AARP Medicare Advantage Patriot No Rx SC-MA01 (HMO-POS) - H5322-043-0
Benefits & Contact Info
 |
Georgetown |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
 |
 |
 |
|
Aetna Medicare Eagle (PPO) - H5521-279-0
Benefits & Contact Info
 |
Georgetown |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,750 |
 |
 |
 |
|
BlueCross Blue Basic (PPO) - H8003-007-0
Benefits & Contact Info
 |
Georgetown |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,900 |
 |
 |
 |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Clover Health Valor (PPO) - H5141-057-0
Benefits & Contact Info
 |
Georgetown |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $7,499 |
 |
 |
 |
|
First Choice VIP Care Plus (Medicare-Medicaid Plan) - H8213-001-0
Benefits & Contact Info
 |
Georgetown |
$0.00 |
$0 |
Enhanced Alternative (EA) | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx/OTC Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
-- |
-- |
-- |
|
Humana USAA Honor Giveback (PPO) - H5216-286-0
Benefits & Contact Info
 |
Georgetown |
$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 |
Humana USAA Honor Giveback (PPO) - H5216-217-0
Benefits & Contact Info
 |
Georgetown |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
 |
 |
 |
|
HumanaChoice H5216-157 (PPO) - H5216-157-0
Benefits & Contact Info
 |
Georgetown |
$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
 |
Georgetown |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $7,550 |
 |
 |
 |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Molina Dual Options (Medicare-Medicaid Plan) - H2533-001-0
Benefits & Contact Info
 |
Georgetown |
$0.00 |
$0 |
Enhanced Alternative (EA) | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx/OTC Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
-- |
-- |
-- |
|
UHC Medicare Advantage Patriot No Rx GS-MA01 (Regional PPO) - R2604-005-0
Benefits & Contact Info
 |
Georgetown |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $9,350 |
 |
 |
 |
|
Wellcare Patriot Giveback (HMO-POS) - H4847-006-0
Benefits & Contact Info
 |
Georgetown |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $7,550 |
 |
 |
 |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan) - H1723-001-0
Benefits & Contact Info
 |
Georgetown |
$0.00 |
$0 |
Enhanced Alternative (EA) | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx/OTC Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
-- |
-- |
-- |
|
AARP Medicare Advantage Essentials from UHC SC-3 (PPO) - H2001-092-0
Benefits & Contact Info
 |
Georgetown |
$0.00 |
$255 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
 |
 |
 |
|
AARP Medicare Advantage Extras from UHC SC-8 (PPO) - H2001-113-0
Benefits & Contact Info
 |
Georgetown |
$0.00 |
$420 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: 28%
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 |
AARP Medicare Advantage from UHC SC-0005 (HMO-POS) - H5322-040-0
Benefits & Contact Info
 |
Georgetown |
$0.00 |
$340 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: 29%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
 |
 |
 |
|
AARP Medicare Advantage Giveback from UHC SC-2 (PPO) - H2001-091-0
Benefits & Contact Info
 |
Georgetown |
$0.00 |
$420 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: 28%
all covered insulin pay $35 or less | $7,500 Browse Formulary |
 |
 |
 |
|
BlueCross Total Value (PPO) - H8003-006-0
Benefits & Contact Info
 |
Georgetown |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: 21% Non-Preferred Drug: 40% Specialty Tier: 30% 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 | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Clover Health LiveHealthy (PPO) - H5141-036-0
Benefits & Contact Info
 |
Georgetown |
$0.00 |
$0 |
Enhanced Alternative (EA) | 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 | $7,499 Browse Formulary |
 |
 |
 |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) - H5619-161-0
Benefits & Contact Info
 |
Georgetown |
$0.00 |
$450 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: 27%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
 |
 |
 |
|
Humana Gold Plus Giveback H5619-169 (HMO) - H5619-169-0
Benefits & Contact Info
 |
Georgetown |
$0.00 |
$450 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | 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 | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Plus H5619-152 (HMO) - H5619-152-0
Benefits & Contact Info
