AARP Medicare Advantage Open (PPO) - H0294-024-0
Benefit Details
|
Sanilac |
$0.00 |
$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 | $5,200 Browse Formulary |
|
|
|
|
AARP Medicare Advantage Patriot (PPO) - H0294-022-0
Benefit Details
|
Sanilac |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,500 |
|
|
|
|
Aetna Medicare Eagle (PPO) - H5521-286-0
Benefit Details
|
Sanilac |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,390 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare Premier (HMO-POS) - H3192-002-0
Benefit Details
|
Sanilac |
$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 | $3,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Value (PPO) - H5521-288-0
Benefit Details
|
Sanilac |
$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 | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BCN Advantage Elements (HMO-POS) - H5883-001-3
Benefit Details
|
Sanilac |
$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 |
BCN Advantage HMO-POS Prime Value (HMO-POS) - H5883-014-3
Benefit Details
|
Sanilac |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $11.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Covenant Advantage (HMO-POS) - H7646-002-0
Benefit Details
|
Sanilac |
$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: $90.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $3,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HAP Medicare Flex (PPO) - H2322-014-0
Benefit Details
|
Sanilac |
$0.00 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $8,300 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HAP MSUHC Medicare (HMO) - H2354-028-0
Benefit Details
|
Sanilac |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 48% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HAP Senior Plus (HMO) - H2354-015-0
Benefit Details
|
Sanilac |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 48% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HAP Senior Plus Medical Only (HMO) - H2354-019-0
Benefit Details
|
Sanilac |
$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 |
HAP Senior Plus Option 1 (PPO) - H2322-011-0
Benefit Details
|
Sanilac |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $42.00 Non-Preferred Drug: 48% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $6,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Honor (PPO) - H5216-190-0
Benefit Details
|
Sanilac |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,500 |
|
|
|
|
HumanaChoice H5216-306 (PPO) - H5216-306-0
Benefit Details
|
Sanilac |
$0.00 |
$350 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: 27%
all covered insulin pay $35 or less | $6,550 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 H8087-004 (PPO) - H8087-004-0
Benefit Details
|
Sanilac |
$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 | $5,000 Browse Formulary |
|
|
|
|
HumanaChoice R3887-001 (Regional PPO) - R3887-001-0
Benefit Details
|
Sanilac |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,500 |
|
|
|
|
McLaren Medicare Inspire (HMO) - H6322-001-0
Benefit Details
|
Sanilac |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,200 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 |
Medicare Plus Blue PPO Essential (PPO) - H9572-004-3
Benefit Details
|
Sanilac |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $11.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Molina Medicare Choice Care (HMO) - H5926-006-0
Benefit Details
|
Sanilac |
$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 |
|
|
|
|
Molina Medicare Choice Care Select (HMO) - H5926-007-0
Benefit Details
|
Sanilac |
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $15.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 27% Select Care Drugs: $5.00
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 |
PriorityMedicare Compass (PPO) - H4875-021-2
Benefit Details
|
Sanilac |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
PriorityMedicare Key (HMO-POS) - H2320-022-4
Benefit Details
|
Sanilac |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) - H5475-031-0
Benefit Details
|
Sanilac |
$0.00 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 25% Select Care Drugs: $0.00
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 |
Wellcare No Premium (HMO-POS) - H5475-026-0
Benefit Details
|
Sanilac |
$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: 48% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) - H2117-001-0
Benefit Details
|
Sanilac |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: 43% Specialty Tier: 33% 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:
|
Wellcare Patriot Giveback Open (PPO) - H2117-003-0
Benefit Details
|
Sanilac |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 |
|
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist (HMO) - H5475-038-0
Benefit Details
|
Sanilac |
$11.90 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 43% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,000 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Low Premium (HMO-POS) - H5475-024-0
Benefit Details
|
Sanilac |
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Drug: 48% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,000 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Dual Access Open (PPO D-SNP) - H2117-002-0
Benefit Details
|
Sanilac |
$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 |
HumanaChoice H8087-001 (PPO) - H8087-001-0
Benefit Details
|
Sanilac |
$19.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
|
|
|
Humana Value Plus H8087-002 (PPO) - H8087-002-0
Benefit Details
|
Sanilac |
$23.90 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
|
Covenant Advantage Plus (HMO-POS) - H7646-005-0
