AARP Medicare Advantage Patriot No Rx PA-MA01 (HMO-POS) - H1944-030-0
Benefits & Contact Info
|
Lycoming |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
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|
Aetna Medicare Advantra Eagle (HMO-POS) - H3959-041-0
Benefits & Contact Info
|
Lycoming |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,900 |
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|
Freedom Blue PPO Valor (PPO) - H3916-043-0
Benefits & Contact Info
|
Lycoming |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,000 |
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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 |
Geisinger Gold Heritage (HMO) - H3954-162-0
Benefits & Contact Info
|
Lycoming |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
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Humana Gold Choice H8145-055 (PFFS) - H8145-055-0
Benefits & Contact Info
|
Lycoming |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a |
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Humana USAA Honor (PPO) - H5216-221-0
Benefits & Contact Info
|
Lycoming |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
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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 |
HumanaChoice H5216-116 (PPO) - H5216-116-0
Benefits & Contact Info
|
Lycoming |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,900 |
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HumanaChoice R0923-001 (Regional PPO) - R0923-001-0
Benefits & Contact Info
|
Lycoming |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
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|
Wellcare Patriot Giveback (HMO) - H2915-013-0
Benefits & Contact Info
|
Lycoming |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $7,550 |
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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 |
AARP Medicare Advantage from UHC PA-0002 (HMO-POS) - H1944-010-0
Benefits & Contact Info
|
Lycoming |
$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 | $5,900 Browse Formulary |
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AARP Medicare Advantage from UHC PA-0011 (PPO) - H2406-072-0
Benefits & Contact Info
|
Lycoming |
$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 |
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AARP Medicare Advantage from UHC PA-0012 (PPO) - H2406-101-0
Benefits & Contact Info
|
Lycoming |
$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 | $8,300 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 Advantra Credit Value (PPO) - H5522-017-0
Benefits & Contact Info
|
Lycoming |
$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 |
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Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Advantra Gold (HMO-POS) - H3959-037-0
Benefits & Contact Info
|
Lycoming |
$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 |
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Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Advantra Silver (PPO) - H5522-004-0
Benefits & Contact Info
|
Lycoming |
$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 |
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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 |
Aetna Medicare Deluxe Plan (PPO) - H5522-023-0
Benefits & Contact Info
|
Lycoming |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 20% Non-Preferred Drug: 50% 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:
|
Aetna Medicare Essentials Plan (PPO) - H5522-027-0
Benefits & Contact Info
|
Lycoming |
$0.00 |
$300 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: 25% Non-Preferred Drug: 40% Specialty Tier: 28%
all covered insulin pay $35 or less | $4,850 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Value (PPO) - H5521-263-0
Benefits & Contact Info
|
Lycoming |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 20% Non-Preferred Drug: 50% 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 |
Community Blue Medicare Plus PPO Signature (PPO) - H3916-039-0
Benefits & Contact Info
|
Lycoming |
$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 | $7,950 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Geisinger Gold Classic 360 Rx (HMO) - H3954-160-0
Benefits & Contact Info
|
Lycoming |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $8,000 Browse Formulary |
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Geisinger Gold Classic Essential Rx (HMO) - H3954-161-0
Benefits & Contact Info
|
Lycoming |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Vaccines ($0 cost sharing): $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 |
Geisinger Gold Preferred Complete Rx (PPO) - H3924-065-0
Benefits & Contact Info
|
Lycoming |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $8,000 Browse Formulary |
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Geisinger Gold Preferred Enhanced Rx (PPO) - H3924-062-23
Benefits & Contact Info
|
Lycoming |
$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% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $7,550 Browse Formulary |
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Humana Gold Choice H8145-052 (PFFS) - H8145-052-0
Benefits & Contact Info
|
Lycoming |
$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 |
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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 H6622-052 (HMO) - H6622-052-0
Benefits & Contact Info
|
Lycoming |
$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 | $7,600 Browse Formulary |
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|
Humana USAA Honor with Rx (PPO) - H5525-059-0
Benefits & Contact Info
|
Lycoming |
