MCS Classicare Patriot (HMO) - H5577-016-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 |
|
|
|
|
Triple S Advantage Basic (HMO) - H5774-003-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,650 |
|
|
|
|
Triple S Advantage Optimo (PPO) - H4005-001-0
Benefits & Contact Info
|
Penuelas |
$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 |
Humana Gold Plus H4007-012 (HMO) - H4007-012-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Drug: $10.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,000 Browse Formulary |
|
|
|
|
Humana Gold Plus H4007-020 (HMO) - H4007-020-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $5.00 Non-Preferred Drug: $20.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,000 Browse Formulary |
|
|
|
|
Humana Gold Plus H4007-021 (HMO) - H4007-021-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Drug: $15.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,000 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 H4007-024 (HMO) - H4007-024-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Drug: $15.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,000 Browse Formulary |
|
|
|
|
Humana Gold Plus H4007-025 (HMO) - H4007-025-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Drug: $15.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,000 Browse Formulary |
|
|
|
|
Humana Gold Plus H4007-028 (HMO-POS) - H4007-028-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Drug: $0.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,000 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 H4007-029 (HMO) - H4007-029-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Drug: $0.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,000 Browse Formulary |
|
|
|
|
Humana Gold Plus SNP-DE H4007-016 (HMO D-SNP) - H4007-016-0
Benefits & Contact Info
|
Penuelas |
$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 |
|
|
|
|
Humana Gold Plus SNP-DE H4007-018 (HMO D-SNP) - H4007-018-0
Benefits & Contact Info
|
Penuelas |
$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 |
Humana Gold Plus SNP-DE H4007-019 (HMO D-SNP) - H4007-019-0
Benefits & Contact Info
|
Penuelas |
$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 |
|
|
|
|
Humana Gold Plus SNP-DE H4007-026 (HMO D-SNP) - H4007-026-0
Benefits & Contact Info
|
Penuelas |
$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 |
|
|
|
|
Humana Gold Plus SNP-DE H4007-027 (HMO D-SNP) - H4007-027-0
Benefits & Contact Info
|
Penuelas |
$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 |
Humana Gold Plus SNP-DE H4007-030 (HMO D-SNP) - H4007-030-0
Benefits & Contact Info
|
Penuelas |
$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 |
|
|
|
|
MCS Classicare Del Caribe (HMO) - H5577-057-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
|
|
|
|
MCS Classicare Efectivo (HMO) - H5577-005-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $4.00 Non-Preferred Brand: $14.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
MCS Classicare En Tu Hogar (HMO) - H5577-043-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $5.00 Non-Preferred Brand: $15.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
|
|
|
|
MCS Classicare Essential (HMO-POS) - H5577-008-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
|
|
|
|
MCS Classicare Exacto (HMO) - H5577-053-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
MCS Classicare Firme (HMO) - H5577-042-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
|
|
|
|
MCS Classicare Hero (HMO) - H5577-044-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $10.00 Preferred Brand: $30.00 Non-Preferred Brand: 25% Specialty Tier: 33% Select Care Drugs: $5.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
|
|
|
|
MCS Classicare InteliCare (HMO) - H5577-052-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
MCS Classicare Platino Del Sur (HMO D-SNP) - H5577-055-0
Benefits & Contact Info
|
Penuelas |
$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 |
|
|
|
|
MCS Classicare Platino Ideal (HMO D-SNP) - H5577-002-0
Benefits & Contact Info
|
Penuelas |
$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 $35 or less | n/a Browse Formulary |
|
|
|
|
MCS Classicare Platino MasCa$h (HMO D-SNP) - H5577-029-0
Benefits & Contact Info
|
Penuelas |
$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 |
MCS Classicare Platino Maximo (HMO D-SNP) - H5577-054-3
Benefits & Contact Info
|
Penuelas |
$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 |
|
|
|
|
MCS Classicare Platino Progreso (HMO D-SNP) - H5577-017-0
Benefits & Contact Info
|
Penuelas |
$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 |
|
|
|
|
MCS Classicare Platino Total (HMO D-SNP) - H5577-046-0
Benefits & Contact Info
|
Penuelas |
$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 |
MCS Classicare Primero (HMO C-SNP) - H5577-038-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
MMM Balance (HMO-POS) - H4004-063-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $1.00 Generic: $2.00 Preferred Brand: $10.00 Non-Preferred Brand: $15.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,250 Browse Formulary |
|
|
|
|
MMM Deluxe (HMO-POS) - H4003-055-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $4.00 Preferred Brand: $10.00 Non-Preferred Brand: $15.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,250 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
