AARP Medicare Advantage Patriot No Rx FL-MA01 (Regional PPO) - R0759-002-0
Benefits & Contact Info
|
Seminole |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $7,500 |
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Aetna Medicare Eagle (PPO) - H5521-440-0
Benefits & Contact Info
|
Seminole |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 |
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BlueMedicare Patriot (PPO) - H5434-044-0
Benefits & Contact Info
|
Seminole |
$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 |
CareSalute (HMO) - H1019-133-0
Benefits & Contact Info
|
Seminole |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
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Cigna Courage Medicare (HMO) - H5410-057-0
Benefits & Contact Info
|
Seminole |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 |
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Freedom Savings Plan (HMO) - H5427-052-0
Benefits & Contact Info
|
Seminole |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 |
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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 USAA Honor (HMO) - H1036-290-0
Benefits & Contact Info
|
Seminole |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
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Humana USAA Honor (PPO) - H5216-257-0
Benefits & Contact Info
|
Seminole |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,100 |
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AARP Medicare Advantage from UHC FL-0007 (HMO-POS) - H1045-030-0
Benefits & Contact Info
|
Seminole |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $2,900 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 |
AARP Medicare Advantage from UHC FL-0018 (PPO) - H2406-010-0
Benefits & Contact Info
|
Seminole |
$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 |
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AARP Medicare Advantage from UHC FL-0031 (Regional PPO) - R0759-001-0
Benefits & Contact Info
|
Seminole |
$0.00 |
$395 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 27%
all covered insulin pay $35 or less | $7,900 Browse Formulary |
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Advantage Care by Ultimate (HMO C-SNP) - H2962-050-0
Benefits & Contact Info
|
Seminole |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic: $0.00 Preferred Brand: $25.00 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
Benefits & Contact Info
|
Seminole |
$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 Choice (HMO-POS) - H1609-028-0
Benefits & Contact Info
|
Seminole |
$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 | $5,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Explorer Premier (PPO) - H5521-436-0
Benefits & Contact Info
|
Seminole |
$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 | $4,700 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 Premier (PPO) - H5521-268-0
Benefits & Contact Info
|
Seminole |
$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 | $5,000 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Premier (PPO) - H5521-033-0
Benefits & Contact Info
|
Seminole |
$0.00 |
$300 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: 28%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Select (HMO) - H1609-042-0
Benefits & Contact Info
|
Seminole |
$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 | $2,600 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 |
AvMed Medicare One (HMO) - H1016-030-0
Benefits & Contact Info
|
Seminole |
$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 |
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Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Classic (HMO) - H1035-020-0
Benefits & Contact Info
|
Seminole |
$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 | $5,000 Browse Formulary |
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BlueMedicare Premier (HMO) - H1035-026-0
Benefits & Contact Info
|
Seminole |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Drug: $93.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $2,900 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 |
BlueMedicare Value (PPO) - H5434-033-0
Benefits & Contact Info
|
Seminole |
$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 | $4,900 Browse Formulary |
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CareAccess (HMO) - H1019-144-0
Benefits & Contact Info
|
Seminole |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $85.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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CareBreeze Platinum (HMO C-SNP) - H1019-125-0
Benefits & Contact Info
|
Seminole |
$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 |
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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 |
CareComplete Platinum (HMO C-SNP) - H1019-122-0
Benefits & Contact Info
|
Seminole |
$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 |
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CareFree (HMO) - H1019-120-2
Benefits & Contact Info
|
Seminole |
$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 | $3,850 Browse Formulary |
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CareFree Platinum (HMO) - H1019-138-0
