AARP Medicare Advantage Patriot No Rx OR-MA01 (PPO) - H2406-073-0
Benefits & Contact Info
|
Washington |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,300 |
|
|
|
|
Aetna Medicare Eagle Plan (PPO) - H9431-015-0
Benefits & Contact Info
|
Washington |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,600 |
|
|
|
|
Humana USAA Honor (PPO) - H5216-315-0
Benefits & Contact Info
|
Washington |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $8,850 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana USAA Honor (PPO) - H5216-301-1
Benefits & Contact Info
|
Washington |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 |
|
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|
|
PacificSource Medicare MyCare Choice 30 (HMO-POS) - H3864-030-0
Benefits & Contact Info
|
Washington |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,950 |
|
|
|
|
Providence Medicare Reverence (HMO-POS) - H9047-035-0
Benefits & Contact Info
|
Washington |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Regence Valiance (HMO) - H6237-006-0
Benefits & Contact Info
|
Washington |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,900 |
|
|
|
|
Regence Valiance (PPO) - H3817-010-0
Benefits & Contact Info
|
Washington |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,000 |
|
|
|
|
Wellcare Patriot No Premium Open (PPO) - H5439-010-0
Benefits & Contact Info
|
Washington |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,500 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
AARP Medicare Advantage from UHC OR-0002 (PPO) - H2406-070-0
Benefits & Contact Info
|
Washington |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $5,600 Browse Formulary |
|
|
|
|
AARP Medicare Advantage from UHC OR-0004 (HMO-POS) - H3805-039-1
Benefits & Contact Info
|
Washington |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
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Aetna Medicare Elite Plan (HMO-POS) - H2056-003-0
Benefits & Contact Info
|
Washington |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
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 |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Aetna Medicare SmartFit Elite Plan (HMO-POS) - H2056-010-0
Benefits & Contact Info
|
Washington |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: 20% Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Value Plan (HMO-POS) - H2056-004-0
Benefits & Contact Info
|
Washington |
$0.00 |
$150 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | 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 | $6,100 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
ATRIO Choice Rx (PPO) - H7006-018-0
Benefits & Contact Info
|
Washington |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,600 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
ATRIO Freedom (PPO) - H7006-021-0
Benefits & Contact Info
|
Washington |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 |
|
|
|
|
Cigna Preferred Medicare (HMO) - H7389-002-0
Benefits & Contact Info
|
Washington |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Cigna True Choice Medicare (PPO) - H7849-055-0
Benefits & Contact Info
|
Washington |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $5,600 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 |
Devoted CHOICE Oregon (PPO) - H7199-001-0
Benefits & Contact Info
|
Washington |
$0.00 |
$225 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | 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 | $5,900 Browse Formulary |
|
new |
new |
|
Devoted CORE Oregon (HMO) - H2923-001-0
Benefits & Contact Info
|
Washington |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $5,200 Browse Formulary |
|
new |
new |
|
Humana Gold Plus - Diabetes (HMO C-SNP) - H1036-306-0
Benefits & Contact Info
|
Washington |
$0.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | 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 | 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 |
Humana Gold Plus H1036-153 (HMO) - H1036-153-0
Benefits & Contact Info
|
Washington |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $5,200 Browse Formulary |
|
|
|
|
HumanaChoice H5216-247 (PPO) - H5216-247-0
Benefits & Contact Info
|
Washington |
$0.00 |
$125 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,500 Browse Formulary |
|
|
|
|
Kaiser Permanente Senior Advantage Value (HMO-POS) - H9003-009-0
Benefits & Contact Info
|
Washington |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $5,000 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Moda Health Elements PPORX (PPO) - H3813-019-0
Benefits & Contact Info
|
Washington |
$0.00 |
$225 Tier 1, 2 and 7 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $93.00 Preferred Specialty Tier: 24% Specialty Tier: 29%
all covered insulin pay $35 or less | $5,465 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Moda Health PPO (PPO) - H3813-001-0
Benefits & Contact Info
|
Washington |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
PacificSource Medicare Explorer Rx 11 (PPO) - H4754-011-0
Benefits & Contact Info
|
Washington |
$0.00 |
$150 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $4.00 Preferred Brand: $42.00 Non-Preferred Drug: 29% Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $6,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
PacificSource Medicare MyCare Choice Rx 34 (HMO-POS) - H3864-034-0
Benefits & Contact Info
|
Washington |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $42.00 Non-Preferred Drug: 31% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
PacificSource Medicare MyCare Rx 40 (HMO) - H3864-040-0
Benefits & Contact Info
|
Washington |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 31% Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Providence Medicare Prime + Rx (HMO) - H9047-037-0
Benefits & Contact Info
|
Washington |
$0.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $4,500 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 |
Regence BlueAdvantage HMO (HMO) - H6237-007-1
Benefits & Contact Info
|
Washington |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Regence MedAdvantage + Rx Primary (PPO) - H3817-011-1
Benefits & Contact Info
|
Washington |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $13.00 Preferred Brand: $40.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $6,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback Open (PPO) - H5439-015-0
Benefits & Contact Info
|
Washington |
$0.00 |
$545 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $8,850 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 |
Wellcare No Premium (HMO) - H6815-039-0
Benefits & Contact Info
|
Washington |
$0.00 |
$250 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 29% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) - H6815-038-0
Benefits & Contact Info
|
Washington |
$0.00 |
$425 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 26% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) - H5439-017-0
Benefits & Contact Info
|
Washington |
$0.00 |
$300 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 28% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,450 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 |
Devoted CHOICE PLUS Oregon (PPO) - H7199-002-0
Benefits & Contact Info
