AARP Medicare Advantage Patriot No Rx VA-MA01 (PPO) - H2001-099-0
Benefits & Contact Info
|
York |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $8,900 |
|
|
|
|
Aetna Medicare Eagle (PPO) - H5521-322-0
Benefits & Contact Info
|
York |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,750 |
|
|
|
|
Humana Gold Choice H8145-042 (PFFS) - H8145-042-0
Benefits & Contact Info
|
York |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $7,550 |
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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 USAA Honor Giveback (PPO) - H5216-310-0
Benefits & Contact Info
|
York |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $9,350 |
|
|
|
|
Humana USAA Honor Giveback (Regional PPO) - R0110-006-0
Benefits & Contact Info
|
York |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $9,350 |
|
|
|
|
HumanaChoice H5216-152 (PPO) - H5216-152-0
Benefits & Contact Info
|
York |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0110-004 (Regional PPO) - R0110-004-0
Benefits & Contact Info
|
York |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $7,550 |
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|
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Sentara Medicare Salute (HMO) - H2563-014-0
Benefits & Contact Info
|
York |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,550 |
|
|
|
|
AARP Medicare Advantage from UHC VA-0004 (PPO) - H2001-096-0
Benefits & Contact Info
|
York |
$0.00 |
$255 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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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 |
AARP Medicare Advantage from UHC VA-0008 (HMO-POS) - H5253-087-0
Benefits & Contact Info
|
York |
$0.00 |
$255 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: 30%
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
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AARP Medicare Advantage Giveback from UHC VA-13 (HMO-POS) - H5253-119-0
Benefits & Contact Info
|
York |
$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 | $8,900 Browse Formulary |
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Aetna Medicare Premier (PPO) - H5521-395-0
Benefits & Contact Info
|
York |
$0.00 |
$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 | $7,900 Browse Formulary |
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|
|
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 Select (HMO-POS) - H3931-100-0
Benefits & Contact Info
|
York |
$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:
|
Anthem Dual Advantage (PPO D-SNP) - H2441-001-0
Benefits & Contact Info
|
York |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: 20% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $9,350 Browse Formulary |
new |
new |
new |
|
Anthem Kidney Care (HMO-POS C-SNP) - H3447-033-0
Benefits & Contact Info
|
York |
$0.00 |
$325 Tier 1, 2 and 6 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: 20% Non-Preferred Drug: 25% Specialty Tier: 29% 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 |
Anthem Medicare Advantage (HMO-POS) - H3447-013-0
Benefits & Contact Info
|
York |
$0.00 |
$275 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: 29% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) - H4909-014-0
Benefits & Contact Info
|
York |
$0.00 |
$295 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: 29% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $7,950 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage 3 (HMO-POS) - H3447-049-0
Benefits & Contact Info
|
York |
$0.00 |
$150 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: 20% Non-Preferred Drug: 35% Specialty Tier: 31%
all covered insulin pay $35 or less | $2,800 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 - Diabetes and Heart (HMO C-SNP) - H6622-084-0
Benefits & Contact Info
|
York |
$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: 40% Specialty Tier: 27%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
Humana Gold Plus Giveback H6622-090 (HMO) - H6622-090-0
Benefits & Contact Info
|
York |
$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 Gold Plus H5619-157 (HMO) - H5619-157-0
Benefits & Contact Info
|
York |
$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: 50% 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 |
Humana Gold Plus H6622-004 (HMO) - H6622-004-0
Benefits & Contact Info
|
York |
$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 |
|
|
|
|
Humana Gold Plus H6622-083 (HMO) - H6622-083-0
Benefits & Contact Info
|
York |
$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 |
|
|
|
|
Humana Gold Plus H6622-091 (HMO) - H6622-091-0
Benefits & Contact Info
|
York |
$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 Together in Health (PPO I-SNP) - H5216-362-0
Benefits & Contact Info
|
York |
$0.00 |
$500 |
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 |
|
|
|
|
HumanaChoice Giveback H5216-308 (PPO) - H5216-308-0
Benefits & Contact Info
|
York |
$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: 43% Specialty Tier: 27%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
HumanaChoice H5216-266 (PPO) - H5216-266-0
Benefits & Contact Info
|
York |
$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: 45% 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 |
HumanaChoice H5216-408 (PPO) - H5216-408-0
Benefits & Contact Info
|
York |
$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: 45% Specialty Tier: 27%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
Sentara Medicare Engage- Lung (HMO C-SNP) - H2563-025-0
Benefits & Contact Info
|
York |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) - H2563-018-0
Benefits & Contact Info
|
York |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,500 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 |
Sentara Medicare Value (HMO) - H2563-017-2
Benefits & Contact Info
|
York |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
UHC Complete Care VA-22 (HMO-POS C-SNP) - H5253-196-0
Benefits & Contact Info
|
York |
$0.00 |
$255 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: 30%
all covered insulin pay $35 or less | $5,400 Browse Formulary |
|
|
|
|
