Advantage Care by Ultimate (HMO C-SNP) - H2962-051-0
Benefits & Contact Info
|
Polk |
$0.00 |
$0 |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Drug: $60.00 Specialty Tier: 33% Select Care Drugs: $10.00
all covered insulin pay $35 or less | Cardiovascular Disorders, Chronic Heart Failure, Diabetes Mellitus Browse Formulary |
|
|
|
|
Advantage Care COPD by Ultimate (HMO C-SNP) - H2962-023-0
Benefits & Contact Info
|
Polk |
$0.00 |
$0 |
Enhanced Alternative (EA) | Preferred Generic: $0.00 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 | Chronic Lung Disorders Browse Formulary |
|
|
|
|
CareBreeze Platinum (HMO C-SNP) - H1019-151-2
Benefits & Contact Info
|
Polk |
$0.00 |
$0 |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | Chronic Lung Disorders Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
SNP Type |
Service |
Exper. |
Cost Info |
CareComplete (HMO C-SNP) - H1019-150-0
Benefits & Contact Info
|
Polk |
$0.00 |
$0 |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $40.00 Non-Preferred Drug: 50% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | Cardiovascular Disorders, Chronic Heart Failure, Diabetes Mellitus Browse Formulary |
|
|
|
|
CareComplete Platinum (HMO C-SNP) - H1019-147-2
Benefits & Contact Info
|
Polk |
$0.00 |
$0 |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Drug: 35% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | Cardiovascular Disorders, Chronic Heart Failure, Diabetes Mellitus Browse Formulary |
|
|
|
|
CareNeeds Platinum (HMO D-SNP) - H1019-146-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: 25% Specialty Tier: 25%
all covered insulin pay $35 or less | Dual-Eligible Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
SNP Type |
Service |
Exper. |
Cost Info |
CareNeeds Plus (HMO D-SNP) - H1019-073-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Enhanced Alternative (EA) | Preferred Generic: 24% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
all covered insulin pay $35 or less | Dual-Eligible Browse Formulary |
|
|
|
|
Devoted DUAL PLUS Florida (HMO D-SNP) - H1290-052-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Enhanced Alternative (EA) | 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 | Dual-Eligible Browse Formulary |
|
|
|
|
Freedom Medi-Medi Full (HMO D-SNP) - H5427-087-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Enhanced Alternative (EA) | Preferred Generic: 24% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Supplemental Drugs: $0.00
all covered insulin pay $35 or less | Dual-Eligible Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
SNP Type |
Service |
Exper. |
Cost Info |
Freedom VIP Care (HMO C-SNP) - H5427-070-0
Benefits & Contact Info
|
Polk |
$0.00 |
$0 |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Preferred Brand: $5.00 Non-Preferred Drug: $50.00 Specialty Tier: 33% Select Diabetic Drugs: $0.00
all covered insulin pay $35 or less | Cardiovascular Disorders, Chronic Heart Failure, Diabetes Mellitus Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Freedom VIP Rewards (HMO C-SNP) - H5427-099-0
Benefits & Contact Info
|
Polk |
$0.00 |
$0 |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Drug: $65.00 Specialty Tier: 33% Select Diabetic Drugs: $10.00
all covered insulin pay $35 or less | Cardiovascular Disorders, Chronic Heart Failure, Diabetes Mellitus Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Freedom VIP Savings (HMO C-SNP) - H5427-072-0
Benefits & Contact Info
|
Polk |
$0.00 |
$0 |
Enhanced Alternative (EA) | 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 | Cardiovascular Disorders, Chronic Heart Failure, Diabetes Mellitus Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
SNP Type |
Service |
Exper. |
Cost Info |
Freedom VIP Savings COPD (HMO C-SNP) - H5427-077-0
Benefits & Contact Info
|
Polk |
$0.00 |
$0 |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Drug: $60.00 Specialty Tier: 33%
all covered insulin pay $35 or less | Chronic Lung Disorders Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Fully Integrated H1036-280 (HMO D-SNP) - H1036-280-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: 25% Specialty Tier: 25%
all covered insulin pay $35 or less | Dual-Eligible Browse Formulary |
|
|
|
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) - H1036-299-0
Benefits & Contact Info
|
Polk |
$0.00 |
$0 |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Drug: 35% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | Cardiovascular Disorders, Chronic Heart Failure, Diabetes Mellitus Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
SNP Type |
Service |
Exper. |
Cost Info |
Humana Gold Plus Lung (HMO C-SNP) - H1036-312-0
Benefits & Contact Info
|
Polk |
$0.00 |
$0 |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | Chronic Lung Disorders Browse Formulary |
|
|
|
|
Humana Gold Plus SNP-DE H1036-102 (HMO D-SNP) - H1036-102-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: 25% Specialty Tier: 25%
