2013 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
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Plan Name | County | Monthly Prem. (Parts C & D) |
Deduct- ible |
(Donut Hole) Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance 30-Day Supply |
MOOP for Part A & B Benefits | |||||
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
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AARP MedicareComplete Choice Essential (Regional PPO) - R5287-002-0 Benefit Details |
Miami-Dade | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,500 | ||||||
AARP MedicareComplete Choice Plan 2 (Regional PPO) - R5287-001-0 Benefit Details |
Miami-Dade | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $6.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $4,900 Browse Formulary | |||||
AARP MedicareComplete Plan 1 (HMO) - H9011-003-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Some Generics | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $30.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
AARP MedicareComplete Plus (HMO-POS) - H9011-016-0 Benefit Details |
Miami-Dade | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $30.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Aetna Medicare Value Plan (HMO) - H5414-019-0 Benefit Details |
Miami-Dade | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,600 Browse Formulary | |||||
Amerivantage Classic+ Rx Plan (HMO) - H8991-028-0 Benefit Details |
Miami-Dade | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $4.00 Preferred Brand: $35.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
AvMed Medicare Choice (HMO) - H1016-001-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $4,000 Browse Formulary | |||||
BlueMedicare HMO (HMO) - H1026-001-0 Benefit Details |
Miami-Dade | $0.00 | $0 | All Generics | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
BlueMedicare Regional PPO (Regional PPO) - R3332-001-0 Benefit Details |
Miami-Dade | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $6.00 Non-Preferred Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,900 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
CareFree PLUS (HMO) - H1019-056-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Few Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $24.00 Non-Preferred Brand: $40.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
CareHeart (HMO SNP) - H1019-063-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $25.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
CareOne PLUS (HMO) - H1019-006-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $25.00 Specialty Tier: 33% | $3,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Clear Skies (HMO SNP) - H4199-005-0 Benefit Details |
Miami-Dade | $0.00 | $0 | All Generics | Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $20.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Coventry Summit Ideal (HMO-POS) - H5850-012-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $25.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Coventry Summit Plus (HMO) - H5850-006-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Coventry Vista Ideal (HMO) - H1013-011-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $20.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Coventry Vista Value (HMO) - H1076-010-0 Benefit Details |
Miami-Dade | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Day Break (HMO) - H4199-002-0 Benefit Details |
Miami-Dade | $0.00 | $0 | All Generics | Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $20.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Day Light (HMO) - H4199-004-0 Benefit Details |
Miami-Dade | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
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Freedom Medicare Plan Rx (HMO) - H5427-060-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Freedom Savings Plan (HMO) - H5427-052-0 Benefit Details |
Miami-Dade | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Freedom VIP Care (HMO SNP) - H5427-070-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Preferred Brand: $5.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Freedom VIP Care COPD (HMO SNP) - H5427-076-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Preferred Brand: $5.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Freedom VIP Savings (HMO SNP) - H5427-072-0 Benefit Details |
Miami-Dade | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Freedom VIP Savings COPD (HMO SNP) - H5427-077-0 Benefit Details |
Miami-Dade | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Healthy Advantage Plan (HMO) - H5431-005-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: 25% Non-Preferred Brand: 33% Specialty Tier: 33% Supplemental Brand and Generic Drugs: $0.00 | $3,400 Browse Formulary | |||||
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Humana Gold Plus H1036-054C (HMO) - H1036-054-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $25.00 Specialty Tier: 33% | $3,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H1036-164 (HMO) - H1036-164-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Few Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $24.00 Non-Preferred Brand: $40.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Humana Gold Plus SNP-CVD/CHF H1036-189 (HMO SNP) - H1036-189-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $25.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Humana Gold Plus SNP-DB H1036-188 (HMO SNP) - H1036-188-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Many Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $25.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Humana Reader's Digest Healthy Living Plan (Regional PPO) - R5826-074-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $4,950 Browse Formulary | |||||
HumanaChoice R5826-018 (Regional PPO) - R5826-018-0 Benefit Details |
Miami-Dade | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
