AARP Medicare Advantage Patriot No Rx GA-MA01 (PPO) - H1889-022-0
Benefits & Contact Info
|
Barrow |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Aetna Medicare Eagle (PPO) - H3288-034-0
Benefits & Contact Info
|
Barrow |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $8,900 |
|
|
|
|
Aetna Medicare Eagle Plus (PPO) - H2293-009-0
Benefits & Contact Info
|
Barrow |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $8,900 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Veteran (HMO-POS) - H5422-014-0
Benefits & Contact Info
|
Barrow |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $7,550 |
|
-- |
|
|
Anthem Veteran (PPO) - H4036-040-0
Benefits & Contact Info
|
Barrow |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $9,350 |
|
|
|
|
Cigna True Choice Courage Medicare (PPO) - H7849-122-0
Benefits & Contact Info
|
Barrow |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,150 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Clover Health Valor (PPO) - H5141-056-0
Benefits & Contact Info
|
Barrow |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $7,499 |
|
|
|
|
Humana USAA Honor Giveback (PPO) - H5216-217-0
Benefits & Contact Info
|
Barrow |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Humana USAA Honor Giveback (PPO) - H5216-286-0
Benefits & Contact Info
|
Barrow |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $9,350 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-157 (PPO) - H5216-157-0
Benefits & Contact Info
|
Barrow |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $9,350 |
|
|
|
|
HumanaChoice R0110-019 (Regional PPO) - R0110-019-0
Benefits & Contact Info
|
Barrow |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $7,550 |
|
|
|
|
Kaiser Permanente Senior Advantage Liberty (HMO) - H1170-014-0
Benefits & Contact Info
|
Barrow |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,000 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UHC Medicare Advantage Patriot No Rx GS-MA01 (Regional PPO) - R2604-005-0
Benefits & Contact Info
|
Barrow |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $9,350 |
|
|
|
|
Wellcare Patriot Giveback Open (PPO) - H0111-007-0
Benefits & Contact Info
|
Barrow |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $8,500 |
|
|
|
|
Wellcare Patriot Simple (HMO-POS) - H1112-034-0
Benefits & Contact Info
|
Barrow |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
AARP Medicare Advantage Extras from UHC GA-8 (PPO) - H1889-027-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$495 Tier 1 and 2 exempt | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 27%
all covered insulin pay $35 or less | $7,900 Browse Formulary |
|
|
|
|
AARP Medicare Advantage from UHC GA-0005 (HMO-POS) - H5322-041-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$420 Tier 1 and 2 exempt | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
|
|
|
Aetna Medicare Freedom (PPO) - H3288-031-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$590 Tier 1 and 2 exempt | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 24% Non-Preferred Drug: 25% Specialty Tier: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare Freedom Plus (PPO) - H2293-031-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$590 Tier 1 and 2 exempt | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 22% Non-Preferred Drug: 25% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Grocery (PPO) - H4036-033-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$295 Tier 1 and 2 exempt | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 20% Non-Preferred Drug: 35% Specialty Tier: 29%
all covered insulin pay $35 or less | $9,300 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Kidney Care (HMO-POS C-SNP) - H5422-015-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$0 | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: 20% Non-Preferred Drug: 25% Specialty Tier: 33% 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 | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage (HMO-POS) - H5422-011-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$295 Tier 1, 2 and 6 exempt | Preferred Generic: $0.00 Generic: $1.00 Preferred Brand: 20% Non-Preferred Drug: 35% Specialty Tier: 29% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $8,400 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Premium Savings (PPO) - H4036-041-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$295 Tier 1 and 2 exempt | Preferred Generic: $0.00 Generic: $4.00 Preferred Brand: 20% Non-Preferred Drug: 35% Specialty Tier: 29%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Cigna Preferred GA Medicare (HMO) - H0439-003-1
Benefits & Contact Info
|
Barrow |
$0.00 |
$0 | 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 | $5,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Cigna Preferred Medicare (HMO) - H0439-015-1
Benefits & Contact Info
|
Barrow |
$0.00 |
$0 | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Cigna True Choice Medicare (PPO) - H7849-137-2
Benefits & Contact Info
|
Barrow |
$0.00 |
$0 | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $6,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Cigna True Choice Savings Medicare (PPO) - H7849-117-1
Benefits & Contact Info
|
Barrow |
$0.00 |
$0 | Preferred Generic: $0.00 Generic: $4.00 Preferred Brand: $45.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $6,751 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Clear Spring Health Choice Plan (PPO) - H9589-003-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$250 Tier 1 and 2 exempt | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $6,751 Browse Formulary |
