AARP Medicare Advantage Patriot No Rx CA-MA01 (HMO-POS) - H0543-121-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,900 |
|
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|
|
Aetna Medicare Eagle Plan (HMO) - H4982-013-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
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|
Aetna Medicare Eagle Plus Plan (PPO) - H5521-369-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
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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 |
Brand New Day Valor Care Plan (HMO) - H0838-048-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,850 |
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Humana USAA Honor (HMO) - H5619-121-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,999 |
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Humana USAA Honor (PPO) - H5525-078-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,900 |
|
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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 |
Imperial Courage Plan (HMO) - H5496-016-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,999 |
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AARP Medicare Advantage from UHC CA-0019 (HMO-POS) - H0543-236-0
Benefits & Contact Info
|
Los Angeles |
$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 | $800 Browse Formulary |
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AARP Medicare Advantage from UHC CA-0029 (PPO) - H0294-037-0
Benefits & Contact Info
|
Los Angeles |
$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 |
|
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
AARP Medicare Advantage from UHC CA-003P (HMO-POS) - H0543-151-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $800 Browse Formulary |
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AARP Medicare Advantage from UHC CA-004P (HMO-POS) - H0543-168-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $800 Browse Formulary |
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Aetna Medicare Core Plan (PPO) - H5521-419-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: 20% Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,900 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 |
Aetna Medicare Plus Plan (HMO) - H4982-001-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $599 Browse Formulary |
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|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Select Plan (HMO) - H0523-022-0
Benefits & Contact Info
|
Los Angeles |
$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 | $2,000 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Alignment Health AVA (PPO) - H4961-007-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $5.00
all covered insulin pay $35 or less | $3,900 Browse Formulary |
|
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|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Alignment Health AVA + Instacart (HMO-POS) - H3815-026-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $3.00 Preferred Brand: $40.00 Non-Preferred Drug: $93.00 Specialty Tier: 33% Select Care Drugs: $3.00
all covered insulin pay $35 or less | $1,999 Browse Formulary |
|
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Alignment Health CalPlus + Veterans (HMO) - H3815-036-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$545 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Select Care Drugs: $5.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
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Alignment Health ESRD Balance (HMO C-SNP) - H3815-033-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $40.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $5.00
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 |
Alignment Health Heart & Diabetes (HMO C-SNP) - H3815-010-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Drug: $75.00 Specialty Tier: 33% Select Care Drugs: $5.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
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Alignment Health My Choice (HMO) - H3815-001-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $30.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $3.00
all covered insulin pay $35 or less | $498 Browse Formulary |
|
|
|
|
Alignment Health My Choice CalPlus (HMO) - H3815-007-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $3.00 Preferred Brand: $40.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $5.00
all covered insulin pay $35 or less | $3,000 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Alignment Health Platinum + Instacart (HMO) - H3815-008-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Drug: $75.00 Specialty Tier: 33% Select Care Drugs: $5.00
all covered insulin pay $35 or less | $198 Browse Formulary |
|
|
|
|
Alignment Health smartHMO (HMO) - H3815-013-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $5.00
all covered insulin pay $35 or less | $2,499 Browse Formulary |
|
|
|
|
Alignment Health the ONE + Rite Aid (HMO) - H3815-034-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $1.00 Preferred Brand: $40.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $5.00
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 |
Anthem I Carelon Chronic Care (HMO C-SNP) - H0544-004-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Drug: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem I Carelon Home Care (HMO I-SNP) - H0544-005-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
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|