Benefit Details
|
Sanilac |
$25.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $40.00 Non-Preferred Drug: $90.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $3,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
McLaren Medicare Inspire Plus (HMO) - H6322-002-0
Benefit Details
|
Sanilac |
$25.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,500 Browse Formulary |
|
new |
new |
|
PriorityMedicare Ideal (PPO) - H4875-018-4
Benefit Details
|
Sanilac |
$25.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 30%
all covered insulin pay $35 or less | $5,800 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Dual Access (HMO-POS D-SNP) - H5475-001-0
Benefit Details
|
Sanilac |
$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 |
AARP Medicare Advantage Open Flex (PPO) - H0294-025-0
Benefit Details
|
Sanilac |
$28.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $4,200 Browse Formulary |
|
|
|
|
McLaren Medicare Inspire Duals (HMO D-SNP) - H6322-004-0
Benefit Details
|
Sanilac |
$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 |
|
HumanaChoice SNP-DE H8087-003 (PPO D-SNP) - H8087-003-0
Benefit Details
|
Sanilac |
$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 |
Molina Medicare Complete Care (HMO D-SNP) - H5926-001-0
Benefit Details
|
Sanilac |
$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: $42.00 Non-Preferred Drug: 36% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Molina Medicare Complete Care Select (HMO D-SNP) - H5926-005-0
Benefit Details
|
Sanilac |
$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: $42.00 Non-Preferred Drug: 34% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
PriorityMedicare D-SNP (HMO D-SNP) - H8379-001-0
Benefit Details
|
Sanilac |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% 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 |
UnitedHealthcare Dual Complete (HMO-POS D-SNP) - H2247-001-0
Benefit Details
|
Sanilac |
$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 Choice (PPO D-SNP) - H0271-028-0
Benefit Details
|
Sanilac |
$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 Select (HMO-POS D-SNP) - H2247-003-0
Benefit Details
|
Sanilac |
$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 |
Wellcare Community Assist (PPO) - H2117-004-0
Benefit Details
|
Sanilac |
$32.70 |
$380 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 25% 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:
|
PriorityMedicare Value (HMO-POS) - H2320-029-4
Benefit Details
|
Sanilac |
$46.00 |
$75 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31%
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
McLaren Medicare Inspire Flex (HMO-POS) - H6322-003-2
Benefit Details
|
Sanilac |
$49.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,800 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 |
HAP Senior Plus Option 2 (PPO) - H2322-012-0
Benefit Details
|
Sanilac |
$70.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $42.00 Non-Preferred Drug: 48% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Vitality (PPO) - H9572-002-3
Benefit Details
|
Sanilac |
$83.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $11.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R3887-002 (Regional PPO) - R3887-002-0
Benefit Details
|
Sanilac |
$87.00 |
$505 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $18.00 Generic: $20.00 Preferred Brand: 18% Non-Preferred Drug: 31% Specialty Tier: 25%
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HAP Senior Plus Option 1 (HMO-POS) - H2354-021-0
Benefit Details
|
Sanilac |
$99.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 48% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
PriorityMedicare (HMO-POS) - H2320-028-4
Benefit Details
|
Sanilac |
$105.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $8.00 Preferred Brand: $38.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
PriorityMedicare Merit (PPO) - H4875-016-2
Benefit Details
|
Sanilac |
$119.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,100 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 |
BCN Advantage HMO-POS Classic (HMO-POS) - H5883-002-3
Benefit Details
|
Sanilac |
$122.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $38.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,800 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Signature (PPO) - H9572-001-3
Benefit Details
|
Sanilac |
$150.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 48% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HAP Senior Plus Option 3 (PPO) - H2322-008-0
Benefit Details
|
Sanilac |
$165.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $42.00 Non-Preferred Drug: 48% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,000 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 |
HAP Senior Plus Option 4 (PPO) - H2322-004-0
Benefit Details
|
Sanilac |
$180.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $42.00 Non-Preferred Drug: 48% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HAP Senior Plus Option 2 (HMO-POS) - H2354-022-0
Benefit Details
|
Sanilac |
$190.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 48% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
PriorityMedicare Select (PPO) - H4875-017-4
Benefit Details
|
Sanilac |
$223.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,500 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 |
BCN Advantage HMO-POS Prestige (HMO-POS) - H5883-003-3
Benefit Details
|
Sanilac |
$236.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $38.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) - H9572-003-3
Benefit Details
|
Sanilac |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|