|
-- |
-- |
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Select Plus (HMO) - H6672-005-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$0 | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
|
-- |
-- |
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Silver Plan (HMO C-SNP) - H6672-003-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$250 Tier 1 and 2 exempt | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $6,751 Browse Formulary |
|
-- |
-- |
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Clover Health LiveHealthy (PPO) - H5141-026-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$0 | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $7,999 Browse Formulary |
|
|
|
|
Humana Gold Choice H8145-069 (PFFS) - H8145-069-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$340 Tier 1 and 2 exempt | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 29%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
|
|
|
Humana Gold Plus Giveback H4141-022 (HMO) - H4141-022-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$450 Tier 1 and 2 exempt | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: 40% Specialty Tier: 27%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Plus H4141-023 (HMO) - H4141-023-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$450 Tier 1 and 2 exempt | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: 40% Specialty Tier: 27%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
Humana Together in Health (PPO I-SNP) - H5216-242-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$470 | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
HumanaChoice - Diabetes and Heart (PPO C-SNP) - H5216-246-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$450 Tier 1 and 2 exempt | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: 44% Specialty Tier: 27%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice Giveback H5216-154 (PPO) - H5216-154-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$400 Tier 1 and 2 exempt | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 36% Specialty Tier: 28%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
HumanaChoice Giveback H5216-345 (PPO) - H5216-345-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$450 Tier 1 and 2 exempt | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: 38% Specialty Tier: 27%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
HumanaChoice H5216-203 (PPO) - H5216-203-1
Benefits & Contact Info
|
Barrow |
$0.00 |
$350 Tier 1 and 2 exempt | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: 39% Specialty Tier: 28%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-421 (PPO) - H5216-421-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$450 Tier 1 and 2 exempt | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 27%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
Kaiser Permanente Dual Essential Plan 2 (HMO D-SNP) - H1170-011-0
Benefits & Contact Info
|
Barrow |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29% Vaccines: $0.00
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
Kaiser Permanente Senior Advantage Basic 2 (HMO) - H1170-012-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$0 | Preferred Generic: $0.00 Generic: $6.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 33% Vaccines: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Sonder Access Plus (PPO) - H4618-001-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$0 | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $44.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $5,500 Browse Formulary |
new |
new |
new |
|
Sonder Breathe Well (HMO C-SNP) - H1748-013-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$0 | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,950 Browse Formulary |
|
-- |
|
|
Sonder Complete Health Advantage (HMO) - H1748-015-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$0 | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $44.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $2,950 Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Sonder Diabetes Wellness (HMO C-SNP) - H1748-003-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$0 | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,950 Browse Formulary |
|
-- |
|
|
Sonder Heart Healthy (HMO C-SNP) - H1748-004-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$0 | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,950 Browse Formulary |
|
-- |
|
|
Sonder Medicare Valorous (HMO) - H1748-017-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$0 | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $44.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $4,950 Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Sonder My Choice Medicare Advantage (HMO) - H1748-010-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$0 | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $44.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
-- |
|
|
Sonder Renal Health (HMO C-SNP) - H1748-012-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$0 | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,950 Browse Formulary |
|
-- |
|
|