JacksonHealth for Life (HMO) - H4155-001-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Many Generics | Generic: $0.00 Preferred Brand: $10.00 Non-Preferred Brand: $25.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
JacksonHealth Secure (HMO SNP) - H4155-003-0 Benefit Details |
MIAMI-DADE | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Generic: $0.00 Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% | n/a Browse Formulary | |||||
Leon Medical Centers Health Plans - Leon Cares (HMO) - H5410-001-0 Benefit Details |
Miami-Dade | $0.00 | $0 | All Generics | Generic: $0.00 Brand: $0.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Medica HealthCare Plans MedicareMax (HMO) - H5420-001-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Many Generics | Generic: $0.00 Preferred Brand: $5.00 Non-Preferred Brand: $20.00 Specialty Tier: 25% | $500 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medica HealthCare Plans MedicareMax Chronic Care (HMO SNP) - H5420-010-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Many Generics | Generic: $0.00 Preferred Brand: $5.00 Non-Preferred Brand: $20.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Medica HealthCare Plans MedicareMax Value (HMO) - H5420-007-0 Benefit Details |
Miami-Dade | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
Medica HealthCare Plans MedicareMax Value RX (HMO) - H5420-009-0 Benefit Details |
Miami-Dade | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Brand: $40.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Optimum Gold Rewards Plan (HMO-POS) - H5594-001-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Preferred Brand: $20.00 Non-Preferred Brand: $69.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Optimum Platinum Plan (HMO-POS) - H5594-002-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Preferred Brand: $5.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Positive Healthcare Partners (HMO SNP) - H3132-001-0 Benefit Details |
Miami-Dade | $0.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% | n/a Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Preferred Choice Dade (HMO-POS) - H1045-001-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Many Generics, Few Brands | Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $20.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Preferred Complete Care (HMO) - H1045-016-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Many Generics, Some Brands | Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $20.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Preferred Medical Plan Choice (HMO) - H3712-001-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Many Generics, Some Brands | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $20.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
new | new | new | |||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Preferred Medical Plan Value (HMO) - H3712-002-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Brand: $45.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
new | new | new | |||||||||
Preferred Premium Advantage Miami-Dade (HMO) - H1045-020-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Many Generics, Few Brands | Generic: $0.00 Preferred Brand: $10.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Preferred Secure Option (HMO) - H1045-023-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Many Generics, Few Brands | Generic: $0.00 Preferred Brand: $40.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Preferred Special Care Miami-Dade (HMO SNP) - H1045-018-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Many Generics, Some Brands | Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $20.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
PUP REWARDS (HMO) - H5696-028-0 Benefit Details |
Miami-Dade | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Preferred Brand: $15.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $4,600 Browse Formulary | |||||
Simply Extra (HMO) - H5471-004-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Brand: $45.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Simply Level (HMO SNP) - H5471-012-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $15.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Simply More (HMO) - H5471-002-0 Benefit Details |
Miami-Dade | $0.00 | $0 | All Generics, All Brands | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $10.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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Simply Options (HMO-POS) - H5471-003-0 Benefit Details |
Miami-Dade | $0.00 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $15.00 Non-Preferred Brand: $30.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
SunPlus Advantage Plan (HMO) - H5431-001-0 Benefit Details |
Miami-Dade | $0.00 | $0 | All Generics, All Brands | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $10.00 Specialty Tier: 25% Supplemental Brand and Generic Drugs: $0.00 | $3,400 Browse Formulary | |||||
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SunPlus Diabetes Special Needs Plan (HMO SNP) - H5431-007-0 Benefit Details |
Miami-Dade | $0.00 | $0 | All Generics, All Brands | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $10.00 Specialty Tier: 25% Supplemental Brand and Generic Drugs: $0.00 | n/a Browse Formulary | |||||
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Sunrise (HMO) - H4199-001-0 Benefit Details |
Miami-Dade | $0.00 | $0 | All Generics | Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $20.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
WellCare Choice (HMO) - H1032-008-0 Benefit Details |
Miami-Dade | $0.00 | $0 | All Generics, All Brands | Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $30.00 Specialty Tier: 33% | $2,500 Browse Formulary | |||||
WellCare Dividend (HMO) - H1032-040-0 Benefit Details |
Miami-Dade | $0.00 | $0 | All Generics | Generic: $0.00 Preferred Brand: $25.00 Non-Preferred Brand: $49.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Preferred Medicare Assist (HMO-POS SNP) - H1045-012-0 Benefit Details |
