Lasso Healthcare Growth (MSA) - H1924-001-0
Benefit Details
|
Lake |
$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
|
Lake |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a |
|
|
|
|
AARP Medicare Advantage Choice (PPO) - H2406-016-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 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 Choice Plan 2 (Regional PPO) - R0759-001-0
Benefit Details
|
Lake |
$0.00 |
$195 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
|
|
|
AARP Medicare Advantage Patriot (Regional PPO) - R0759-002-0
Benefit Details
|
Lake |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Advantage Care by Ultimate (HMO C-SNP) - H2962-029-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Drug: $60.00 Specialty Tier: 33% Select Care Drugs: $10.00
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 |
Advantage Care COPD by Ultimate (HMO C-SNP) - H2962-023-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Drug: $60.00 Specialty Tier: 33% Select Care Drugs: $10.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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|
Aetna Medicare Premier (PPO) - H5521-033-0
Benefit Details
|
Lake |
$0.00 |
$300 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Premier Plus (PPO) - H5521-271-0
Benefit Details
|
Lake |
$0.00 |
$150 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare Select (HMO) - H1609-042-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $90.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $2,750 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Classic (HMO) - H1035-019-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Drug: $93.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
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|
BlueMedicare Patriot (PPO) - H5434-038-0
Benefit Details
|
Lake |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
BlueMedicare Premier (HMO) - H1035-043-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $93.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $2,700 Browse Formulary |
|
|
|
|
BlueMedicare Value (PPO) - H5434-036-0
Benefit Details
|
Lake |
$0.00 |
$150 Tier 1, 2 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 | $5,000 Browse Formulary |
|
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Bright Advantage Health Dollars Plan (HMO) - H4709-011-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $1,199 Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Bright Advantage Part B Savings Plan (HMO) - H4709-029-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $2,500 Browse Formulary |
|
-- |
|
|
Bright Advantage Part B Savings Plan (PPO) - H3281-010-0
Benefit Details
|
Lake |
$0.00 |
$110 Tier 1 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: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
-- |
|
|
CareBreeze (HMO C-SNP) - H1019-116-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Drug: $85.00 Specialty Tier: 33%
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 |
CareBreeze Platinum (HMO C-SNP) - H1019-125-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Drug: $70.00 Specialty Tier: 33%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
CareComplete (HMO C-SNP) - H1019-107-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Drug: $85.00 Specialty Tier: 33%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
CareComplete Platinum (HMO C-SNP) - H1019-122-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Drug: $70.00 Specialty Tier: 33%
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 |
CareFree (HMO) - H1019-120-1
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Drug: $85.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $3,200 Browse Formulary |
|
|
|
|
CareFree Platinum (HMO) - H1019-137-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $45.00 Non-Preferred Drug: $85.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
|
|
|
|
CareOne Platinum (HMO) - H1019-112-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Drug: $85.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $3,000 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
CareOne Plus (HMO-POS) - H1019-057-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Drug: $85.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $2,750 Browse Formulary |
|
|
|
|
CareSalute (HMO) - H1019-133-0
Benefit Details
|
Lake |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Cigna Preferred Medicare (HMO) - H5410-024-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $2,700 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 |
Cigna Preferred Savings Medicare (HMO) - H5410-026-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $3,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Cigna True Choice Medicare (PPO) - H7849-017-0
Benefit Details
|
Lake |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $4,950 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Devoted CHOICE North Florida (PPO) - H9884-012-0
Benefit Details
|
Lake |
$0.00 |
$150 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $4,900 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 |
Devoted CORE North Florida (HMO) - H1290-027-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Drug: $85.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $2,750 Browse Formulary |
|
|
|
|
Devoted ESSENTIALS North Florida (HMO) - H1290-035-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Drug: $85.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $3,400 Browse Formulary |
|
|
|
|