Anthem I Carelon Kidney Care (HMO C-SNP) - H0544-015-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Drug: $85.00 Specialty Tier: 33% 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 I Carelon Lung Care (HMO C-SNP) - H0544-014-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Drug: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem I Carelon Medicare Advantage (HMO) - H4161-011-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Drug: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $499 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem I Carelon Medicare Advantage 2 (HMO) - H0544-002-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Drug: $85.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $1,000 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 I Carelon Premium Savings (HMO) - H4161-012-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $1,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem I Carelon Premium Savings 2 (HMO) - H0544-007-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $14.50 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $3,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (HMO) - H0544-061-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $7,550 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 Prime (HMO) - H4161-009-0
Benefits & Contact Info
|
Los Angeles |
$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 | $499 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Select (HMO) - H0544-058-0
Benefits & Contact Info
|
Los Angeles |
$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 | $800 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Astiva Health C-SNP Deluxe (HMO C-SNP) - H1993-007-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $28.00 Non-Preferred Drug: $75.00 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 |
Astiva Health Premier Plan (HMO) - H1993-010-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $1,900 Browse Formulary |
|
|
|
|
Astiva Health Savings Plan (HMO) - H1993-001-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Drug: $98.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $2,500 Browse Formulary |
|
|
|
|
Blue Shield 65 Plus (HMO) - H0504-015-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $38.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $999 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 |
Blue Shield 65 Plus Plan 2 (HMO) - H0504-021-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $1,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Blue Shield AdvantageOptimum Plan (HMO) - H5928-004-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $3.00 Preferred Brand: $40.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $2,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Blue Shield Inspire (HMO) - H0504-043-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $3.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $699 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 |
Brand New Day Classic Care I Plan (HMO) - H0838-050-1
Benefits & Contact Info
|
Los Angeles |
$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% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $1,199 Browse Formulary |
|
|
|
|
Brand New Day Embrace Care Plan (HMO C-SNP) - H0838-039-1
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Brand New Day Part B Savings Plan (HMO) - H0838-049-0
Benefits & Contact Info
|
Los Angeles |
$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% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,200 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Central Health Focus Plan (HMO C-SNP) - H5649-006-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $75.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Central Health Medicare Plan (HMO) - H5649-001-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $75.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $1,100 Browse Formulary |
|
|
|
|
Central Health Premier Plan I (HMO) - H5649-020-1
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $75.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,200 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Central Health Savings Plan (HMO) - H5649-019-0
Benefits & Contact Info
|
Los Angeles |
$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% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $2,900 Browse Formulary |
|
|
|
|
Champion Advantage (HMO C-SNP) - H6170-001-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
new |
new |
new |
|
Clever Care Active (HMO) - H7607-007-1
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Brand: $99.00 Specialty Tier: 33% Supplemental Drugs: $0.00
all covered insulin pay $35 or less | $2,500 Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Clever Care Longevity (HMO) - H7607-002-1
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Brand: $99.00 Specialty Tier: 33% Supplemental Drugs: $0.00
all covered insulin pay $35 or less | $1,700 Browse Formulary |
|
-- |
|
|
Clever Care Value (HMO) - H7607-008-1
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: $99.00 Specialty Tier: 33% Supplemental Drugs: $0.00
all covered insulin pay $35 or less | $2,900 Browse Formulary |
|
-- |
|
|
Humana Gold Plus H5619-021 (HMO) - H5619-021-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $800 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 H5619-146 (HMO) - H5619-146-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $2,500 Browse Formulary |
|
|
|
|
Humana USAA Honor with Rx (PPO) - H5525-057-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$350 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: 27%
all covered insulin pay $35 or less | $6,100 Browse Formulary |
|
|
|
|
HumanaChoice H5525-075 (PPO) - H5525-075-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Imperial Dynamic Plan (HMO) - H5496-012-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $3.00 Preferred Brand: $30.00 Non-Preferred Drug: $75.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $298 Browse Formulary |
|
|
|
|
