AARP Medicare Advantage Patriot No Rx KY-MA01 (PPO) - H8768-020-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Aetna Medicare Eagle (PPO) - H5521-488-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,900 |
|
|
|
|
Anthem Veteran (PPO) - H4909-023-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana USAA Honor Giveback (PPO) - H5216-105-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Humana USAA Honor Giveback (PPO) - H5216-225-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Humana USAA Honor Giveback (PPO) - H5216-442-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $9,350 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0110-011 (Regional PPO) - R0110-011-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,600 |
|
|
|
|
Wellcare Patriot Giveback Open (PPO) - H3975-002-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,000 |
|
|
|
|
AARP Medicare Advantage Essentials from UHC KY-1 (HMO-POS) - H5253-099-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
$340 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $5,400 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
AARP Medicare Advantage Extras from UHC KY-5 (HMO-POS) - H5253-128-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
$420 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | 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 |
|
|
|
|
AARP Medicare Advantage from UHC KY-0003 (PPO) - H8768-013-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
$420 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 28%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
|
|
|
AARP Medicare Advantage Giveback from UHC KY-4 (HMO-POS) - H5253-127-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
$495 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 27%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare Premier (HMO-POS) - H0628-008-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
$0 |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: 25% Non-Preferred Drug: 35% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare SmartFit (PPO) - H5521-442-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
$590 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 24% Non-Preferred Drug: 25% Specialty Tier: 25%
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Value (PPO) - H5521-156-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
$590 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 24% Non-Preferred Drug: 25% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,350 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Kidney Care (HMO-POS C-SNP) - H9525-011-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
$0 |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $2.00 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:
|
Anthem Medicare Advantage (HMO-POS) - H9525-013-3
Benefits & Contact Info
|
Jessamine |
$0.00 |
$0 |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 20% Non-Preferred Drug: 40% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,850 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) - H4036-036-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $2.00 Preferred Brand: 20% Non-Preferred Drug: 35% Specialty Tier: 28% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $6,750 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Devoted CHOICE GIVEBACK Kentucky (PPO) - H5718-002-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
$590 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
new |
new |
new |
|
Devoted CHOICE Kentucky (PPO) - H5718-001-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
$590 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
all covered insulin pay $35 or less | $5,500 Browse Formulary |
new |
new |
new |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) - H5619-164-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: 38% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $6,750 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Plus - End Stage Renal Disease (HMO C-SNP) - H5619-170-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
$590 Tier 1, 2, 3 and 6 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: 44% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $7,500 Browse Formulary |
|
|
|
|
Humana Gold Plus H5619-071 (HMO) - H5619-071-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
$250 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 30%
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
|
|
|
Humana Together in Health (PPO I-SNP) - H5216-446-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
$510 |
Enhanced Alternative (EA) | 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 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana USAA Honor Giveback with Rx (PPO) - H5216-396-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
$350 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 28%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
HumanaChoice Giveback H5216-322 (PPO) - H5216-322-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
$590 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 31% Specialty Tier: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
HumanaChoice H5216-226 (PPO) - H5216-226-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
$200 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 30%
all covered insulin pay $35 or less | $6,800 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-317 (PPO) - H5216-317-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
$250 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 30%
all covered insulin pay $35 or less | $6,750 Browse Formulary |
|
|
|
|
Signature Advantage Community (HMO I-SNP) - H2400-002-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
$590 |
Defined Standard (DS) | Tier 1: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
-- |
|
|
UHC Complete Care KY-6 (HMO-POS C-SNP) - H5253-182-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
$340 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Giveback (HMO-POS) - H9730-007-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
$420 Tier 1, 2 and 6 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 25% Non-Preferred Drug: 48% Specialty Tier: 28% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Simple (HMO-POS) - H9730-009-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
$420 Tier 1, 2 and 6 exempt |
Enhanced Alternative (EA) | 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 | $5,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Simple Open (PPO) - H3975-001-0