 |
Georgetown |
$0.00 |
$350 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 28%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
 |
 |
 |
|
Humana Gold Plus H5619-171 (HMO) - H5619-171-0
Benefits & Contact Info
 |
Georgetown |
$0.00 |
$450 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | 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) - H5216-243-0
Benefits & Contact Info
 |
Georgetown |
$0.00 |
$480 |
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 |
HumanaChoice - Diabetes and Heart (PPO C-SNP) - H5216-244-0
Benefits & Contact Info
 |
Georgetown |
$0.00 |
$450 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 27%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
 |
 |
 |
|
HumanaChoice Giveback H5216-154 (PPO) - H5216-154-0
Benefits & Contact Info
 |
Georgetown |
$0.00 |
$400 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | 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
 |
Georgetown |
$0.00 |
$450 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: 27%
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 H5216-347 (PPO) - H5216-347-0
Benefits & Contact Info
 |
Georgetown |
$0.00 |
$350 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: 43% Specialty Tier: 28%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
 |
 |
 |
|
HumanaChoice H5216-423 (PPO) - H5216-423-0
Benefits & Contact Info
 |
Georgetown |
$0.00 |
$450 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: 43% Specialty Tier: 27%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
 |
 |
 |
|
UHC Complete Care SC-1 (PPO C-SNP) - H2001-060-0
Benefits & Contact Info
 |
Georgetown |
$0.00 |
$340 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $0.00 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 Open (PPO) - H7326-003-0
Benefits & Contact Info
 |
Georgetown |
$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: 32% Specialty Tier: 28% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $8,700 Browse Formulary |
 |
 |
 |
Higher cost-sharing at standard network pharmacies. Details:
 |
Wellcare Mutual of Omaha Simple Open (PPO) - H7326-001-0
Benefits & Contact Info
 |
Georgetown |
$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: 43% Specialty Tier: 28% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,150 Browse Formulary |
 |
 |
 |
Higher cost-sharing at standard network pharmacies. Details:
 |
Wellcare Simple (HMO-POS) - H4847-001-0
Benefits & Contact Info
 |
Georgetown |
$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: 34% Specialty Tier: 28% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,200 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) - H5521-251-0
Benefits & Contact Info
 |
Georgetown |
$19.00 |
$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 | $6,750 Browse Formulary |
 |
 |
 |
Higher cost-sharing at standard network pharmacies. Details:
 |
Aetna Medicare Dual Choice (PPO D-SNP) - H5521-539-0
Benefits & Contact Info
 |
Georgetown |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | All formulary drugs: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
 |
 |
 |
|
Wellcare Assist Open (PPO) - H7326-007-0
Benefits & Contact Info
 |
Georgetown |
$22.90 |
$590 Tier 1 and 6 exempt |
Basic Alternative Standard (BA) | Preferred Generic: $10.00 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 | $5,000 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 |
Aetna Medicare Value Plus (HMO) - H3146-011-0
Benefits & Contact Info
 |
Georgetown |
$23.90 |
$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 | $6,750 Browse Formulary |
 |
 |
 |
Higher cost-sharing at standard network pharmacies. Details:
 |
BlueCross Total (PPO) - H8003-003-0
Benefits & Contact Info
 |
Georgetown |
$25.00 |
$0 |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: 25% Non-Preferred Drug: 40% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $8,900 Browse Formulary |
 |
 |
 |
Higher cost-sharing at standard network pharmacies. Details:
 |
Aetna Medicare Assure (HMO D-SNP) - H3146-017-0
Benefits & Contact Info
 |
Georgetown |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | All formulary drugs: 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 Complete Care GS-2 (Regional PPO C-SNP) - R2604-003-0
Benefits & Contact Info
 |
Georgetown |
$28.00 |
$495 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: 27%
all covered insulin pay $35 or less | $7,900 Browse Formulary |