Sonder Vitality Matters (HMO) - H1748-016-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$0 | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $44.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $3,950 Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UHC Complete Care GA-3 (PPO C-SNP) - H1889-020-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$420 Tier 1 and 2 exempt | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
|
|
|
UHC Medicare Advantage Essentials GA-2 (PPO) - H1889-013-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$420 Tier 1 and 2 exempt | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
|
|
|
Wellcare Giveback (HMO-POS) - H1112-042-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$420 Tier 1, 2 and 6 exempt | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 25% Non-Preferred Drug: 39% Specialty Tier: 28% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Mutual of Omaha Simple Open (PPO) - H0111-001-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$420 Tier 1, 2 and 6 exempt | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 25% Non-Preferred Drug: 46% 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:
|
Wellcare Simple (HMO-POS) - H1112-038-0
Benefits & Contact Info
|
Barrow |
$0.00 |
$420 Tier 1, 2 and 6 exempt | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 25% Non-Preferred Drug: 32% Specialty Tier: 28% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Value Plus (PPO) - H2293-033-0
Benefits & Contact Info
|
Barrow |
$15.70 |
$590 Tier 1 and 2 exempt | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 24% Non-Preferred Drug: 25% Specialty Tier: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Cigna Preferred Plus Medicare (HMO) - H0439-006-0
Benefits & Contact Info
|
Barrow |
$18.00 |
$0 | Preferred Generic: $0.00 Generic: $4.00 Preferred Brand: $45.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $6,800 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Dual Choice (PPO D-SNP) - H2293-021-0
Benefits & Contact Info
|
Barrow |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. | Tier 1: tbd
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
Anthem Dual Advantage (HMO D-SNP) - H5422-018-0
Benefits & Contact Info
|
Barrow |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. | Tier 1: tbd
all covered insulin pay $35 or less | $6,750 Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Full Dual Advantage (HMO D-SNP) - H5422-019-0
Benefits & Contact Info
|
Barrow |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. | Tier 1: tbd
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
-- |
|
|
UHC Dual Complete GA-D002 (HMO-POS D-SNP) - H5322-030-0
Benefits & Contact Info
|
Barrow |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. | Tier 1: tbd
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
Humana Gold Plus SNP-DE H4141-003 (HMO D-SNP) - H4141-003-0
Benefits & Contact Info
|
Barrow |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. | Tier 1: tbd
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare Dual Preferred (HMO D-SNP) - H5302-013-0
Benefits & Contact Info
|
Barrow |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. | Tier 1: tbd
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
Aetna Medicare Preferred Premium (PPO) - H3288-042-0
Benefits & Contact Info
|
Barrow |
$28.00 |
$590 Tier 1 and 2 exempt | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 24% Non-Preferred Drug: 25% Specialty Tier: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
UHC Complete Care GS-2 (Regional PPO C-SNP) - R2604-003-0
Benefits & Contact Info
|
Barrow |
$28.00 |
$495 Tier 1 and 2 exempt | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 27%
all covered insulin pay $35 or less | $7,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage 3 (PPO) - H4036-042-0
Benefits & Contact Info
|
Barrow |
$29.00 |
$0 | Preferred Generic: $0.00 Generic: $4.00 Preferred Brand: 20% Non-Preferred Drug: 40% Specialty Tier: 33%
all covered insulin pay $35 or less | $6,750 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clover Health LiveHealthy Value (PPO) - H5141-045-0
Benefits & Contact Info
|
Barrow |
$29.40 |
$200 Tier 1 exempt | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: 25% Non-Preferred Drug: 35% Specialty Tier: 30%
all covered insulin pay $35 or less | $7,499 Browse Formulary |
|
|
|
|
HumanaChoice H5525-024 (PPO) - H5525-024-0
Benefits & Contact Info
|
Barrow |
$30.00 |
$350 Tier 1 and 2 exempt | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 28%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Dual Advantage (PPO D-SNP) - H4036-039-0
Benefits & Contact Info
|
Barrow |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. | Tier 1: tbd
all covered insulin pay $35 or less | $5,000 Browse Formulary |
|
|
|
|
Wellcare Assist (HMO-POS) - H1112-043-0
Benefits & Contact Info
|
Barrow |
$31.70 |
$590 Tier 1 and 6 exempt | Preferred Generic: $18.00 Generic: $19.00 Preferred Brand: 20% Non-Preferred Drug: $100.00 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:
|
Cigna TotalCare (HMO D-SNP) - H0439-002-0
Benefits & Contact Info
|
Barrow |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. | Tier 1: tbd
all covered insulin pay $35 or less | $7,200 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Dual Reserve (HMO-POS D-SNP) - H1112-046-0
Benefits & Contact Info
|
Barrow |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. | Tier 1: tbd
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
|
Wellcare Dual Access (HMO-POS D-SNP) - H1112-006-0
Benefits & Contact Info
|
Barrow |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. | Tier 1: tbd
