) - H2185-001-0
Benefit Details
|
Richmond City |
$34.60 |
$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 |
Molina Medicare Complete Care (HMO D-SNP) - H7559-001-0
Benefit Details
|
Richmond City |
$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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|
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Molina Medicare Complete Care Select (HMO D-SNP) - H7559-002-0
Benefit Details
|
Richmond City |
$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: 33% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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UnitedHealthcare Dual Complete Choice (PPO D-SNP) - H1889-006-0
Benefit Details
|
Richmond City |
$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 |
UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP) - H0710-032-0
Benefit Details
|
Richmond City |
$37.50 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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HumanaChoice H5216-144 (PPO) - H5216-144-0
Benefit Details
|
Richmond City |
$39.00 |
$265 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
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Humana Gold Choice H8145-004 (PFFS) - H8145-004-0
Benefit Details
|
Richmond City |
$68.00 |
$160 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: $99.00 Specialty Tier: 30%
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 |
Aetna Medicare Essential Plan (PPO) - H5521-082-0
Benefit Details
|
Richmond City |
$77.00 |
$300 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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|
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R1390-002 (Regional PPO) - R1390-002-0
Benefit Details
|
Richmond City |
$98.00 |
$480 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Generic: $18.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
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