Freedom Platinum Plan Rx (HMO) - H5427-094-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Drug: $70.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $2,000 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Freedom Platinum Rewards Plan Rx (HMO) - H5427-096-0
Benefit Details
|
Lake |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $85.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $3,400 Browse Formulary |
|
|
|
|
Freedom Savings Plan (HMO) - H5427-052-0
Benefit Details
|
Lake |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 |
|
|
|
|
Freedom VIP Care (HMO C-SNP) - H5427-070-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Preferred Brand: $15.00 Non-Preferred Drug: $55.00 Specialty Tier: 33% Select Diabetic 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 |
Freedom VIP Savings (HMO C-SNP) - H5427-072-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Drug: $65.00 Specialty Tier: 33% Select Diabetic Drugs: $10.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Freedom VIP Savings COPD (HMO C-SNP) - H5427-077-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Drug: $60.00 Specialty Tier: 33%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Humana Community (HMO) - H1036-295-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Drug: $90.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $2,500 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) - H1036-300-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Humana Gold Plus H1036-146 (HMO) - H1036-146-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Drug: $85.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $2,600 Browse Formulary |
|
|
|
|
Humana Gold Plus H1036-269 (HMO) - H1036-269-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $3,200 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Honor (HMO) - H1036-290-0
Benefit Details
|
Lake |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Humana Honor (PPO) - H5216-257-0
Benefit Details
|
Lake |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,100 |
|
|
|
|
HumanaChoice Florida H5216-074 (PPO) - H5216-074-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $5,800 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 Florida H5216-304 (PPO) - H5216-304-0
Benefit Details
|
Lake |
$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 | $4,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-018 (Regional PPO) - R5826-018-0
Benefit Details
|
Lake |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $7,550 |
|
|
|
|
Optimum Diamond Savings (HMO C-SNP) - H5594-030-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Drug: $80.00 Specialty Tier: 33% Select Diabetic Drugs: $10.00
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 |
Optimum Diamond Savings COPD (HMO C-SNP) - H5594-031-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Drug: $80.00 Specialty Tier: 33%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Optimum Gold Rewards Plan (HMO) - H5594-026-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $85.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $3,400 Browse Formulary |
|
|
|
|
Premier by Ultimate (HMO) - H2962-028-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Drug: $60.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $2,500 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Simply Freedom (PPO) - H9469-009-0
Benefit Details
|
Lake |
$0.00 |
$125 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
new |
new |
new |
|
UnitedHealthcare Medicare Advantage Walgreens (HMO-POS C-SNP) - H1045-048-4
Benefit Details
|
Lake |
$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 | n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
UnitedHealthcare The Villages Medicare Advantage (HMO-POS) - H1045-025-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | 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 | $2,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UnitedHealthcare The Villages Medicare Focus (HMO-POS) - H1045-056-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $40.00 Non-Preferred Drug: $90.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $2,400 Browse Formulary |
|
|
|
|
Wellcare Giveback (HMO) - H1032-193-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Drug: $80.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) - H1032-194-0
Benefit Details
|
Lake |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Drug: $65.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $2,900 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 |
Wellcare No Premium Open (PPO) - H5199-008-0
Benefit Details
|
Lake |
$0.00 |
$150 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: $90.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-074 (Regional PPO) - R5826-074-0
Benefit Details
|
Lake |
$4.00 |
$395 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
|
CareNeeds Plus (HMO D-SNP) - H1019-026-0
Benefit Details
|
Lake |
$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: $3.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 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 |
Cigna Primary Medicare (HMO) - H5410-033-0
Benefit Details
|
Lake |
$17.20 |
$505 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $18.00 Preferred Brand: 20% Non-Preferred Drug: 43% Specialty Tier: 25%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Dual Access Open (PPO D-SNP) - H5199-016-0
Benefit Details
|
Lake |
$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) - H5410-046-0
Benefit Details
|
Lake |