$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 | $7,850 Browse Formulary |
|
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HumanaChoice H5525-051 (PPO) - H5525-051-1
Benefits & Contact Info
|
Lycoming |
$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 | $7,800 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 |
HumanaChoice H5525-058 (PPO) - H5525-058-0
Benefits & Contact Info
|
Lycoming |
$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 | $7,000 Browse Formulary |
|
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|
|
HumanaChoice H5525-060 (PPO) - H5525-060-0
Benefits & Contact Info
|
Lycoming |
$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 | $8,050 Browse Formulary |
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UPMC for Life HMO No Rx (HMO) - H3907-002-0
Benefits & Contact Info
|
Lycoming |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 |
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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 |
UPMC for Life HMO Premier Rx (HMO) - H3907-046-0
Benefits & Contact Info
|
Lycoming |
$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 | $5,500 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
UPMC for Life PPO Premier Rx (PPO) - H5533-011-0
Benefits & Contact Info
|
Lycoming |
$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 | $5,900 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
UPMC for Life PPO Salute (PPO) - H5533-012-0
Benefits & Contact Info
|
Lycoming |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,500 |
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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 |
Wellcare Giveback Open (PPO) - H2128-004-0
Benefits & Contact Info
|
Lycoming |
$0.00 |
$545 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 49% 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:
|
Wellcare No Premium (HMO) - H2915-016-0
Benefits & Contact Info
|
Lycoming |
$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: 48% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $7,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) - H2128-002-0
Benefits & Contact Info
|
Lycoming |
$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: $42.00 Non-Preferred Drug: 43% Specialty Tier: 30% 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 |
Aetna Medicare Value Plus (PPO) - H5522-013-0
Benefits & Contact Info
|
Lycoming |
$14.60 |
$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 | $6,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
UPMC for Life HMO Deductible Rx (HMO) - H3907-037-0
Benefits & Contact Info
|
Lycoming |
$20.80 |
$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 | $6,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Advantra Premier (HMO-POS) - H3959-039-0
Benefits & Contact Info
|
Lycoming |
$21.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 20% Non-Preferred Drug: 50% 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 |
Wellcare Assist (HMO) - H2915-011-0
Benefits & Contact Info
|
Lycoming |
$21.30 |
$435 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: 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:
|
UPMC for Life PPO Rx Choice (PPO) - H5533-009-0
Benefits & Contact Info
|
Lycoming |
$23.00 |
$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 | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AARP Medicare Advantage from UHC PA-0007 (PPO) - H2406-046-0
Benefits & Contact Info
|
Lycoming |
$25.00 |
$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 |
|
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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 |
HumanaChoice H5525-017 (PPO) - H5525-017-0
Benefits & Contact Info
|
Lycoming |
$26.00 |
$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 | $6,300 Browse Formulary |
|
|
|
|
Community Blue Medicare Plus PPO Distinct (PPO) - H3916-036-0
Benefits & Contact Info
|
Lycoming |
$27.00 |
$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 | $5,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Dual Access Open (PPO D-SNP) - H2128-005-0
Benefits & Contact Info
|
Lycoming |
$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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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UHC Dual Complete PA-V001 (HMO-POS D-SNP) - H3113-014-0
Benefits & Contact Info
|
Lycoming |
$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% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
UHC Nursing Home Plan EX-F002 (PPO I-SNP) - H0710-017-0
Benefits & Contact Info
|
Lycoming |
$32.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Geisinger Gold Classic Complete Rx (HMO) - H3954-158-13
Benefits & Contact Info
|
Lycoming |
$34.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Vaccines ($0 cost sharing): $0.00
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 |
Aetna Medicare Dual Preferred (PPO D-SNP) - H5522-024-0
Benefits & Contact Info
|
Lycoming |
$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 Tier 2: $0.00 Tier 3: $0.00 Tier 4: $0.00 Tier 5: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
UPMC for Life HMO Rx Choice (HMO) - H3907-057-4
Benefits & Contact Info
|
Lycoming |
$36.00 |
$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 | $4,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Silver (HMO-POS) - H3931-070-0
Benefits & Contact Info
|
Lycoming |
$37.00 |
$250 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: 20% Non-Preferred Drug: 50% Specialty Tier: 29%
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 Advantra Cares (HMO D-SNP) - H3959-036-0
Benefits & Contact Info
|
Lycoming |
$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 Tier 2: $0.00 Tier 3: $0.00 Tier 4: $0.00 Tier 5: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
