AARP Medicare Advantage Patriot No Rx GA-MA01 (PPO) - H1889-022-0
Benefits & Contact Info
|
Wilkes |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Aetna Medicare Eagle (PPO) - H3288-034-0
Benefits & Contact Info
|
Wilkes |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,350 |
|
|
|
|
Aetna Medicare Eagle Plus (PPO) - H2293-009-0
Benefits & Contact Info
|
Wilkes |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,900 |
|
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Veteran (HMO) - H5422-014-0
Benefits & Contact Info
|
Wilkes |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $7,550 |
|
|
|
|
Clover Health Valor (PPO) - H5141-056-0
Benefits & Contact Info
|
Wilkes |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $7,499 |
|
|
|
|
Humana USAA Honor (PPO) - H5216-217-0
Benefits & Contact Info
|
Wilkes |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-157 (PPO) - H5216-157-0
Benefits & Contact Info
|
Wilkes |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,100 |
|
|
|
|
HumanaChoice R3392-001 (Regional PPO) - R3392-001-0
Benefits & Contact Info
|
Wilkes |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $7,550 |
|
|
|
|
UHC Medicare Advantage Patriot No Rx GS-MA01 (Regional PPO) - R2604-005-0
Benefits & Contact Info
|
Wilkes |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $7,500 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO-POS) - H1112-034-0
Benefits & Contact Info
|
Wilkes |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 |
|
|
|
|
AARP Medicare Advantage from UHC GA-0004 (PPO) - H1889-021-0
Benefits & Contact Info
|
Wilkes |
$0.00 |
$395 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: 27%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
|
AARP Medicare Advantage from UHC GA-0005 (HMO-POS) - H5322-041-0
Benefits & Contact Info
|
Wilkes |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $6,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare Freedom (PPO) - H3288-031-0
Benefits & Contact Info
|
Wilkes |
$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 | $8,850 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Freedom Plus (PPO) - H2293-008-0
Benefits & Contact Info
|
Wilkes |
$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 | $6,350 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Kidney Care (HMO C-SNP) - H5422-015-0
Benefits & Contact Info
|
Wilkes |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage (HMO) - H5422-011-0
Benefits & Contact Info
|
Wilkes |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $11.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $7,100 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) - H4036-031-0
Benefits & Contact Info
|
Wilkes |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $13.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Choice Plan (PPO) - H9589-003-0
Benefits & Contact Info
|
Wilkes |
$0.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 29%
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 |
Clear Spring Health Select Plus (HMO) - H6672-005-0
Benefits & Contact Info
|
Wilkes |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
|
-- |
-- |
Higher cost-sharing at standard network pharmacies. Details:
|
Clover Health LiveHealthy (PPO) - H5141-026-0
Benefits & Contact Info
|
Wilkes |
$0.00 |
$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 | $7,999 Browse Formulary |
|
|
|
|
Humana Gold Choice H8145-069 (PFFS) - H8145-069-0
Benefits & Contact Info
|
Wilkes |
$0.00 |
$340 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: 28%
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 Gold Plus H4141-017 (HMO) - H4141-017-5
Benefits & Contact Info
|
Wilkes |
$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 |
|
|
|
|
Humana USAA Honor (PPO) - H5216-286-0
Benefits & Contact Info
|
Wilkes |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $8,600 |
|
|
|
|
HumanaChoice - Diabetes and Heart (PPO C-SNP) - H5216-246-0
Benefits & Contact Info
|
Wilkes |
$0.00 |
$145 Tier 1, 2, 3 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: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-154 (PPO) - H5216-154-0
Benefits & Contact Info
|
Wilkes |
$0.00 |
$400 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 27%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-207 (PPO) - H5216-207-0
Benefits & Contact Info
|
Wilkes |
$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 | $8,300 Browse Formulary |
|
|
|
|
HumanaChoice H5216-345 (PPO) - H5216-345-0
Benefits & Contact Info
|
Wilkes |
$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 | $8,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-349 (PPO) - H5216-349-0
Benefits & Contact Info
|
Wilkes |
$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 | $3,450 Browse Formulary |
|
|
|
|
HumanaChoice R3392-004 (Regional PPO) - R3392-004-0
Benefits & Contact Info
|
Wilkes |
$0.00 |
$195 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
UHC Complete Care GA-0003 (PPO C-SNP) - H1889-020-0
Benefits & Contact Info
|
Wilkes |
$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 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UHC Medicare Advantage GA-0002 (PPO) - H1889-013-0
Benefits & Contact Info
|
Wilkes |
$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 | $6,300 Browse Formulary |
|
|
|
|
Wellcare Giveback (HMO) - H1112-042-0
Benefits & Contact Info
|
Wilkes |
$0.00 |
$545 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Mutual of Omaha No Premium Open (PPO) - H0111-001-0
Benefits & Contact Info
|
Wilkes |
$0.00 |
$200 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: 50% Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $7,500 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 |
Wellcare No Premium (HMO) - H1112-039-0
Benefits & Contact Info
|
Wilkes |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $6,350 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-142 (PPO) - H5216-142-2