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
CareSource Dual Advantage (HMO D-SNP) - H8390-015-0
Benefits & Contact Info
|
Barrow |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. | Tier 1: tbd
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
-- |
-- |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare Dual Select (HMO D-SNP) - H5302-020-0
Benefits & Contact Info
|
Barrow |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. | Tier 1: tbd
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
Anthem Extra Help (HMO-POS) - H5422-013-0
Benefits & Contact Info
|
Barrow |
$38.60 |
$590 Tier 1 and 6 exempt | 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 | $5,900 Browse Formulary |
|
-- |
|
|
Georgia Health Advantage Choice (HMO I-SNP) - H8093-002-0
Benefits & Contact Info
|
Barrow |
$38.60 |
$590 | Tier 1: tbd
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Full Dual Advantage (PPO D-SNP) - H4036-032-0
Benefits & Contact Info
|
Barrow |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. | Tier 1: tbd
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
Cigna TotalCare Plus (HMO D-SNP) - H0439-012-0
Benefits & Contact Info
|
Barrow |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. | Tier 1: tbd
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
Georgia Health Advantage (HMO I-SNP) - H8093-001-0
Benefits & Contact Info
|
Barrow |
$40.00 |
$590 | Tier 1: tbd
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Dual Select H5216-206 (PPO D-SNP) - H5216-206-0
Benefits & Contact Info
|
Barrow |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. | Tier 1: tbd
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
HumanaChoice H5216-280 (PPO) - H5216-280-1
Benefits & Contact Info
|
Barrow |
$40.00 |
$590 Tier 1 and 2 exempt | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 33% Specialty Tier: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
HumanaChoice SNP-DE H5216-205 (PPO D-SNP) - H5216-205-0
Benefits & Contact Info
|
Barrow |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. | Tier 1: tbd
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
PruittHealth Premier D-SNP (HMO D-SNP) - H3291-002-0
Benefits & Contact Info
|
Barrow |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. | Tier 1: tbd
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
-- |
|
|
Sonder Dual Complete (HMO D-SNP) - H1748-005-0
Benefits & Contact Info
|
Barrow |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. | Preferred Generic: 25% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
-- |
|
|
UHC Complete Care Support GA-9 (PPO C-SNP) - H1889-028-0
Benefits & Contact Info
|
Barrow |
$40.00 |
$590 | Tier 1: tbd
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UHC Dual Complete GA-S001 (PPO D-SNP) - H3256-001-0
Benefits & Contact Info
|
Barrow |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. | Tier 1: tbd
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
UHC Dual Complete GA-S2 (PPO D-SNP) - H3256-003-0
Benefits & Contact Info
|
Barrow |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. | Tier 1: tbd
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
UHC Dual Complete GA-S3 (HMO-POS D-SNP) - H5322-045-0
Benefits & Contact Info
|
Barrow |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. | Tier 1: tbd
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UHC Dual Complete GA-V001 (PPO D-SNP) - H3256-002-0
Benefits & Contact Info
|
Barrow |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. | Tier 1: tbd
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
|
|
|
UHC Nursing Home Plan GA-F001 (PPO I-SNP) - H0710-033-0
Benefits & Contact Info
|
Barrow |
$40.00 |
$590 | Tier 1: tbd
all covered insulin pay $35 or less | $6,000 Browse Formulary |
|
-- |
|
|
Wellcare Dual Access Open (PPO D-SNP) - H0111-004-0
Benefits & Contact Info
|
Barrow |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. | Preferred Generic: $12.00 Generic: $19.00 Preferred Brand: 20% Non-Preferred Drug: 40% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Dual Liberty (HMO-POS D-SNP) - H1112-033-0
Benefits & Contact Info
|
Barrow |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. | Tier 1: tbd
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
UHC Complete Care Support GS-1A (Regional PPO C-SNP) - R2604-002-0
Benefits & Contact Info
|
Barrow |
$41.10 |
$590 | Tier 1: tbd
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
AARP Medicare Advantage from UHC GA-0006 (HMO-POS) - H5322-042-0
Benefits & Contact Info
|
Barrow |
$47.00 |
$420 Tier 1 and 2 exempt | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
all covered insulin pay $35 or less | $5,400 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage 2 (PPO) - H4036-030-0
Benefits & Contact Info
|
Barrow |
$77.00 |
$0 | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: 20% Non-Preferred Drug: 35% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $6,750 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
UHC Medicare Advantage GS-0001 (Regional PPO) - R2604-001-0
Benefits & Contact Info
|
Barrow |
$87.00 |
$570 Tier 1 and 2 exempt | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26%
all covered insulin pay $35 or less | $8,900 Browse Formulary |
|
|
|
|
Humana Full Access R0110-020 (Regional PPO) - R0110-020-0
Benefits & Contact Info
|
Barrow |
$92.00 |
$340 Tier 1 and 2 exempt | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 29%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|