AARP Medicare Advantage Patriot No Rx OH-MA01 (PPO) - H8768-021-0
Benefits & Contact Info
|
Putnam |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Anthem Veteran (PPO) - H4036-022-0
Benefits & Contact Info
|
Putnam |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,900 |
|
|
|
|
Anthem Veteran (Regional PPO) - R5941-013-0
Benefits & Contact Info
|
Putnam |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,900 |
|
|
|
|
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 (PPO) - H5216-218-0
Benefits & Contact Info
|
Putnam |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,900 |
|
|
|
|
HumanaChoice R5495-001 (Regional PPO) - R5495-001-0
Benefits & Contact Info
|
Putnam |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,900 |
|
|
|
|
Mount Carmel MediGold Cash Back No Premium MA Only (HMO) - H3668-013-0
Benefits & Contact Info
|
Putnam |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,900 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Paramount Elite Courage (PPO) - H5232-002-0
Benefits & Contact Info
|
Putnam |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,900 |
|
-- |
-- |
|
Paramount Elite Prevail (HMO-POS) - H3653-018-0
Benefits & Contact Info
|
Putnam |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,900 |
|
|
|
|
The Health Plan SecureCare Integrity Plan 3 (HMO) - H3672-014-0
Benefits & Contact Info
|
Putnam |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,900 |
|
|
|
|
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 OH-0005 (HMO-POS) - H5253-144-2
Benefits & Contact Info
|
Putnam |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
|
|
|
AARP Medicare Advantage from UHC OH-0009 (HMO-POS) - H5253-130-0
Benefits & Contact Info
|
Putnam |
$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 | $5,500 Browse Formulary |
|
|
|
|
AARP Medicare Advantage from UHC OH-0016 (PPO) - H8768-038-2
Benefits & Contact Info
|
Putnam |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
AARP Medicare Advantage from UHC OH-0017 (HMO-POS) - H5253-135-0
Benefits & Contact Info
|
Putnam |
$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 | $6,500 Browse Formulary |
|
|
|
|
Aetna Medicare Premier (HMO-POS) - H0628-001-0
Benefits & Contact Info
|
Putnam |
$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 | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare SmartFit (PPO) - H5521-441-0
Benefits & Contact Info
|
Putnam |
$0.00 |
$400 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: 20% Non-Preferred Drug: 40% Specialty Tier: 27%
all covered insulin pay $35 or less | $3,850 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare Value Plan (PPO) - H5521-088-0
Benefits & Contact Info
|
Putnam |
$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 | $5,300 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (HMO) - H3655-045-1
Benefits & Contact Info
|
Putnam |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Devoted CHOICE Ohio (PPO) - H2526-001-0
Benefits & Contact Info
|
Putnam |
$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 | $5,300 Browse Formulary |
|
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Devoted CORE Ohio (HMO) - H2697-001-0
Benefits & Contact Info
|
Putnam |
$0.00 |
$0 |
Yes, some additional gap coverage. | 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 | $3,800 Browse Formulary |
|
|
|
|
Devoted GIVEBACK Ohio (HMO) - H2697-003-0
Benefits & Contact Info
|
Putnam |
$0.00 |
$545 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
|
|
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) - H6622-017-0
Benefits & Contact Info
|
Putnam |
$0.00 |
$200 Tier 1, 2 and 6 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: 30% Select Care Drugs: $7.00
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 |
Humana Gold Plus H6622-022 (HMO-POS) - H6622-022-0
Benefits & Contact Info
|
Putnam |
$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 | $4,500 Browse Formulary |
|
|
|
|
Humana USAA Honor with Rx (PPO) - H5216-307-0
Benefits & Contact Info
|
Putnam |
$0.00 |
$350 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 27%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-285 (PPO) - H5216-285-0
Benefits & Contact Info
|
Putnam |
$0.00 |
$200 Tier 1, 2 and 3 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 | $5,300 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 H5216-309 (PPO) - H5216-309-0
Benefits & Contact Info
|
Putnam |
$0.00 |
$545 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
|
MedMutual Advantage Classic (HMO) - H6723-001-2
Benefits & Contact Info
|
Putnam |
$0.00 |
$95 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31%
all covered insulin pay $35 or less | $5,150 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Molina Medicare Choice Care (HMO) - H9955-002-0
Benefits & Contact Info
|
Putnam |
$0.00 |
$125 Tier 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $8,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Molina Medicare Choice Care Select (HMO) - H9955-004-0
Benefits & Contact Info
|
Putnam |
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $15.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 27% Select Care Drugs: $5.00
all covered insulin pay $35 or less | $8,300 Browse Formulary |
|
|
|
|
Mount Carmel MediGold Cash Back No Premium (HMO) - H3668-030-0
Benefits & Contact Info
|
Putnam |
$0.00 |
$150 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
|
|
|
Mount Carmel MediGold No Premium (HMO) - H3668-020-0
Benefits & Contact Info
|
Putnam |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Drug: $75.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Mount Carmel MediGold No Premium Choice (PPO) - H1846-006-0