all covered insulin pay $35 or less | Dual-Eligible Browse Formulary |
|
|
|
|
Humana Gold Plus SNP-DE H1036-314 (HMO D-SNP) - H1036-314-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: 25% Specialty Tier: 25%
all covered insulin pay $35 or less | Dual-Eligible Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
SNP Type |
Service |
Exper. |
Cost Info |
Optimum Diamond Savings (HMO C-SNP) - H5594-030-0
Benefits & Contact Info
|
Polk |
$0.00 |
$0 |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $85.00 Specialty Tier: 33% Select Diabetic Drugs: $10.00
all covered insulin pay $35 or less | Cardiovascular Disorders, Chronic Heart Failure, Diabetes Mellitus Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Optimum Diamond Savings COPD (HMO C-SNP) - H5594-031-0
Benefits & Contact Info
|
Polk |
$0.00 |
$0 |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $85.00 Specialty Tier: 33%
all covered insulin pay $35 or less | Chronic Lung Disorders Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Optimum Emerald Full (HMO D-SNP) - H5594-017-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Enhanced Alternative (EA) | Preferred Generic: 24% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Supplemental Drugs: $0.00
all covered insulin pay $35 or less | Dual-Eligible Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
SNP Type |
Service |
Exper. |
Cost Info |
Simply Comfort (HMO I-SNP) - H5471-068-0
Benefits & Contact Info
|
Polk |
$0.00 |
$590 Tier 1 and 6 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Supplemental Drugs: $0.00
all covered insulin pay $35 or less | Institutional Browse Formulary |
|
|
|
|
Simply Complete (HMO D-SNP) - H5471-066-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Enhanced Alternative (EA) | Preferred Generic: $1.00 Generic: $3.00 Preferred Brand: 14% Non-Preferred Drug: 25% Specialty Tier: 25% Supplemental Drugs: $0.00
all covered insulin pay $35 or less | Dual-Eligible Browse Formulary |
|
|
|
|
Simply Complete Platinum (HMO D-SNP) - H5471-118-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Enhanced Alternative (EA) | Preferred Generic: 24% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Supplemental Drugs: $0.00
all covered insulin pay $35 or less | Dual-Eligible Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
SNP Type |
Service |
Exper. |
Cost Info |
Simply Level (HMO C-SNP) - H5471-070-0
Benefits & Contact Info
|
Polk |
$0.00 |
$0 |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $15.00 Non-Preferred Drug: $55.00 Specialty Tier: 33% Supplemental Drugs: $0.00
all covered insulin pay $35 or less | Cardiovascular Disorders, Chronic Heart Failure, Diabetes Mellitus Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Simply Level Platinum (HMO C-SNP) - H5471-119-0
Benefits & Contact Info
|
Polk |
$0.00 |
$0 |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Supplemental Drugs: $0.00
all covered insulin pay $35 or less | Cardiovascular Disorders, Chronic Heart Failure, Diabetes Mellitus Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Solis Wellness Plan (HMO C-SNP) - H0982-021-0
Benefits & Contact Info
|
Polk |
$0.00 |
$0 |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $15.00 Non-Preferred Drug: $75.00 Specialty Tier: 33% Supplemental Drugs: $0.00
all covered insulin pay $35 or less | Cardiovascular Disorders, Chronic Heart Failure, Diabetes Mellitus Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
SNP Type |
Service |
Exper. |
Cost Info |
UHC Complete Care FL-14 (HMO-POS C-SNP) - H1045-048-3
Benefits & Contact Info
|
Polk |
$0.00 |
$175 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | Cardiovascular Disorders, Chronic Heart Failure, Diabetes Mellitus Browse Formulary |
|
|
|
|
Devoted DUAL Florida (HMO D-SNP) - H1290-024-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Enhanced Alternative (EA) | 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 | Dual-Eligible Browse Formulary |
|
|
|
|
Aetna Medicare FL Dual Select (HMO D-SNP) - H1609-049-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | All formulary drugs: 25%
all covered insulin pay $35 or less | Dual-Eligible Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
SNP Type |
Service |
Exper. |
Cost Info |
Freedom Medi-Medi Partial (HMO D-SNP) - H5427-078-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Enhanced Alternative (EA) | Preferred Generic: 24% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Supplemental Drugs: $0.00
all covered insulin pay $35 or less | Dual-Eligible Browse Formulary |
|
|
|
|
UHC Dual Complete FL-D002 (HMO-POS D-SNP) - H1045-039-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | All formulary drugs: 25%
all covered insulin pay $35 or less | Dual-Eligible Browse Formulary |
|
|
|
|
Wellcare Dual Access (HMO D-SNP) - H1032-124-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | All formulary drugs: 25%