$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 |
Cigna TotalCare Plus (HMO D-SNP) - H5410-025-0
Benefit Details
|
Lake |
$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 |
|
-- |
|
|
Aetna Medicare Assure Plus (HMO D-SNP) - H1609-046-0
Benefit Details
|
Lake |
$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: $15.00 Preferred Brand: 25% Non-Preferred Drug: 37% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP) - H1036-213-0
Benefit Details
|
Lake |
$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: $12.00 Generic: $18.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 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 |
Humana Fully Integrated H1036-280 (HMO D-SNP) - H1036-280-0
Benefit Details
|
Lake |
$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: $1.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Freedom Platinum Plus Plan Rx (HMO) - H5427-104-0
Benefit Details
|
Lake |
$30.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Drug: $60.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $1,500 Browse Formulary |
|
|
|
|
Devoted DUAL North Florida (HMO D-SNP) - H1290-033-0
Benefit Details
|
Lake |
$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: 25% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 |
Advantage Plus by Ultimate (Full) (HMO D-SNP) - H2962-035-0
Benefit Details
|
Lake |
$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: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Supplemental Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Advantage Plus by Ultimate (Partial) (HMO D-SNP) - H2962-036-0
Benefit Details
|
Lake |
$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: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Supplemental Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
BlueMedicare Complete (HMO D-SNP) - H1035-029-0
Benefit Details
|
Lake |
$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: 25% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 |
Bright Advantage Embrace Assist Plan (HMO C-SNP) - H4709-039-0
Benefit Details
|
Lake |
$35.90 |
$505 Tier 1 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Bright Advantage Embrace Choice Plan (HMO C-SNP) - H4709-031-0
Benefit Details
|
Lake |
$35.90 |
$505 Tier 1 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Devoted PREMIUM (HMO) - H1290-044-1
Benefit Details
|
Lake |
$35.90 |
$0 |
Yes, some additional gap coverage. | 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 | $2,750 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Freedom Medi-Medi Full (HMO D-SNP) - H5427-087-0
Benefit Details
|
Lake |
$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: $15.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Freedom Medi-Medi Partial (HMO D-SNP) - H5427-078-0
Benefit Details
|
Lake |
$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: $15.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Longevity Health Plan (HMO I-SNP) - H1644-001-0
Benefit Details
|
Lake |
$35.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 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 |
Optimum Emerald Full (HMO D-SNP) - H5594-017-0
Benefit Details
|
Lake |
$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: $15.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Optimum Emerald Partial (HMO D-SNP) - H5594-016-0
Benefit Details
|
Lake |
$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: $15.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
UnitedHealthcare Assisted Living Plan (PPO I-SNP) - H0710-012-0
Benefit Details
|
Lake |
$35.90 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
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 Choice (PPO D-SNP) - H1889-002-1
Benefit Details
|
Lake |
$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 |
|
|
|
|
UnitedHealthcare Dual Complete LP (HMO-POS D-SNP) - H1045-039-0
Benefit Details
|
Lake |
$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 |
|
|
|
|
UnitedHealthcare Dual Complete ONE (HMO-POS D-SNP) - H2509-001-0
Benefit Details
|
Lake |
$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 |
new |
|
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 RP (Regional PPO D-SNP) - R0759-003-0
Benefit Details
|
Lake |
$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 |
|
|
|
|
UnitedHealthcare Nursing Home Plan (PPO I-SNP) - H0710-010-0
Benefit Details
|
Lake |
$35.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Wellcare Dual Access (HMO D-SNP) - H1032-124-0
Benefit Details
|
Lake |
$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 |
Wellcare Dual Liberty (HMO D-SNP) - H1032-175-0
Benefit Details
|
Lake |
$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 |
|
|
|
|
Wellcare Dual Select (HMO D-SNP) - H1032-182-0
Benefit Details
|
Lake |
$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 |
|
|
|
|
BlueMedicare Choice (Regional PPO) - R3332-001-0
Benefit Details
|
Lake |
$49.90 |
$250 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Drug: $93.00 Specialty Tier: 29% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $6,500 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice Florida H7284-001 (PPO) - H7284-001-0
Benefit Details
|
Lake |
$84.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $2,500 Browse Formulary |
|
|
|
|
Wellcare Premium Enhanced Open (PPO) - H5199-010-0
Benefit Details
|
Lake |
$99.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-005 (Regional PPO) - R5826-005-0
Benefit Details
|
Lake |
$111.00 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
|
|
|