Benefits & Contact Info
|
Putnam |
$0.00 |
$150 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $5,700 Browse Formulary |
|
|
|
|
Paramount Elite Preferred (PPO) - H5232-001-0
Benefits & Contact Info
|
Putnam |
$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%
all covered insulin pay $35 or less | $5,300 Browse Formulary |
|
-- |
-- |
|
Paramount Elite Standard (HMO-POS) - H3653-015-0
Benefits & Contact Info
|
Putnam |
$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%
all covered insulin pay $35 or less | $4,200 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
SummaCare Medicare Amber (HMO) - H3660-052-2
Benefits & Contact Info
|
Putnam |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
|
|
|
The Health Plan SecureCare - Option II (HMO) - H3672-013-0
Benefits & Contact Info
|
Putnam |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $3,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice Optimum (PPO) - H8604-014-1
Benefits & Contact Info
|
Putnam |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Giveback (HMO) - H0908-005-0
Benefits & Contact Info
|
Putnam |
$0.00 |
$275 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 29% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $7,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) - H0908-003-0
Benefits & Contact Info
|
Putnam |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) - H7169-001-0
Benefits & Contact Info
|
Putnam |
$0.00 |
$300 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 28% Select Care Drugs: $0.00
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 |
Devoted PRIME Ohio (HMO) - H2697-002-0
Benefits & Contact Info
|
Putnam |
$14.00 |
$0 |
Yes, some additional gap coverage. | 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 | $3,900 Browse Formulary |
|
|
|
|
Wellcare All Dual Assure (HMO D-SNP) - H0908-006-0
Benefits & Contact Info
|
Putnam |
$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 |
|
|
|
|
Humana Together in Health (PPO I-SNP) - H5216-401-0
Benefits & Contact Info
|
Putnam |
$18.40 |
$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 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Extra Help (HMO) - H3655-041-0
Benefits & Contact Info
|
Putnam |
$19.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $7,550 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
SummaCare Medicare Jade with Bene-FlexTM (HMO) - H3660-056-2
Benefits & Contact Info
|
Putnam |
$20.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $44.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,850 Browse Formulary |
|
|
|
|
Molina Medicare Complete Care (HMO D-SNP) - H9955-001-0
Benefits & Contact Info
|
Putnam |
$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 |
Wellcare Assist (HMO) - H0908-004-0
Benefits & Contact Info
|
Putnam |
$21.40 |
$535 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 | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AARP Medicare Advantage from UHC OH-0006 (HMO-POS) - H5253-124-2
Benefits & Contact Info
|
Putnam |
$24.00 |
$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 | $3,500 Browse Formulary |
|
|
|
|
Anthem Dual Advantage (HMO D-SNP) - H3655-048-0
Benefits & Contact Info
|
Putnam |
$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 |
Wellcare Dual Access Open (PPO D-SNP) - H7169-003-0
Benefits & Contact Info
|
Putnam |
$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 |
|
|
|
|
Molina Medicare Complete Care Select (HMO D-SNP) - H9955-003-0
Benefits & Contact Info
|
Putnam |
$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 |
|
|
|
|
Paramount Elite Prime (HMO-POS) - H3653-022-0
Benefits & Contact Info
|
Putnam |
$28.00 |
$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%
all covered insulin pay $35 or less | $3,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Additional Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Devoted DUAL PLUS Ohio (HMO D-SNP) - H2697-010-0
Benefits & Contact Info
|
Putnam |
$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 |
|
|
|
|
AARP Medicare Advantage from UHC OH-0008 (HMO-POS) - H5253-126-2
Benefits & Contact Info
|
Putnam |
$29.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $4,200 Browse Formulary |
|
|
|
|
HumanaChoice H5525-042 (PPO) - H5525-042-0
Benefits & Contact Info
|
Putnam |
$30.00 |
$545 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: 25%
all covered insulin pay $35 or less | $8,850 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 DUAL Ohio (HMO D-SNP) - H2697-011-0
Benefits & Contact Info
|
Putnam |
$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 |
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Aetna Medicare Assure 1 (HMO D-SNP) - H0628-013-0
Benefits & Contact Info
|
Putnam |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $0.00 Tier 3: $0.00 Tier 4: $0.00 Tier 5: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Value Plus H5525-041 (PPO) - H5525-041-0
Benefits & Contact Info
|
Putnam |
$37.10 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $8,850 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 |
Wellcare Dual Access (HMO D-SNP) - H0908-001-0
Benefits & Contact Info
|
Putnam |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Anthem Full Dual Advantage (HMO D-SNP) - H3655-033-0
Benefits & Contact Info
|
Putnam |
$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 |
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The Health Plan SecureCare SNP (HMO D-SNP) - H3672-019-0
Benefits & Contact Info
|
Putnam |
$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 |
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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 |