all covered insulin pay $35 or less | Dual-Eligible Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
SNP Type |
Service |
Exper. |
Cost Info |
Cigna TotalCare (HMO D-SNP) - H5410-046-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | All formulary drugs: 25%
all covered insulin pay $35 or less | Dual-Eligible Browse Formulary |
|
|
|
|
Wellcare Dual Liberty (HMO D-SNP) - H1032-175-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | All formulary drugs: 25%
all covered insulin pay $35 or less | Dual-Eligible Browse Formulary |
|
-- |
|
|
Aetna Medicare Assure (HMO D-SNP) - H1609-019-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | All formulary drugs: 25%
all covered insulin pay $35 or less | Dual-Eligible Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
SNP Type |
Service |
Exper. |
Cost Info |
Optimum Emerald Partial (HMO D-SNP) - H5594-016-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Enhanced Alternative (EA) | Preferred Generic: 24% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Supplemental Drugs: $0.00
all covered insulin pay $35 or less | Dual-Eligible Browse Formulary |
|
|
|
|
Advantage Plus by Ultimate (Full) (HMO D-SNP) - H2962-035-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Enhanced Alternative (EA) | 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 | Dual-Eligible Browse Formulary |
|
|
|
|
Advantage Plus by Ultimate (Partial) (HMO D-SNP) - H2962-036-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Enhanced Alternative (EA) | 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 | Dual-Eligible Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
SNP Type |
Service |
Exper. |
Cost Info |
Cigna TotalCare Plus (HMO D-SNP) - H5410-025-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | All formulary drugs: 25%
all covered insulin pay $35 or less | Dual-Eligible Browse Formulary |
|
|
|
|
Florida Complete Care (HMO I-SNP) - H9986-001-0
Benefits & Contact Info
|
Polk |
$20.30 |
$590 |
Defined Standard (DS) | All formulary drugs: 25%
all covered insulin pay $35 or less | Institutional Browse Formulary |
|
-- |
|
|
Florida Complete Care- In The Community (HMO-POS I-SNP) - H9986-002-0
Benefits & Contact Info
|
Polk |
$20.30 |
$590 |
Defined Standard (DS) | All formulary drugs: 25%
all covered insulin pay $35 or less | Institutional Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
SNP Type |
Service |
Exper. |
Cost Info |
Florida Complete Care-Duals VIP (HMO-POS D-SNP) - H9986-004-1
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | All formulary drugs: 25%
all covered insulin pay $35 or less | Dual-Eligible Browse Formulary |
|
-- |
|
|
HumanaChoice Florida SNP-DE H5216-394 (PPO D-SNP) - H5216-394-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | All formulary drugs: 25%
all covered insulin pay $35 or less | Dual-Eligible Browse Formulary |
|
|
|
|
Solis Guardian Plan (HMO D-SNP) - H0982-023-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Enhanced Alternative (EA) | 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 | Dual-Eligible Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
SNP Type |
Service |
Exper. |
Cost Info |
UHC Dual Complete FL-D003 (PPO D-SNP) - H1889-002-1
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | All formulary drugs: 25%
all covered insulin pay $35 or less | Dual-Eligible Browse Formulary |
|
|
|
|
UHC Dual Complete FL-D005 (Regional PPO D-SNP) - R0759-003-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | All formulary drugs: 25%
all covered insulin pay $35 or less | Dual-Eligible Browse Formulary |
|
|
|
|
UHC Dual Complete FL-Y001 (HMO-POS D-SNP) - H2509-001-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | All formulary drugs: 25%
all covered insulin pay $35 or less | Dual-Eligible Browse Formulary |
|
new |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
SNP Type |
Service |
Exper. |
Cost Info |
UHC Dual Complete FL-Y4 (PPO D-SNP) - H1889-026-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | All formulary drugs: 25%
all covered insulin pay $35 or less | Dual-Eligible Browse Formulary |
|
|
|
|
UHC Dual Complete FL-Y5 (HMO-POS D-SNP) - H2509-003-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | All formulary drugs: 25%
all covered insulin pay $35 or less | Dual-Eligible Browse Formulary |
|
new |
|
|
UHC Nursing Home Plan FL-F001 (PPO I-SNP) - H0710-010-0
Benefits & Contact Info
|
Polk |
$20.30 |
$590 |
Defined Standard (DS) | All formulary drugs: 25%
all covered insulin pay $35 or less | Institutional Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
SNP Type |
Service |
Exper. |
Cost Info |
Wellcare Dual Reserve (HMO D-SNP) - H1032-202-0
Benefits & Contact Info
|
Polk |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | All formulary drugs: 25%
all covered insulin pay $35 or less | Dual-Eligible Browse Formulary |
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