Imperial Senior Value (HMO C-SNP) - H5496-005-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $45.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Select Care Drugs: $3.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Imperial Strong (HMO) - H5496-014-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$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 | $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 |
Imperial Traditional (HMO) - H5496-007-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $45.00 Non-Preferred Drug: $90.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $1,349 Browse Formulary |
|
|
|
|
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) - H0524-003-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $999 Browse Formulary |
|
|
|
|
Kaiser Permanente Sr Advantage LA, Orange Value (HMO) - H0524-078-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $1,999 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Memory Care (HMO C-SNP) - H3274-003-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$400 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
new |
new |
|
Molina Medicare Choice Care (HMO) - H5810-014-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
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: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $8,300 Browse Formulary |
|
-- |
|
|
Molina Medicare Choice Care Select (HMO) - H5810-015-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$450 |
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: 25% Select Care Drugs: $5.00
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 |
PHP (HMO C-SNP) - H5852-001-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$475 Tier 5 exempt |
Yes, some additional gap coverage. | Generic: 15% Preferred Brand: 15% Non-Preferred Brand: 25% Specialty Tier: 25% Select Care Drugs: 0%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Premier Care (HMO I-SNP) - H3274-002-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$400 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
new |
new |
|
SCAN Affirm partnered with Included LGBTQ+ Health (HMO) - H5425-092-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
all covered insulin pay $35 or less | $199 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 |
SCAN Balance (HMO C-SNP) - H5425-034-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $30.00 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:
|
SCAN Classic (HMO) - H5425-006-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $11.00
all covered insulin pay $35 or less | $199 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
SCAN Compass (HMO) - H5425-115-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $11.00
all covered insulin pay $35 or less | $1,000 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 |
SCAN Embrace (HMO I-SNP) - H5425-086-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $99.00 Specialty Tier: 33% Select Care Drugs: $11.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
SCAN Healthy at Home (HMO I-SNP) - H9104-006-0
Benefits & Contact Info
|
Los Angeles |
$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: $11.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
-- |
Higher cost-sharing at standard network pharmacies. Details:
|
SCAN Heart First (HMO C-SNP) - H5425-028-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% 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 |
SCAN Navigate (HMO) - H5425-116-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $11.00
all covered insulin pay $35 or less | $1,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
SCAN Venture (HMO) - H5425-084-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $11.00
all covered insulin pay $35 or less | $1,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
UHC Complete Care CA-018P (HMO-POS C-SNP) - H0543-217-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 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 |
Wellcare Giveback (HMO) - H5087-032-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$545 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: 43% 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 No Premium (HMO) - H5087-005-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$150 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $42.00 Non-Preferred Drug: 38% Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $1,000 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Focus (HMO) - H0562-125-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$150 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: 39% Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $1,000 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 Specialty No Premium (HMO C-SNP) - H0562-092-0
Benefits & Contact Info
|
Los Angeles |
$0.00 |
$150 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $42.00 Non-Preferred Drug: 37% Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) - H3815-039-0
Benefits & Contact Info
|
Los Angeles |
$8.50 |
$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% Tier 6: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Aetna Medicare Value Plus Plan (HMO-POS) - H4982-017-0
Benefits & Contact Info
|
Los Angeles |
$12.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $599 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 |
Clever Care Total + (HMO C-SNP) - H7607-011-1
Benefits & Contact Info
|
Los Angeles |
$15.70 |
$545 Tier 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 25% Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% Supplemental Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Molina Medicare Complete Care (HMO D-SNP) - H3038-001-0
Benefits & Contact Info
|
Los Angeles |
$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 |
new |
new |
new |
|
UHC Complete Care CA-01AP (HMO-POS C-SNP) - H0543-239-0
Benefits & Contact Info
|
Los Angeles |