CareSource Dual Advantage (HMO D-SNP) - H6396-015-0
Benefits & Contact Info
|
Putnam |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $0.00 Tier 3: $0.00 Tier 4: $0.00 Tier 5: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP) - H6622-015-0
Benefits & Contact Info
|
Putnam |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $0.00 Tier 3: $0.00 Tier 4: $0.00 Tier 5: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus SNP-DE H6622-087 (HMO D-SNP) - H6622-087-0
Benefits & Contact Info
|
Putnam |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $0.00 Tier 3: $0.00 Tier 4: $0.00 Tier 5: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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|
|
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 H5525-046 (PPO D-SNP) - H5525-046-0
Benefits & Contact Info
|
Putnam |
$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 |
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UHC Dual Complete OH-D002 (HMO-POS D-SNP) - H5322-028-0
Benefits & Contact Info
|
Putnam |
$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 |
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UHC Dual Complete OH-S001 (PPO D-SNP) - H0271-055-0
Benefits & Contact Info
|
Putnam |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Tier 1: $0.00 Tier 2: $0.00 Tier 3: $0.00 Tier 4: $0.00 Tier 5: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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|
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 OH-V002 (HMO-POS D-SNP) - H5322-034-0
Benefits & Contact Info
|
Putnam |
$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 |
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Valor Health Plan (HMO I-SNP) - H1119-001-0
Benefits & Contact Info
|
Putnam |
$40.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
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-- |
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HumanaChoice H5216-024 (PPO) - H5216-024-0
Benefits & Contact Info
|
Putnam |
$41.00 |
$100 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: 31%
all covered insulin pay $35 or less | $6,700 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 |
Anthem Medicare Advantage 3 (PPO) - H4036-025-0
Benefits & Contact Info
|
Putnam |
$49.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
SummaCare Medicare Ruby (HMO) - H3660-044-0
Benefits & Contact Info
|
Putnam |
$50.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $44.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,600 Browse Formulary |
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HumanaChoice R5495-002 (Regional PPO) - R5495-002-0
Benefits & Contact Info
|
Putnam |
$51.00 |
$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 | $6,700 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 |
Paramount Elite Enhanced (HMO-POS) - H3653-004-0
Benefits & Contact Info
|
Putnam |
$68.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $42.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $3,600 Browse Formulary |
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Anthem Medicare Advantage (Regional PPO) - R5941-014-0
Benefits & Contact Info
|
Putnam |
$73.00 |
$50 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: 41% Specialty Tier: 32% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $6,050 Browse Formulary |
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|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Plus H6622-019 (HMO) - H6622-019-0
Benefits & Contact Info
|
Putnam |
$73.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $4,200 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 |
SummaCare Medicare Sapphire (HMO-POS) - H3660-029-0
Benefits & Contact Info
|
Putnam |
$79.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $44.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,550 Browse Formulary |
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MedMutual Advantage Choice (HMO) - H6723-002-2
Benefits & Contact Info
|
Putnam |
$93.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $4,800 Browse Formulary |
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|
|
Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Select (PPO) - H4497-001-2
Benefits & Contact Info
|
Putnam |
$93.00 |
$95 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31%
all covered insulin pay $35 or less | $6,900 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 |
The Health Plan SecureChoice - Option II (PPO) - H8604-010-0
Benefits & Contact Info
|
Putnam |
$93.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5525-030 (PPO) - H5525-030-0
Benefits & Contact Info
|
Putnam |
$115.00 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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|
MedMutual Advantage Plus (HMO) - H6723-003-2
Benefits & Contact Info
|
Putnam |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 |
MedMutual Advantage Preferred (PPO) - H4497-002-2
Benefits & Contact Info
|
Putnam |
$143.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Premier Plus 2 (Regional PPO) - R6694-005-0
Benefits & Contact Info
|
Putnam |
$149.00 |
$250 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 20% Non-Preferred Drug: 40% Specialty Tier: 29%
all covered insulin pay $35 or less | $5,100 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Premium (PPO) - H4497-003-2
Benefits & Contact Info
|
Putnam |
$193.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 Premier Plus 1 (Regional PPO) - R6694-003-0
Benefits & Contact Info
|
Putnam |
$208.00 |
$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 | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|