|
Washington |
$12.00 |
$150 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $5,400 Browse Formulary |
|
new |
new |
|
Wellcare Assist (HMO) - H6815-037-0
Benefits & Contact Info
|
Washington |
$16.60 |
$380 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Aetna Medicare Choice Plan (PPO) - H9431-005-0
Benefits & Contact Info
|
Washington |
$20.00 |
$150 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | 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 | $5,600 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 |
Aetna Medicare Value Plus Plan (HMO-POS) - H2056-011-0
Benefits & Contact Info
|
Washington |
$20.70 |
$400 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: 20% Non-Preferred Drug: 40% Specialty Tier: 27%
all covered insulin pay $35 or less | $6,100 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
UHC Complete Care OR-001A (PPO C-SNP) - H0271-036-0
Benefits & Contact Info
|
Washington |
$21.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Wellcare Low Premium Open (PPO) - H5439-019-0
Benefits & Contact Info
|
Washington |
$24.00 |
$350 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 27% 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 |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
UHC Nursing Home Plan OR-F002 (PPO I-SNP) - H2406-033-0
Benefits & Contact Info
|
Washington |
$28.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Providence Medicare Bridge + Rx (HMO-POS) - H9047-059-0
Benefits & Contact Info
|
Washington |
$29.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
UHC Nursing Home Plan OR-F001 (PPO I-SNP) - H0710-036-0
Benefits & Contact Info
|
Washington |
$30.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25%
all covered insulin pay $35 or less | 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 |
UHC Care Advantage RI-E002 (PPO I-SNP) - H2406-049-0
Benefits & Contact Info
|
Washington |
$33.00 |
$200 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Humana Value Plus H5216-294 (PPO) - H5216-294-0
Benefits & Contact Info
|
Washington |
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: 21% Non-Preferred Drug: 25% Specialty Tier: 25%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
AARP Medicare Advantage from UHC OR-0001 (PPO) - H2406-042-0
Benefits & Contact Info
|
Washington |
$39.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Moda Health + Fred Meyer PPORX (PPO) - H3813-016-0
Benefits & Contact Info
|
Washington |
$39.00 |
$200 Tier 1, 2 and 7 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $93.00 Preferred Specialty Tier: 24% Specialty Tier: 29%
all covered insulin pay $35 or less | $6,750 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AgeRight Advantage Health Plan (HMO I-SNP) - H1372-001-0
Benefits & Contact Info
|
Washington |
$40.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Tier 1: 25%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
ATRIO Select Rx (PPO) - H7006-019-0
Benefits & Contact Info
|
Washington |
$40.60 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $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 |
CareOregon Advantage Plus (HMO-POS D-SNP) - H5859-001-0
Benefits & Contact Info
|
Washington |
$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 | Generic: 25% Preferred Brand: 25% Non-Preferred Brand: 25% Specialty Tier: 25% Supplemental Drugs: $1.55
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
PacificSource Dual Care (HMO D-SNP) - H3864-043-0
Benefits & Contact Info
|
Washington |
$0.00 for people who qualify for both Medicare and Medicaid. |
$0 for people who qualify for both Medicare and Medicaid. |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 34% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
Providence Medicare Dual Plus (HMO D-SNP) - H9047-043-0
Benefits & Contact Info
|
Washington |
$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: 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15%
all covered insulin pay $35 or less | 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 |
UHC Care Advantage OR-E001 (PPO I-SNP) - H0710-037-0
Benefits & Contact Info
|
Washington |
$40.60 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Regence BlueAdvantage HMO Plus (HMO) - H6237-008-1
Benefits & Contact Info
|
Washington |
$41.00 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Regence MedAdvantage + Rx Classic (PPO) - H3817-008-1
Benefits & Contact Info
|
Washington |
$44.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $13.00 Preferred Brand: $40.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $5,700 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 |
Kaiser Permanente Senior Advantage Standard (HMO-POS) - H9003-006-0
Benefits & Contact Info
|
Washington |
$46.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,650 Browse Formulary |
|
|
|
|
AgeRight Advantage Plus Health Plan (HMO I-SNP) - H1372-002-0
Benefits & Contact Info
|
Washington |
$55.00 |
$300 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
AgeRight Advantage Premier Health Plan (HMO C-SNP) - H1372-003-0
Benefits & Contact Info
|
Washington |
$55.00 |
$300 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
all covered insulin pay $35 or less | 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 |
AARP Medicare Advantage from UHC OR-0003 (HMO-POS) - H3805-001-0
Benefits & Contact Info
|
Washington |
$58.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
|
|
|
|
Providence Medicare Choice + Rx (HMO-POS) - H9047-065-0
Benefits & Contact Info
|
Washington |
$71.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Moda Health Metro PPORX (PPO) - H3813-013-0
Benefits & Contact Info
|
Washington |
$86.00 |
$150 Tier 1, 2 and 7 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $93.00 Preferred Specialty Tier: 25% Specialty Tier: 30%
all covered insulin pay $35 or less | $5,090 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 |
ATRIO Prime Rx (PPO) - H7006-020-0
Benefits & Contact Info
|
Washington |
$125.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 33% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $2,950 Browse Formulary |
|
|
|
|
Providence Medicare Focus Medical (HMO) - H9047-033-0
Benefits & Contact Info
|
Washington |
$128.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 |
|
|
|
|
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) - H9003-001-0
Benefits & Contact Info
|
Washington |
$131.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Drug: $90.00 Specialty Tier: 33% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $3,000 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Premium Ultra Open (PPO) - H5439-011-0
Benefits & Contact Info
|
Washington |
$139.00 |
$150 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $10.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Providence Medicare Extra + Rx (HMO) - H9047-064-0
Benefits & Contact Info
|
Washington |
$155.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $3,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Regence MedAdvantage + Rx Enhanced (PPO) - H3817-009-1
Benefits & Contact Info
|
Washington |
$166.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Drug: $100.00 Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|