$18.60 |
$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 |
AARP Medicare Advantage from UHC CA-014P (HMO-POS) - H0543-210-0
Benefits & Contact Info
|
Los Angeles |
$19.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $800 Browse Formulary |
|
|
|
|
SCAN Connections at Home (HMO D-SNP) - H0976-002-0
Benefits & Contact Info
|
Los Angeles |
$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 |
new |
new |
new |
|
Wellcare Dual Align (HMO D-SNP) - H3561-008-0
Benefits & Contact Info
|
Los Angeles |
$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 Aligned (HMO D-SNP) - H4471-001-0
Benefits & Contact Info
|
Los Angeles |
$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 |
new |
new |
new |
|
SCAN Connections (HMO D-SNP) - H0976-001-0
Benefits & Contact Info
|
Los Angeles |
$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 |
new |
new |
new |
|
VillageHealth (HMO-POS C-SNP) - H5943-002-0
Benefits & Contact Info
|
Los Angeles |
$24.00 |
$545 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Select Care Drugs: $11.00
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 |
Molina Medicare Complete Care Plus (HMO D-SNP) - H3038-003-0
Benefits & Contact Info
|
Los Angeles |
$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 |
new |
new |
new |
|
SCAN Strive (HMO C-SNP) - H5425-097-0
Benefits & Contact Info
|
Los Angeles |
$24.70 |
$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% Tier 6: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
AARP Medicare Advantage from UHC CA-0013 (HMO-POS) - H0543-164-0
Benefits & Contact Info
|
Los Angeles |
$25.00 |
$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 | $800 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
SCAN Inspired by women for women (HMO) - H5425-100-0
Benefits & Contact Info
|
Los Angeles |
$25.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $11.00
all covered insulin pay $35 or less | $299 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
SCAN Prime (HMO) - H5425-065-0
Benefits & Contact Info
|
Los Angeles |
$25.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Select Care Drugs: $11.00
all covered insulin pay $35 or less | $299 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Dual Advantage (HMO D-SNP) - H4471-009-0
Benefits & Contact Info
|
Los Angeles |
$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 |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Low Premium (HMO) - H0562-130-1
Benefits & Contact Info
|
Los Angeles |
$29.00 |
$300 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $42.00 Non-Preferred Drug: 44% Specialty Tier: 28% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,850 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Brand New Day Classic Care II Plan (HMO) - H0838-051-2
Benefits & Contact Info
|
Los Angeles |
$34.30 |
$50 Tier 1 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 32% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $899 Browse Formulary |
|
|
|
|
Senior Advantage Medicare Medi-Cal South P1 (HMO D-SNP) - H8794-001-0
Benefits & Contact Info
|
Los Angeles |
$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 |
new |
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Astiva Health C-SNP WOW (HMO C-SNP) - H1993-008-0
Benefits & Contact Info
|
Los Angeles |
$40.00 |
$545 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Blue Shield TotalDual Plan (HMO D-SNP) - H2819-001-0
Benefits & Contact Info
|
Los Angeles |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
new |
new |
new |
|
Brand New Day Dual Access Plan (HMO D-SNP) - H0838-024-0
Benefits & Contact Info
|
Los Angeles |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Brand New Day Embrace Choice Plan (HMO C-SNP) - H0838-040-1
Benefits & Contact Info
|
Los Angeles |
$41.00 |
$545 Tier 1 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Central Health Medi-Medi Plan (HMO D-SNP) - H5649-002-0
Benefits & Contact Info
|
Los Angeles |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Central Health Premier Plan II (HMO) - H5649-021-2
Benefits & Contact Info
|
Los Angeles |
$41.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $35.00 Non-Preferred Drug: $75.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $1,199 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Champion Connect (HMO C-SNP) - H6170-002-0
Benefits & Contact Info
|
Los Angeles |
$41.00 |
$545 Tier 1 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
new |
new |
new |
|
Champion Select (HMO C-SNP) - H6170-003-0
Benefits & Contact Info
|
Los Angeles |
$41.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
new |
new |
new |
|
L.A. Care Medicare Plus (HMO D-SNP) - H1224-001-0
Benefits & Contact Info
|
Los Angeles |
$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 |
|
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Senior Care (HMO I-SNP) - H3274-001-0
Benefits & Contact Info
|
Los Angeles |
$41.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
new |
new |
|
AARP Medicare Advantage from UHC CA-0026 (PPO) - H0294-034-0
Benefits & Contact Info
|
Los Angeles |
$42.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $2,900 Browse Formulary |
|
|
|
|
Blue Shield Enhanced (HMO) - H0504-049-0
Benefits & Contact Info
|
Los Angeles |
$45.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $3.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $1,200 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 H5525-074 (PPO) - H5525-074-0
Benefits & Contact Info
|
Los Angeles |
$46.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $2.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $2,900 Browse Formulary |
|
|
|
|
Aetna Medicare Choice Plan (PPO) - H5521-125-0
Benefits & Contact Info
|
Los Angeles |
$77.00 |
$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 | $5,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|