 |
 |
 |
|
Wellcare Assist (HMO-POS) - H4847-005-0
Benefits & Contact Info
 |
Georgetown |
$28.90 |
$450 Tier 1 and 6 exempt |
Basic Alternative Standard (BA) | Preferred Generic: $10.00 Generic: $19.00 Preferred Brand: 22% Non-Preferred Drug: $100.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
 |
 |
 |
Higher cost-sharing at standard network pharmacies. Details:
 |
HumanaChoice H5525-024 (PPO) - H5525-024-0
Benefits & Contact Info
 |
Georgetown |
$30.00 |
$350 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | 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 | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
AARP Medicare Advantage from UHC SC-0004 (PPO) - H2001-108-0
Benefits & Contact Info
 |
Georgetown |
$37.00 |
$340 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $6,300 Browse Formulary |
 |
 |
 |
|
Humana Gold Plus SNP-DE H5619-082 (HMO D-SNP) - H5619-082-0
Benefits & Contact Info
 |
Georgetown |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | All formulary drugs: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
 |
 |
 |
|
AARP Medicare Advantage from UHC SC-0006 (HMO-POS) - H5322-044-0
Benefits & Contact Info
 |
Georgetown |
$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 | $5,900 Browse Formulary |
 |
 |
 |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Molina Medicare Complete Care (HMO D-SNP) - H8176-001-0
Benefits & Contact Info
 |
Georgetown |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | All formulary drugs: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
 |
 |
 |
|
Wellcare Dual Liberty (HMO-POS D-SNP) - H4847-004-0
Benefits & Contact Info
 |
Georgetown |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | All formulary drugs: 25%
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
 |
Georgetown |
$41.10 |
$590 |
Defined Standard (DS) | All formulary drugs: 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 Liberty Open (PPO D-SNP) - H7326-006-0
Benefits & Contact Info
 |
Georgetown |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | All formulary drugs: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
 |
 |
 |
|
First Choice VIP Care (HMO D-SNP) - H4739-001-0
Benefits & Contact Info
 |
Georgetown |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | All formulary drugs: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
 |
-- |
-- |
|
HumanaChoice H5216-280 (PPO) - H5216-280-2
Benefits & Contact Info
 |
Georgetown |
$46.60 |
$590 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | 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 |
 |
 |
 |
|
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 H5216-277 (PPO D-SNP) - H5216-277-0
Benefits & Contact Info
 |
Georgetown |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | All formulary drugs: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
 |
 |
 |
|
UHC Complete Care Support SC-7 (PPO C-SNP) - H2001-076-0
Benefits & Contact Info
 |
Georgetown |
$46.60 |
$590 |
Defined Standard (DS) | All formulary drugs: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
 |
 |
 |
|
UHC Dual Complete SC-S001 (PPO D-SNP) - H2001-032-0
Benefits & Contact Info
 |
Georgetown |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | All formulary drugs: 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 SC-S2 (PPO D-SNP) - H2001-075-0
Benefits & Contact Info
 |
Georgetown |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | All formulary drugs: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
 |
 |
 |
|
UHC Dual Complete SC-V001 (PPO D-SNP) - H2001-059-0
Benefits & Contact Info
 |
Georgetown |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Defined Standard (DS) | All formulary drugs: 25%
all covered insulin pay $35 or less | $4,900 Browse Formulary |
 |
 |
 |
|
UHC Medicare Advantage GS-0001 (Regional PPO) - R2604-001-0
Benefits & Contact Info
 |
Georgetown |
$87.00 |
$570 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: 26%
all covered insulin pay $35 or less | $8,900 Browse Formulary |
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 |
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Full Access R0110-020 (Regional PPO) - R0110-020-0
Benefits & Contact Info
 |
Georgetown |
$92.00 |
$340 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | 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 |
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