AARP MedicareComplete Plan 7 (HMO) - H5253-049-0
Benefit Details
|
Summit |
$0.00 |
$255 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| $4,500 Browse Formulary |
|
|
|
|
Aetna Medicare Value Plan (HMO) - H3931-107-0
Benefit Details
|
Summit |
$0.00 |
$175 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 29%
| $5,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Essential (HMO) - H3655-032-0
Benefit Details
|
Summit |
$0.00 |
$60 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 31% Select Care Drugs: $0.00
| $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
CareSource MyCare Ohio (Medicare-Medicaid Plan) - H8452-001-0
Benefit Details
|
Summit |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
Gateway Health Medicare Assured Select (HMO) - H9190-019-0
Benefit Details
|
Summit |
$0.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $16.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
-- |
-- |
|
|
HealthSpan Medicare Core 1 (HMO) - H6298-005-0
Benefit Details
|
Summit |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
new |
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthSpan Medicare Only Basic (Cost) - H6360-012-0
Benefit Details
|
Summit |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 |
-- |
|
|
|
HealthSpan Medicare Plus Basic II (Cost) - H6360-007-0
Benefit Details
|
Summit |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 |
-- |
|
|
|
HealthSpan Medicare Plus Basic III (Cost) - H6360-008-0
Benefit Details
|
Summit |
$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 |
Service |
Exper. |
Cost Info |
HealthSpan Medicare Plus Basic IV (Cost) - H6360-011-0
Benefit Details
|
Summit |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 |
-- |
|
|
|
HealthSpan Medicare Value (HMO) - H6298-001-0
Benefit Details
|
Summit |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Vaccines: $0.00
| $4,000 Browse Formulary |
new |
new |
new |
|
Humana Gold Plus H8953-006 (HMO) - H8953-006-0
Benefit Details
|
Summit |
$0.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Brand: $97.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R5826-021 (Regional PPO) - R5826-021-0
Benefit Details
|
Summit |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
MedMutual Advantage Classic (HMO) - H6723-001-1
Benefit Details
|
Summit |
$0.00 |
$165 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 29%
| $3,950 Browse Formulary |
new |
new |
new |
|
PrimeTime Health Plan Aultimate (HMO-POS) - H3664-021-0
Benefit Details
|
Summit |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
PrimeTime Health Plan Basic - MA Only (HMO-POS) - H3664-014-0
Benefit Details
|
Summit |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 |
|
|
|
|
SecureCare - Option I (HMO) - H3672-014-0
Benefit Details
|
Summit |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 |
|
|
|
|
SecureCare - Option IV (HMO) - H3672-018-0
Benefit Details
|
Summit |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
SummaCare Medicare Topaz (HMO) - H3660-050-0
Benefit Details
|
Summit |
$0.00 |
$150 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 29% Vaccines: $0.00
| $6,000 Browse Formulary |
|
|
|
|
UnitedHealthcare Connected for MyCareOhio (Medicare-Medicaid Plan) - H2531-001-0
Benefit Details
|
Summit |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx/OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
HealthSpan Medicare Core 2 (HMO) - H6298-007-0
Benefit Details
|
Summit |
$2.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd
| $6,700 Browse Formulary |
new |
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem MediBlue Access Core (Regional PPO) - R5941-013-0
Benefit Details
|
Summit |
$17.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
UnitedHealthcare Dual Complete (HMO SNP) - H5253-059-0
Benefit Details
|
Summit |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd
| n/a Browse Formulary |
|
|
|
|
AARP MedicareComplete Plan 1 (HMO) - H5253-050-0
Benefit Details
|
Summit |
$29.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $3,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
MedMutual Advantage Choice (HMO) - H6723-002-1
Benefit Details
|
Summit |
$29.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33%
| $3,500 Browse Formulary |
new |
new |
new |
|
Anthem MediBlue Dual Advantage (HMO SNP) - H3655-033-0
Benefit Details
|
Summit |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $1.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Buckeye Health Plan Advantage (HMO SNP) - H0908-001-0
Benefit Details
|
Summit |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Gateway Health Medicare Assured Diamond (HMO SNP) - H9190-001-0
Benefit Details
|
Summit |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd
| n/a Browse Formulary |
-- |
-- |
|
|
Gateway Health Medicare Assured Ruby (HMO SNP) - H9190-002-0
Benefit Details
|
Summit |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd
| n/a Browse Formulary |
-- |
-- |
|
|
UnitedHealthcare Nursing Home Plan (PPO SNP) - H2406-001-0
Benefit Details
|
Summit |
$29.50 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd
| n/a Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
SecureCare SNP (HMO SNP) - H3672-017-0
Benefit Details
|
Summit |
$1.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
No additional gap coverage, only the Donut Hole Discount | Tier 1: tbd
| n/a Browse Formulary |
|
|
|
|
PrimeTime Health Plan Classic (HMO-POS) - H3664-020-0
Benefit Details
|
Summit |
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
|
|
|
|
HealthSpan Medicare Plus IV (Cost) - H6360-010-0
Benefit Details
|
Summit |
$34.20 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $9.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $0.00
| $3,400 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
MedMutual Advantage Select (PPO) - H4497-001-1
Benefit Details
|
Summit |
$39.00 |
$165 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 29%
| $6,400 Browse Formulary |
new |
new |
new |
|
SummaCare Medicare Ruby (HMO) - H3660-044-0
Benefit Details
|
Summit |
$40.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $0.00
| $5,000 Browse Formulary |