AARP Medicare Advantage from UHC PA-0003 (HMO-POS) - H1944-011-0
Benefits & Contact Info
|
Lycoming |
$39.00 |
$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 | $5,200 Browse Formulary |
|
|
|
|
Aetna Medicare Longevity Plan (HMO I-SNP) - H3959-066-0
Benefits & Contact Info
|
Lycoming |
$39.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 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 |
UHC Dual Complete PA-S002 (HMO-POS D-SNP) - H3113-009-0
Benefits & Contact Info
|
Lycoming |
$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 Tier 2: $0.00 Tier 3: $0.00 Tier 4: $0.00 Tier 5: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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|
|
|
AARP Medicare Advantage from UHC PA-0014 (PPO) - H2577-021-0
Benefits & Contact Info
|
Lycoming |
$40.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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|
|
|
AmeriHealth Caritas VIP Care (HMO D-SNP) - H4227-002-0
Benefits & Contact Info
|
Lycoming |
$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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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Geisinger Gold Secure Rx (HMO D-SNP) - H3954-097-0
Benefits & Contact Info
|
Lycoming |
$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 |
|
|
|
|
Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) - H5932-001-0
Benefits & Contact Info
|
Lycoming |
$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: $38.00 Non-Preferred Drug: 40% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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|
|
|
Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) - H5932-009-0
Benefits & Contact Info
|
Lycoming |
$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: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 46% 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 Value Plus H5216-117 (PPO) - H5216-117-0
Benefits & Contact Info
|
Lycoming |
$40.20 |
$545 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 | $7,800 Browse Formulary |
|
|
|
|
HumanaChoice SNP-DE H5216-227 (PPO D-SNP) - H5216-227-0
Benefits & Contact Info
|
Lycoming |
$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 Tier 2: $0.00 Tier 3: $0.00 Tier 4: $0.00 Tier 5: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
UHC Dual Complete PA-S001 (PPO D-SNP) - H1889-007-0
Benefits & Contact Info
|
Lycoming |
$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 Tier 2: $0.00 Tier 3: $0.00 Tier 4: $0.00 Tier 5: $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
Benefits & Contact Info
|
Lycoming |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Drug: 49% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Dual Access (HMO D-SNP) - H2915-007-0
Benefits & Contact Info
|
Lycoming |
$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 Plus PPO Premier (PPO) - H3916-046-0
Benefits & Contact Info
|
Lycoming |
$46.00 |
$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 | $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 |
HumanaChoice R0923-002 (Regional PPO) - R0923-002-0
Benefits & Contact Info
|
Lycoming |
$46.00 |
$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 |
|
|
|
|
HumanaChoice H5525-005 (PPO) - H5525-005-0
Benefits & Contact Info
|
Lycoming |
$53.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $8,300 Browse Formulary |
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|
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Freedom Blue PPO ValueRx (PPO) - H3916-018-0
Benefits & Contact Info
|
Lycoming |
$58.00 |
$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 |
Freedom Blue PPO Basic (PPO) - H3916-012-0
Benefits & Contact Info
|
Lycoming |
$64.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,900 |
|
|
|
|
Aetna Medicare Advantra Premier Plus (PPO) - H5522-002-0
Benefits & Contact Info
|
Lycoming |
$67.00 |
$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 |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-163 (PFFS) - H8145-163-0
Benefits & Contact Info
|
Lycoming |
$75.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a |
|
|
|
|
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 Rx (HMO) - H3907-029-0
Benefits & Contact Info
|
Lycoming |
$81.00 |
$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 | $4,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Geisinger Gold Preferred Advantage Rx (PPO) - H3924-059-21
Benefits & Contact Info
|
Lycoming |
$94.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,000 Browse Formulary |
|
|
|
|
Geisinger Gold Classic Advantage Rx (HMO) - H3954-157-22
Benefits & Contact Info
|
Lycoming |
$100.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $3,450 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 H5216-120 (PPO) - H5216-120-0
Benefits & Contact Info
|
Lycoming |
$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 | $7,600 Browse Formulary |
|
|
|
|
Aetna Medicare Gold Plan (PPO) - H5521-122-0
Benefits & Contact Info
|
Lycoming |
$145.00 |
$250 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: 20% Non-Preferred Drug: 50% Specialty Tier: 29%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Freedom Blue PPO Standard (PPO) - H3916-015-0
Benefits & Contact Info
|
Lycoming |
$164.00 |
$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:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Freedom Blue PPO Deluxe (PPO) - H3916-005-0
Benefits & Contact Info
|
Lycoming |
$278.00 |
$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
Benefits & Contact Info
|
Lycoming |
$295.00 |
$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 | $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|