Molina Medicare Complete Care (HMO D-SNP) - H7559-001-0
Benefits & Contact Info
|
York |
$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 |
Anthem Extra Help (HMO-POS) - H3447-028-0
Benefits & Contact Info
|
York |
$8.10 |
$590 Tier 1 and 6 exempt |
Enhanced Alternative (EA) | 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 | $2,900 Browse Formulary |
|
|
|
|
Molina Medicare Complete Care Select (HMO D-SNP) - H7559-002-0
Benefits & Contact Info
|
York |
$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 |
|
|
|
|
Anthem Full Dual Advantage 2 (HMO D-SNP) - H4694-001-0
Benefits & Contact Info
|
York |
$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 |
new |
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Dual Advantage (HMO D-SNP) - H4694-002-0
Benefits & Contact Info
|
York |
$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 |
new |
new |
new |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) - H5619-145-0
Benefits & Contact Info
|
York |
$19.40 |
$450 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: 35% Specialty Tier: 27%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
Humana Gold Plus H6622-085 (HMO) - H6622-085-0
Benefits & Contact Info
|
York |
$19.70 |
$590 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 42% 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 |
Aetna Medicare Value Plus (PPO) - H5521-084-0
Benefits & Contact Info
|
York |
$20.00 |
$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 | $5,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Sentara Community Complete Select (HMO D-SNP) - H2563-020-0
Benefits & Contact Info
|
York |
$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 |
|
|
|
|
Sentara Community Complete (HMO D-SNP) - H4499-001-0
Benefits & Contact Info
|
York |
$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 |
new |
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible | Drug Benefit Detail | Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare Better Health (HMO D-SNP) - H1610-001-0
Benefits & Contact Info
|
York |
$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 |
|
|
|
|
Aetna Medicare Assure Value (HMO D-SNP) - H1610-003-0
Benefits & Contact Info
|
York |
$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 VA-0009 (HMO-POS) - H5253-088-0
Benefits & Contact Info
|
York |
$29.00 |
$255 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: 30%
all covered insulin pay $35 or less | $3,900 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 Full Dual Advantage (HMO D-SNP) - H4694-004-0
Benefits & Contact Info
|
York |
$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 |
new |
new |
new |
|
Anthem Full Dual Advantage Support (HMO D-SNP) - H4694-003-0
Benefits & Contact Info
|
York |
$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 |
new |
new |
new |
|
Humana Dual Fully Integrated H2875-001 (HMO-POS D-SNP) - H2875-001-0
Benefits & Contact Info
|
York |
$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 |
new |
new |
new |
|
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 SNP-DE H2875-002 (HMO-POS D-SNP) - H2875-002-0
Benefits & Contact Info
|
York |
$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 |
new |
new |
new |
|
HumanaChoice H5216-363 (PPO) - H5216-363-0
Benefits & Contact Info
|
York |
$30.70 |
$590 Tier 1 and 2 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 38% Specialty Tier: 25%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
|
|
|
|
UHC Dual Complete VA-Q001 (HMO-POS D-SNP) - H2445-002-0
Benefits & Contact Info
|
York |
$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 |
new |
new |
new |
|
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 VA-V001 (HMO-POS D-SNP) - H2445-004-0
Benefits & Contact Info
|
York |
$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 | $3,600 Browse Formulary |
new |
new |
new |
|
UHC Dual Complete VA-Y001 (HMO-POS D-SNP) - H2445-001-0
Benefits & Contact Info
|
York |
$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 |
new |
new |
new |
|
UHC Dual Complete VA-Y002 (HMO-POS D-SNP) - H2445-003-0
Benefits & Contact Info
|
York |
$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 |
new |
new |
new |
|
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 VA-Y3 (HMO-POS D-SNP) - H2445-005-0
Benefits & Contact Info
|
York |
$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 |
new |
new |
new |
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UHC Dual Complete VA-Y4 (PPO D-SNP) - H0421-001-0
Benefits & Contact Info
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York |
$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 |
new |
new |
new |
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UHC Nursing Home Plan EX-F004 (PPO I-SNP) - H0710-032-0
Benefits & Contact Info
|
York |
$39.00 |
$590 |
Defined Standard (DS) | All formulary drugs: 25%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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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 |
HumanaChoice H5216-144 (PPO) - H5216-144-0
Benefits & Contact Info
|
York |
$45.00 |
$350 Tier 1, 2 and 3 exempt |
Enhanced Alternative (EA) | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 28%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
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Sentara Medicare Prime (HMO) - H2563-005-2
Benefits & Contact Info
|
York |
$65.00 |
$130 Tier 1, 2, 3 and 6 exempt |
Enhanced Alternative (EA) | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Humana Full Access R0110-005 (Regional PPO) - R0110-005-0
Benefits & Contact Info
|
York |
$128.00 |
$480 Tier 1, 2 and 3 exempt |
Enhanced Alternative (EA) | Preferred Generic: $8.00 Generic: $18.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 27%
all covered insulin pay $35 or less | $9,350 Browse Formulary |
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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 |
AARP Medicare Advantage Access from UHC VA-20 (PPO) - H2001-115-0
Benefits & Contact Info
|
York |
$247.00 |
$570 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: 26%
all covered insulin pay $35 or less | $3,000 Browse Formulary |
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