Benefits & Contact Info
|
Seminole |
$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 | $3,300 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 |
CareOne Plus (HMO-POS) - H1019-057-0
Benefits & Contact Info
|
Seminole |
$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 |
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Cigna Preferred Medicare (HMO) - H5410-024-0
Benefits & Contact Info
|
Seminole |
$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 | $2,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Cigna Preferred Savings Medicare (HMO) - H5410-026-0
Benefits & Contact Info
|
Seminole |
$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 | $3,200 Browse Formulary |
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|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Cigna True Choice Access Medicare (PPO) - H7849-116-0
Benefits & Contact Info
|
Seminole |
$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 | $4,600 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Cigna True Choice Medicare (PPO) - H7849-017-0
Benefits & Contact Info
|
Seminole |
$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 | $4,500 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Devoted CHOICE Orlando (PPO) - H9884-003-0
Benefits & Contact Info
|
Seminole |
$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 |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Devoted CORE Orlando (HMO) - H1290-005-0
Benefits & Contact Info
|
Seminole |
$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 | $2,900 Browse Formulary |
|
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Devoted ESSENTIALS Orlando (HMO) - H1290-018-0
Benefits & Contact Info
|
Seminole |
$0.00 |
$150 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: 30%
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
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FHCP Medicare Premier Advantage (HMO) - H1035-040-0
Benefits & Contact Info
|
Seminole |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $44.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $3,650 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 |
FHCP Medicare Premier Plus (HMO) - H1035-011-0
Benefits & Contact Info
|
Seminole |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $45.00 Non-Preferred Drug: $98.00 Specialty Tier: 33% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $5,200 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
FHCP Medicare Rx Savings (HMO) - H1035-014-0
Benefits & Contact Info
|
Seminole |
$0.00 |
$395 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Drug: $98.00 Specialty Tier: 25% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $8,300 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Freedom Maximo (HMO-POS) - H5427-112-0
Benefits & Contact Info
|
Seminole |
$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 |
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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 |
Freedom Platinum Plan Rx (HMO) - H5427-089-0
Benefits & Contact Info
|
Seminole |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Drug: $65.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $2,000 Browse Formulary |
|
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Freedom Platinum Rewards Plan Rx (HMO) - H5427-102-0
Benefits & Contact Info
|
Seminole |
$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 |
|
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Freedom VIP Care (HMO C-SNP) - H5427-070-0
Benefits & Contact Info
|
Seminole |
$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 |
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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 |
Freedom VIP Savings (HMO C-SNP) - H5427-072-0
Benefits & Contact Info
|
Seminole |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Drug: $60.00 Specialty Tier: 33% Select Diabetic Drugs: $10.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
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Freedom VIP Savings COPD (HMO C-SNP) - H5427-077-0
Benefits & Contact Info
|
Seminole |
$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 |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) - H1036-300-0
Benefits & Contact Info
|
Seminole |
$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 |
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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 H1036-146 (HMO) - H1036-146-0
Benefits & Contact Info
|
Seminole |
$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
Benefits & Contact Info
|
Seminole |
$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 |
|
|
|
|
Humana Gold Plus Lung (HMO C-SNP) - H1036-313-0
Benefits & Contact Info
|
Seminole |
$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 |
|
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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 Florida H5216-072 (PPO) - H5216-072-0
Benefits & Contact Info
|
Seminole |
$0.00 |
$150 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $5,400 Browse Formulary |
|
|
|
|
HumanaChoice Florida H5216-304 (PPO) - H5216-304-0
Benefits & Contact Info
|
Seminole |
$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 Florida H5216-393 (PPO) - H5216-393-0