|
|
|
|
HealthSpan Medicare Plus III (Cost) - H6360-006-0
Benefit Details
|
Summit |
$44.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $18.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $0.00
| $3,400 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
AARP MedicareComplete Essential (HMO) - H5253-058-0
Benefit Details
|
Summit |
$45.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,900 |
|
|
|
|
HealthSpan Medicare Standard (HMO) - H6298-002-0
Benefit Details
|
Summit |
$49.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Vaccines: $0.00
| $3,700 Browse Formulary |
new |
new |
new |
|
HealthSpan Medicare Plus II (Cost) - H6360-002-0
Benefit Details
|
Summit |
$49.10 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $16.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Vaccines: $0.00
| $3,400 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Gateway Health Medicare Assured Gold (HMO SNP) - H9190-003-0
Benefit Details
|
Summit |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
-- |
-- |
|
|
SecureCare - Option II (HMO) - H3672-013-0
Benefit Details
|
Summit |
$60.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) - R5941-014-0
Benefit Details
|
Summit |
$68.00 |
$20 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 32% Select Care Drugs: $0.00
| $6,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
MedMutual Advantage Preferred (PPO) - H4497-002-1
Benefit Details
|
Summit |
$69.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33%
| $4,800 Browse Formulary |
new |
new |
new |
|
Anthem MediBlue Plus (HMO) - H3655-034-0
Benefit Details
|
Summit |
$70.00 |
$60 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 31% Select Care Drugs: $0.00
| $4,100 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
PrimeTime Health Plan Plus (HMO-POS) - H3664-017-0
Benefit Details
|
Summit |
$72.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 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 |
Service |
Exper. |
Cost Info |
Anthem MediBlue Access (PPO) - H4036-010-2
Benefit Details
|
Summit |
$73.00 |
$50 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 31% Select Care Drugs: $0.00
| $5,800 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
SummaCare Medicare Sapphire (HMO-POS) - H3660-029-0
Benefit Details
|
Summit |
$78.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33% Vaccines: $0.00
| $5,000 Browse Formulary |
|
|
|
|
Humana Gold Plus H8953-016 (HMO) - H8953-016-0
Benefit Details
|
Summit |
$79.00 |
$100 |
Yes, some additional gap coverage. | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Brand: $97.00 Specialty Tier: 30%
| $3,900 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
SecureChoice - Option II (PPO) - H8604-010-0
Benefit Details
|
Summit |
$80.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-082 (PPO) - H6609-082-0
Benefit Details
|
Summit |
$85.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Brand: $97.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
Anthem MediBlue Access Enhanced (PPO) - H4036-012-2
Benefit Details
|
Summit |
$92.00 |
$40 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 32% Select Care Drugs: $0.00
| $4,100 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Gateway Health Medicare Assured Prime (HMO) - H9190-006-0
Benefit Details
|
Summit |
$96.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 27%
| $6,700 Browse Formulary |
-- |
-- |
|
|
Gateway Health Medicare Assured Platinum (HMO SNP) - H9190-004-0
Benefit Details
|
Summit |
$97.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
-- |
-- |
|
|
HealthSpan Medicare Enhanced (HMO) - H6298-009-0
Benefit Details
|
Summit |
$99.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Vaccines: $0.00
| $3,500 Browse Formulary |
new |
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthSpan Medicare Plus Basic I (Cost) - H6360-004-0
Benefit Details
|
Summit |
$101.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 |
-- |
|
|
|
HumanaChoice R5826-007 (Regional PPO) - R5826-007-0
Benefit Details
|
Summit |
$101.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Brand: $97.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
MedMutual Advantage Premium (PPO) - H4497-003-1
Benefit Details
|
Summit |
$109.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33%
| $3,500 Browse Formulary |
new |
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare Standard Plan (PPO) - H5521-020-0
Benefit Details
|
Summit |
$114.00 |
$175 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 29%
| $5,000 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
AARP MedicareComplete Plan 3 (HMO) - H5253-051-0
Benefit Details
|
Summit |
$120.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 33%
| $2,900 Browse Formulary |
|
|
|
|
HealthSpan Medicare Plus I (Cost) - H6360-001-0
Benefit Details
|
Summit |
$148.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $16.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Vaccines: $0.00
| $3,000 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 |
Anthem MediBlue Connect for OPERS (HMO) - H3655-035-0
Benefit Details
|
Summit |
$151.00 |
$20 |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $42.00 Non-Preferred Brand: $92.00 Specialty Tier: 32% Select Care Drugs: $0.00
| $3,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare OH Connect Gold (Regional PPO) - R6694-003-0
Benefit Details
|
Summit |
$154.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 28%
| $3,500 Browse Formulary |
new |
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5525-030 (PPO) - H5525-030-0
Benefit Details
|
Summit |
$163.00 |
$100 |
Yes, some additional gap coverage. | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Brand: $97.00 Specialty Tier: 30%
| $3,400 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
SummaCare Medicare Emerald (HMO-POS) - H3660-028-0
Benefit Details
|
Summit |
$182.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% Vaccines: $0.00
| $4,000 Browse Formulary |
|
|
|
|
Aetna Medicare Connect Plus (PPO) - H5521-052-0
Benefit Details
|
Summit |
$188.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|