Benefits & Contact Info
|
Jessamine |
$0.00 |
$420 Tier 1, 2 and 6 exempt |
Enhanced Alternative (EA) | 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 | $6,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Plus H5619-172 (HMO) - H5619-172-0
Benefits & Contact Info
|
Jessamine |
$11.00 |
$590 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: 38% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,750 Browse Formulary |
|
|
|
|
Passport Advantage (HMO D-SNP) - H1799-003-2
Benefits & Contact Info
|
Jessamine |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | Tier 1: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
HumanaChoice H5216-019 (PPO) - H5216-019-0
Benefits & Contact Info
|
Jessamine |
$35.00 |
$200 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 30%
all covered insulin pay $35 or less | $6,750 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Full Dual Advantage (HMO D-SNP) - H9525-007-0
Benefits & Contact Info
|
Jessamine |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | Tier 1: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
Wellcare Assist (HMO-POS) - H9730-010-0
Benefits & Contact Info
|
Jessamine |
$37.40 |
$590 Tier 1 and 6 exempt |
Basic Alternative Standard (BA) | Preferred Generic: $12.00 Generic: $19.00 Preferred Brand: 20% Non-Preferred Drug: 36% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Dual Advantage (HMO D-SNP) - H9525-016-0
Benefits & Contact Info
|
Jessamine |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | Tier 1: 25%
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage 2 (PPO) - H4036-035-0
Benefits & Contact Info
|
Jessamine |
$38.00 |
$0 |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $6.00 Preferred Brand: 20% Non-Preferred Drug: 35% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,950 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AARP Medicare Advantage from UHC KY-0002 (HMO-POS) - H5253-100-0
Benefits & Contact Info
|
Jessamine |
$39.00 |
$340 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
|
|
|
|
HumanaChoice R0110-012 (Regional PPO) - R0110-012-0
Benefits & Contact Info
|
Jessamine |
$39.10 |
$245 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 30%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Full Dual Advantage 2 (HMO D-SNP) - H9525-019-0
Benefits & Contact Info
|
Jessamine |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | Tier 1: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
HumanaChoice H5216-188 (PPO) - H5216-188-0
Benefits & Contact Info
|
Jessamine |
$43.00 |
$0 |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $6,800 Browse Formulary |
|
|
|
|
Signature Advantage Plan (HMO I-SNP) - H2400-001-0
Benefits & Contact Info
|
Jessamine |
$47.30 |
$590 |
Defined Standard (DS) | Tier 1: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare Assure 1 (HMO D-SNP) - H0628-012-0
Benefits & Contact Info
|
Jessamine |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | Tier 1: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
UHC Dual Complete KY-S002 (HMO-POS D-SNP) - H6595-004-0
Benefits & Contact Info
|
Jessamine |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | Tier 1: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
Anthem Medicare Advantage 3 (PPO) - H4036-034-0
Benefits & Contact Info
|
Jessamine |
$49.00 |
$0 |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: 20% Non-Preferred Drug: 35% 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 | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare Value Plus (PPO) - H5521-490-0
Benefits & Contact Info
|
Jessamine |
$49.60 |
$250 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: 25% Non-Preferred Drug: 26% Specialty Tier: 30%
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Dual Select H5619-075 (HMO D-SNP) - H5619-075-0
Benefits & Contact Info
|
Jessamine |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | Tier 1: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
Humana Gold Plus SNP-DE H5619-163 (HMO D-SNP) - H5619-163-0
Benefits & Contact Info
|
Jessamine |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | Tier 1: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice SNP-DE H5525-045 (PPO D-SNP) - H5525-045-0
Benefits & Contact Info
|
Jessamine |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | Tier 1: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
UHC Dual Complete KY-S001 (PPO D-SNP) - H1889-008-0
Benefits & Contact Info
|
Jessamine |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | Tier 1: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
UHC Dual Complete KY-S3 (PPO D-SNP) - H1889-030-0
Benefits & Contact Info
|
Jessamine |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | Tier 1: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UHC Dual Complete KY-S4 (HMO-POS D-SNP) - H6595-005-0
Benefits & Contact Info
|
Jessamine |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | Tier 1: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
UHC Dual Complete KY-V001 (HMO-POS D-SNP) - H6595-003-0
Benefits & Contact Info
|
Jessamine |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | Tier 1: 25%
all covered insulin pay $35 or less | $5,400 Browse Formulary |
|
|
|
|
Wellcare Dual Access (HMO-POS D-SNP) - H9730-003-0
Benefits & Contact Info
|
Jessamine |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | Tier 1: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Dual Access Open (PPO D-SNP) - H3975-004-0
Benefits & Contact Info
|
Jessamine |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | Tier 1: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
Wellcare Dual Liberty (HMO-POS D-SNP) - H9730-004-0
Benefits & Contact Info
|
Jessamine |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | Tier 1: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
Wellcare Dual Reserve (HMO-POS D-SNP) - H9730-011-0
Benefits & Contact Info
|
Jessamine |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | Tier 1: 25%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage (Regional PPO) - R4487-001-0
Benefits & Contact Info
|
Jessamine |
$74.00 |
$0 |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $8.00 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:
|
HumanaChoice H5216-107 (PPO) - H5216-107-0
Benefits & Contact Info
|
Jessamine |
$121.00 |
$300 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 29%
all covered insulin pay $35 or less | $6,750 Browse Formulary |
|
|
|
|