Benefits & Contact Info
|
Seminole |
$0.00 |
$350 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
all covered insulin pay $35 or less | $6,500 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 |
Optimum Diamond Savings (HMO C-SNP) - H5594-030-0
Benefits & Contact Info
|
Seminole |
$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 |
|
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|
|
Optimum Diamond Savings COPD (HMO C-SNP) - H5594-031-0
Benefits & Contact Info
|
Seminole |
$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 |
|
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|
|
Optimum Gold Rewards Plan (HMO) - H5594-022-0
Benefits & Contact Info
|
Seminole |
$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 |
|
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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 |
Premier by Ultimate (HMO) - H2962-046-0
Benefits & Contact Info
|
Seminole |
$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 | $2,900 Browse Formulary |
|
|
|
|
Simply Comfort (HMO I-SNP) - H5471-068-0
Benefits & Contact Info
|
Seminole |
$0.00 |
$545 Tier 1 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Simply Extra (HMO) - H5471-107-0
Benefits & Contact Info
|
Seminole |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33%
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 |
Simply Extra Platinum (HMO) - H5471-120-0
Benefits & Contact Info
|
Seminole |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $3,200 Browse Formulary |
|
|
|
|
Simply Freedom (PPO) - H9469-006-0
Benefits & Contact Info
|
Seminole |
$0.00 |
$150 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
|
new |
new |
|
Simply Level (HMO C-SNP) - H5471-073-0
Benefits & Contact Info
|
Seminole |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Brand: $75.00 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 |
Simply Level Platinum (HMO C-SNP) - H5471-122-0
Benefits & Contact Info
|
Seminole |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Simply More (HMO) - H5471-074-0
Benefits & Contact Info
|
Seminole |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Brand: $75.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
|
|
|
|
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP) - H1045-048-1
Benefits & Contact Info
|
Seminole |
$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:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Giveback (HMO) - H1032-212-0
Benefits & Contact Info
|
Seminole |
$0.00 |
$545 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 44% 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 No Premium (HMO) - H1032-213-0
Benefits & Contact Info
|
Seminole |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $42.00 Non-Preferred Drug: 43% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $2,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) - H5199-012-0
Benefits & Contact Info
|
Seminole |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $42.00 Non-Preferred Drug: 40% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Devoted DUAL PLUS Florida (HMO D-SNP) - H1290-052-0
Benefits & Contact Info
|
Seminole |
$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% Supplemental Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Devoted DUAL Orlando (HMO D-SNP) - H1290-022-0
Benefits & Contact Info
|
Seminole |
$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% Supplemental Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Freedom Medi-Medi Full (HMO D-SNP) - H5427-087-0
Benefits & Contact Info
|
Seminole |
$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 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Devoted PREMIUM Florida (HMO) - H1290-037-4
Benefits & Contact Info
|
Seminole |
$21.90 |
$545 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
all covered insulin pay $35 or less | $3,400 Browse Formulary |
|
|
|
|
HumanaChoice Florida H5216-392 (PPO) - H5216-392-0
Benefits & Contact Info
|
Seminole |
$22.00 |
$150 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Drug: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $3,400 Browse Formulary |
|
|
|
|
Optimum Emerald Partial (HMO D-SNP) - H5594-016-0
Benefits & Contact Info
|
Seminole |
$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 |
|
|
|
|
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
Benefits & Contact Info
|
Seminole |
$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 |
|
|
|
|
Wellcare Dual Access Open (PPO D-SNP) - H5199-016-0
Benefits & Contact Info
|
Seminole |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Cigna TotalCare Plus (HMO D-SNP) - H5410-025-0
Benefits & Contact Info
|
Seminole |
$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 |
Freedom Medi-Medi Partial (HMO D-SNP) - H5427-078-0
Benefits & Contact Info
|
Seminole |
$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 |
|
|
|
|
Cigna TotalCare (HMO D-SNP) - H5410-046-0
Benefits & Contact Info
|
Seminole |
$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 |
|
|
|
|
Aetna Medicare Assure Plus (HMO D-SNP) - H1609-046-0
Benefits & Contact Info
|
Seminole |
$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: $10.00 Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