MIAMI-DADE | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
PUP EXTRA (HMO SNP) - H5696-021-0 Benefit Details |
MIAMI-DADE | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Preferred Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $0.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Sunny Days (HMO SNP) - H4199-006-0 Benefit Details |
MIAMI-DADE | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | n/a Browse Formulary | |||||
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WellCare Select (HMO-POS SNP) - H1032-061-0 Benefit Details |
MIAMI-DADE | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
WellCare Liberty (HMO SNP) - H1032-170-0 Benefit Details |
MIAMI-DADE | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $30.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
WellCare Access (HMO SNP) - H1032-176-0 Benefit Details |
MIAMI-DADE | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $30.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Humana Gold Plus SNP-DE H1036-077A (HMO SNP) - H1036-077-0 Benefit Details |
MIAMI-DADE | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Coventry Summit Maximum (HMO SNP) - H5850-002-0 Benefit Details |
MIAMI-DADE | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Preferred Generic: $0.00 Preferred Brand: $40.00 Non-Preferred Brand: $76.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Molina Medicare Options Plus (HMO SNP) - H8130-001-0 Benefit Details |
MIAMI-DADE | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Generic: $0.00 Preferred Brand: $0.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
CareNeeds (HMO SNP) - H1019-024-0 Benefit Details |
MIAMI-DADE | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Humana Gold Plus SNP-I H1036-187 (HMO SNP) - H1036-187-0 Benefit Details |
Miami-Dade | $21.30 | $325 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Plus SNP-DE H1036-163 (HMO SNP) - H1036-163-0 Benefit Details |
MIAMI-DADE | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Freedom Medi-Medi Full (HMO SNP) - H5427-087-0 Benefit Details |
MIAMI-DADE | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Tier 1: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medica HealthCare Plans MedicareMax Plus (HMO SNP) - H5420-006-0 Benefit Details |
MIAMI-DADE | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Generic: $0.00 Preferred Brand: 25% Non-Preferred Brand: 35% Specialty Tier: 25% | n/a Browse Formulary | |||||
Sunshine State Health Plan (HMO SNP) - H5190-001-0 Benefit Details |
MIAMI-DADE | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Injectable Drugs: $95.00 | n/a Browse Formulary | |||||
Amerivantage Specialty + Rx (HMO SNP) - H8991-017-0 Benefit Details |
Miami-Dade | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | Some Generics | Preferred Generic: $0.00 Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Coventry Vista Maximum (HMO SNP) - H1013-024-0 Benefit Details |
MIAMI-DADE | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Preferred Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $76.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Freedom Medi-Medi Partial (HMO SNP) - H5427-078-0 Benefit Details |
MIAMI-DADE | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Tier 1: 25% | n/a Browse Formulary | |||||
MediMax (HMO) - H5431-006-0 Benefit Details |
Miami-Dade | $24.70 | $325 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 25% Non-Preferred Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% Supplemental Brand and Generic Drugs: $0.00 | $3,400 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
CareNeeds PLUS (HMO SNP) - H1019-048-0 Benefit Details |
MIAMI-DADE | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Optimum Emerald Full (HMO SNP) - H5594-017-0 Benefit Details |
MIAMI-DADE | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Tier 1: 25% | n/a Browse Formulary | |||||
Optimum Emerald Partial (HMO SNP) - H5594-016-0 Benefit Details |
MIAMI-DADE | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Tier 1: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Simply Care (HMO SNP) - H5471-008-0 Benefit Details |
Miami-Dade | $24.80 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $10.00 Non-Preferred Brand: $25.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Simply Complete (HMO SNP) - H5471-001-0 Benefit Details |
MIAMI-DADE | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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UnitedHealthcare Dual Complete RP (Regional PPO SNP) - R5287-003-0 Benefit Details |
Statewide | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Coventry Vista Maximum Choice (HMO SNP) - H1076-011-0 Benefit Details |
MIAMI-DADE | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | n/a | Preferred Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Brand: $76.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Simply Comfort (HMO SNP) - H5471-009-0 Benefit Details |
Miami-Dade | $25.80 | $0 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $10.00 Non-Preferred Brand: $25.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Aetna Medicare Premier Plan (PPO) - H5521-033-0 Benefit Details |
Miami-Dade | $33.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
HumanaChoice H5415-056 (PPO) - H5415-056-0 Benefit Details |
Miami-Dade | $42.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Preferred Brand: $43.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $5,000 Browse Formulary | |||||
HumanaChoice R5826-005 (Regional PPO) - R5826-005-0 Benefit Details |
Miami-Dade | $85.00 | $0 | Few Generics, Few Brands | Preferred Generic: $3.00 Non-Preferred Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Brand: $85.00 Specialty Tier: 33% | $4,750 Browse Formulary | |||||
Humana Gold Choice H8145-061 (PFFS) - H8145-061-0 Benefit Details |
Miami-Dade | $102.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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