MMM Diamante Platino (HMO D-SNP) - H4003-017-0
Benefits & Contact Info
|
Penuelas |
$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 |
|
|
|
|
MMM Elite (HMO-POS) - H4003-034-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $3.00 Non-Preferred Brand: $5.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,250 Browse Formulary |
|
|
|
|
MMM Plenitud (HMO-POS) - H4004-065-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $5.00 Non-Preferred Brand: $7.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,250 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
MMM Plus Platino (HMO D-SNP) - H4004-067-0
Benefits & Contact Info
|
Penuelas |
$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 |
|
|
|
|
MMM Relax Platino (HMO D-SNP) - H4004-062-0
Benefits & Contact Info
|
Penuelas |
$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 |
|
|
|
|
MMM Supremo (HMO C-SNP) - H4003-009-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $5.00 Non-Preferred Brand: $20.00 Specialty Tier: 33% 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 |
MMM Valioso (HMO-POS) - H4004-066-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $6.00 Preferred Brand: $15.00 Non-Preferred Brand: $20.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,250 Browse Formulary |
|
|
|
|
MMM Valor Platino (HMO D-SNP) - H4003-049-0
Benefits & Contact Info
|
Penuelas |
$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 |
|
|
|
|
PMC Max (HMO-POS) - H4004-056-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $1.00 Generic: $2.00 Preferred Brand: $7.00 Non-Preferred Brand: $10.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,250 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
PMC Premier Platino (HMO D-SNP) - H4004-048-0
Benefits & Contact Info
|
Penuelas |
$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 |
|
|
|
|
Triple S Advantage AhorroMax (HMO) - H5774-037-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Brand: $35.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Triple S Advantage Brillante (HMO-POS) - H5774-031-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Brand: $40.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 |
Triple S Advantage Contigo Plus (HMO C-SNP) - H5774-022-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $10.00 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:
|
Triple S Advantage Enlace Plus (HMO) - H5774-038-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $10.00 Non-Preferred Brand: $15.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Triple S Advantage Magno (HMO-POS) - H5774-027-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $5.00 Non-Preferred Brand: $25.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 |
Triple S Advantage Optimo Plus (PPO) - H4005-004-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Brand: $40.00 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:
|
Triple S Advantage Platino Advance (HMO D-SNP) - H5774-026-0
Benefits & Contact Info
|
Penuelas |
$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: $16.00 Generic: $17.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $8.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Triple S Advantage Platino Blindao (HMO D-SNP) - H5774-028-0
Benefits & Contact Info
|
Penuelas |
$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: $16.00 Generic: $17.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $8.00
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 |
Triple S Advantage Platino Enlace (HMO D-SNP) - H5774-035-0
Benefits & Contact Info
|
Penuelas |
$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: $16.00 Generic: $17.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $8.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Triple S Advantage Platino Plus (HMO D-SNP) - H5774-024-0
Benefits & Contact Info
|
Penuelas |
$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: $16.00 Generic: $17.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $8.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Triple S Advantage Platino Titan (HMO D-SNP) - H5774-036-0
Benefits & Contact Info
|
Penuelas |
$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: $16.00 Generic: $17.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $8.00
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 |
Triple S Advantage Real (HMO) - H5774-005-0
Benefits & Contact Info
|
Penuelas |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $5.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
MMM Unico (HMO-POS) - H4003-019-0
Benefits & Contact Info
|
Penuelas |
$15.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $3.00 Non-Preferred Brand: $5.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,250 Browse Formulary |
|
|
|
|
Triple S Advantage Optimo Xtra (PPO) - H4005-007-0
Benefits & Contact Info
|
Penuelas |
$30.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $15.00 Non-Preferred Brand: $30.00 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:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice Value H2029-001 (PPO) - H2029-001-0
Benefits & Contact Info
|
Penuelas |
$44.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Drug: $40.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
-- |
|
|