CareNeeds Plus (HMO D-SNP) - H1019-026-0
Benefits & Contact Info
|
Seminole |
$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 |
|
|
|
|
Advantage Plus by Ultimate (Full) (HMO D-SNP) - H2962-035-0
Benefits & Contact Info
|
Seminole |
$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 |
|
|
|
|
Humana Fully Integrated H1036-280 (HMO D-SNP) - H1036-280-0
Benefits & Contact Info
|
Seminole |
$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 |
HumanaChoice R5826-074 (Regional PPO) - R5826-074-0
Benefits & Contact Info
|
Seminole |
$31.00 |
$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: 27%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
|
UHC Nursing Home Plan FL-F001 (PPO I-SNP) - H0710-010-0
Benefits & Contact Info
|
Seminole |
$32.40 |
$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 |
|
-- |
|
|
CareNeeds Platinum (HMO D-SNP) - H1019-146-0
Benefits & Contact Info
|
Seminole |
$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 |
|
|
|
|
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 (Partial) (HMO D-SNP) - H2962-036-0
Benefits & Contact Info
|
Seminole |
$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 |
|
|
|
|
Humana Gold Plus SNP-DE H1036-314 (HMO D-SNP) - H1036-314-0
Benefits & Contact Info
|
Seminole |
$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 |
|
|
|
|
Wellcare All Dual (HMO D-SNP) - H1032-124-0
Benefits & Contact Info
|
Seminole |
$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 |
Simply Complete (HMO D-SNP) - H5471-072-0
Benefits & Contact Info
|
Seminole |
$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 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 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
Benefits & Contact Info
|
Seminole |
$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 |
|
|
|
|
Wellcare Dual Liberty (HMO D-SNP) - H1032-175-0
Benefits & Contact Info
|
Seminole |
$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 |
American Health Advantage of Florida (HMO I-SNP) - H6652-001-0
Benefits & Contact Info
|
Seminole |
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
-- |
|
BlueMedicare Complete (HMO D-SNP) - H1035-029-0
Benefits & Contact Info
|
Seminole |
$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 |
|
|
|
|
Florida Complete Care (HMO I-SNP) - H9986-001-0
Benefits & Contact Info
|
Seminole |
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
new |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Florida Complete Care- D-SNP (HMO D-SNP) - H9986-003-0
Benefits & Contact Info
|
Seminole |
$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 |
|
new |
|
|
Florida Complete Care- In The Community (HMO I-SNP) - H9986-002-0
Benefits & Contact Info
|
Seminole |
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
new |
|
|
HumanaChoice Florida SNP-DE H5216-394 (PPO D-SNP) - H5216-394-0
Benefits & Contact Info
|
Seminole |
$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 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Longevity Health Plan (HMO I-SNP) - H1644-001-0
Benefits & Contact Info
|
Seminole |
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simply Complete Platinum (HMO D-SNP) - H5471-121-0
Benefits & Contact Info
|
Seminole |
$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 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
UHC Care Advantage FL-E001 (PPO I-SNP) - H0710-012-0
Benefits & Contact Info
|
Seminole |
$37.70 |
$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 |
UHC Dual Complete FL-D002 (HMO-POS D-SNP) - H1045-039-0
Benefits & Contact Info
|
Seminole |
$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 Dual Complete FL-D003 (PPO D-SNP) - H1889-002-1
Benefits & Contact Info
|
Seminole |
$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 Dual Complete FL-D005 (Regional PPO D-SNP) - R0759-003-0
Benefits & Contact Info
|
Seminole |
$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 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Dual Reserve (HMO D-SNP) - H1032-202-0
Benefits & Contact Info
|
Seminole |
$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 |
|
|
|
|
HumanaChoice R5826-018 (Regional PPO) - R5826-018-0
Benefits & Contact Info
|
Seminole |
$59.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $7,550 |
|
|
|
|
BlueMedicare Choice (Regional PPO) - R3332-001-0
Benefits & Contact Info
|
Seminole |
$67.40 |
$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 |
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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 Florida H7284-001 (PPO) - H7284-001-0
Benefits & Contact Info
|
Seminole |
$90.00 |
$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 |
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Wellcare Premium Enhanced Open (PPO) - H5199-010-0
Benefits & Contact Info
|
Seminole |
$93.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $42.00 Non-Preferred Drug: 46% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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HumanaChoice R5826-005 (Regional PPO) - R5826-005-0
Benefits & Contact Info
|
Seminole |
$173.00 |
$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 |
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