Benefits & Contact Info
|
Wilkes |
$7.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $7,800 Browse Formulary |
|
|
|
|
Humana Together in Health (PPO I-SNP) - H5216-242-0
Benefits & Contact Info
|
Wilkes |
$18.00 |
$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 |
PruittHealth Premier Advantage (HMO I-SNP) - H3291-003-0
Benefits & Contact Info
|
Wilkes |
$20.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
UHC Complete Care GS-001A (Regional PPO C-SNP) - R2604-002-0
Benefits & Contact Info
|
Wilkes |
$20.70 |
$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 |
|
|
|
|
Aetna Medicare Value Plus (PPO) - H2293-001-0
Benefits & Contact Info
|
Wilkes |
$25.20 |
$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 | $8,300 Browse Formulary |
|
new |
new |
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 Preferred Premium (PPO) - H3288-042-0
Benefits & Contact Info
|
Wilkes |
$28.00 |
$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 | $8,300 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
UHC Complete Care GS-0002 (Regional PPO C-SNP) - R2604-003-0
Benefits & Contact Info
|
Wilkes |
$28.00 |
$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 | n/a Browse Formulary |
|
|
|
|
Anthem Dual Advantage (HMO D-SNP) - H5422-018-0
Benefits & Contact Info
|
Wilkes |
$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% Tier 6: 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 |
UHC Dual Complete GA-D002 (HMO-POS D-SNP) - H5322-030-0
Benefits & Contact Info
|
Wilkes |
$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 Dual Select Choice (PPO D-SNP) - H2293-022-0
Benefits & Contact Info
|
Wilkes |
$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 |
|
new |
new |
|
Anthem Extra Help (HMO) - H5422-013-0
Benefits & Contact Info
|
Wilkes |
$32.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $5.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare Dual Choice (PPO D-SNP) - H2293-021-0
Benefits & Contact Info
|
Wilkes |
$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 |
|
new |
new |
|
Wellcare Assist (HMO) - H1112-043-0
Benefits & Contact Info
|
Wilkes |
$35.00 |
$410 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: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clover Health LiveHealthy Value (PPO) - H5141-045-0
Benefits & Contact Info
|
Wilkes |
$35.50 |
$545 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: 23% Non-Preferred Drug: 33% Specialty Tier: 25%
all covered insulin pay $35 or less | $7,499 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 from UHC GA-0006 (HMO-POS) - H5322-042-0
Benefits & Contact Info
|
Wilkes |
$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 | $4,900 Browse Formulary |
|
|
|
|
UHC Dual Complete GA-S001 (PPO D-SNP) - H3256-001-0
Benefits & Contact Info
|
Wilkes |
$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 Dual Liberty (HMO D-SNP) - H1112-033-0
Benefits & Contact Info
|
Wilkes |
$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 |
Anthem Full Dual Advantage (PPO D-SNP) - H4036-032-0
Benefits & Contact Info
|
Wilkes |
$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 Tier 6: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Humana Gold Plus SNP-DE H4141-003 (HMO D-SNP) - H4141-003-0
Benefits & Contact Info
|
Wilkes |
$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) - H1112-006-0
Benefits & Contact Info
|
Wilkes |
$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 |
Anthem Full Dual Advantage (HMO D-SNP) - H5422-019-0
Benefits & Contact Info
|
Wilkes |
$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 Tier 6: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Anthem Full Dual Advantage 2 (HMO D-SNP) - H5422-007-0
Benefits & Contact Info
|
Wilkes |
$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 Tier 6: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Georgia Health Advantage (HMO I-SNP) - H8093-001-0
Benefits & Contact Info
|
Wilkes |
$44.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Georgia Health Advantage Choice (HMO I-SNP) - H8093-002-0
Benefits & Contact Info
|
Wilkes |
$44.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
HumanaChoice H5216-284 (PPO) - H5216-284-0
Benefits & Contact Info
|
Wilkes |
$44.20 |
$545 Tier 1 exempt |
Yes, some additional gap coverage. | 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 | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice SNP-DE H5216-205 (PPO D-SNP) - H5216-205-0
Benefits & Contact Info
|
Wilkes |
$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 SNP-DE H5216-206 (PPO D-SNP) - H5216-206-0
Benefits & Contact Info
|
Wilkes |
$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 |
|
|
|
|
PruittHealth Premier (HMO I-SNP) - H3291-001-0
Benefits & Contact Info
|
Wilkes |
$44.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
UHC Dual Complete GA-V001 (PPO D-SNP) - H3256-002-0
Benefits & Contact Info
|
Wilkes |
$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 Access Open (PPO D-SNP) - H0111-004-0
Benefits & Contact Info
|
Wilkes |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Anthem Medicare Advantage 2 (PPO) - H4036-030-0
Benefits & Contact Info
|
Wilkes |
$59.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $13.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $6,050 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
UHC Medicare Advantage GS-0001 (Regional PPO) - R2604-001-0
Benefits & Contact Info
|
Wilkes |
$62.00 |
$345 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 | $6,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R3392-002 (Regional PPO) - R3392-002-0
Benefits & Contact Info
|
Wilkes |
$92.00 |
$340 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: 28%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
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