Page 2 - UHC MA Plans Comparison Zip 32820_Year-2019
P. 2
2/14/2019 AARP AARP AARP AARP
MedicareComplete MedicareComplete MedicareComplete MedicareComplete
Membership in Health Club / Fitness Classes and/or (HMO) Choice (PPO) Choice Plan 2 Choice Essential
Fitness through Fitbit® (Regional PPO) (Regional PPO)
Over-the-Counter Items
Prescription Drug Benefits Covered (Basic Covered (Basic No coverage 1 No coverage 1
Annual Prescription Deductible membership in a membership in a
fitness program at a fitness program at a
network location) 1 network location) 1
$40 credit per quarter $40 credit per quarter No Coverage No Coverage
to use on approved to use on approved
health products. 1 health products. 1
$0 for Tier 1, Tier 2 $0 for Tier 1, Tier 2
$0 $150 for Tier 3, Tier $395 for Tier 3, Tier N/A
4, Tier 5* 4, Tier 5*
Tier 1: Preferred Generic Drugs Standard Network Standard Network Standard Network N/A
Pharmacy Cost Pharmacy Cost Pharmacy Cost
Tier 2: Generic Drugs Sharing (30 days) $3 Sharing (30 days) $3 Sharing (30 days) $3
copay Preferred Mail copay Preferred Mail copay Preferred Mail
Tier 3: Preferred Brand Drugs Order Pharmacy (90 Order Pharmacy (90 Order Pharmacy (90
Plan Costs days)$0 copay days)$0 copay days)$0 copay
Plan Premium3 Standard Mail Order Standard Mail Order Standard Mail Order
Drug Costs from Formulary Pharmacy (90 Pharmacy (90 Pharmacy (90
Medical Benefits days)$9 copay days)$9 copay days)$9 copay
Standard Network Standard Network Standard Network N/A
Pharmacy Cost Pharmacy Cost Pharmacy Cost
Sharing (30 days) Sharing (30 days) Sharing (30 days)
$10 copay Preferred $10 copay Preferred $14 copay Preferred
Mail Order Mail Order Mail Order
Pharmacy (90 Pharmacy (90 Pharmacy (90
days)$0 copay days)$0 copay days)$28 copay
Standard Mail Order Standard Mail Order Standard Mail Order
Pharmacy (90 Pharmacy (90 Pharmacy (90
days)$30 copay days)$30 copay days)$42 copay
Standard Network Standard Network Standard Network N/A
Pharmacy Cost Pharmacy Cost Pharmacy Cost
Sharing (30 days) Sharing (30 days) Sharing (30 days)
$45 copay Preferred $45 copay Preferred $47 copay Preferred
Mail Order Mail Order Mail Order
Pharmacy (90 Pharmacy (90 Pharmacy (90
days)$125 copay days)$125 copay days)$131 copay
Standard Mail Order Standard Mail Order Standard Mail Order
Pharmacy (90 Pharmacy (90 Pharmacy (90
days)$135 copay days)$135 copay days)$141 copay
Monthly$0Yearly$0 Monthly$0Yearly$0 Monthly$0Yearly$0 Monthly$0Yearly$0
Monthly--Yearly-- Monthly--Yearly-- Monthly--Yearly-- N/A
Estimate drug costs Estimate drug costs Estimate drug costs
Varies4
Varies4 Varies4 Varies4
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MedicareComplete MedicareComplete MedicareComplete MedicareComplete
Membership in Health Club / Fitness Classes and/or (HMO) Choice (PPO) Choice Plan 2 Choice Essential
Fitness through Fitbit® (Regional PPO) (Regional PPO)
Over-the-Counter Items
Prescription Drug Benefits Covered (Basic Covered (Basic No coverage 1 No coverage 1
Annual Prescription Deductible membership in a membership in a
fitness program at a fitness program at a
network location) 1 network location) 1
$40 credit per quarter $40 credit per quarter No Coverage No Coverage
to use on approved to use on approved
health products. 1 health products. 1
$0 for Tier 1, Tier 2 $0 for Tier 1, Tier 2
$0 $150 for Tier 3, Tier $395 for Tier 3, Tier N/A
4, Tier 5* 4, Tier 5*
Tier 1: Preferred Generic Drugs Standard Network Standard Network Standard Network N/A
Pharmacy Cost Pharmacy Cost Pharmacy Cost
Tier 2: Generic Drugs Sharing (30 days) $3 Sharing (30 days) $3 Sharing (30 days) $3
copay Preferred Mail copay Preferred Mail copay Preferred Mail
Tier 3: Preferred Brand Drugs Order Pharmacy (90 Order Pharmacy (90 Order Pharmacy (90
Plan Costs days)$0 copay days)$0 copay days)$0 copay
Plan Premium3 Standard Mail Order Standard Mail Order Standard Mail Order
Drug Costs from Formulary Pharmacy (90 Pharmacy (90 Pharmacy (90
Medical Benefits days)$9 copay days)$9 copay days)$9 copay
Standard Network Standard Network Standard Network N/A
Pharmacy Cost Pharmacy Cost Pharmacy Cost
Sharing (30 days) Sharing (30 days) Sharing (30 days)
$10 copay Preferred $10 copay Preferred $14 copay Preferred
Mail Order Mail Order Mail Order
Pharmacy (90 Pharmacy (90 Pharmacy (90
days)$0 copay days)$0 copay days)$28 copay
Standard Mail Order Standard Mail Order Standard Mail Order
Pharmacy (90 Pharmacy (90 Pharmacy (90
days)$30 copay days)$30 copay days)$42 copay
Standard Network Standard Network Standard Network N/A
Pharmacy Cost Pharmacy Cost Pharmacy Cost
Sharing (30 days) Sharing (30 days) Sharing (30 days)
$45 copay Preferred $45 copay Preferred $47 copay Preferred
Mail Order Mail Order Mail Order
Pharmacy (90 Pharmacy (90 Pharmacy (90
days)$125 copay days)$125 copay days)$131 copay
Standard Mail Order Standard Mail Order Standard Mail Order
Pharmacy (90 Pharmacy (90 Pharmacy (90
days)$135 copay days)$135 copay days)$141 copay
Monthly$0Yearly$0 Monthly$0Yearly$0 Monthly$0Yearly$0 Monthly$0Yearly$0
Monthly--Yearly-- Monthly--Yearly-- Monthly--Yearly-- N/A
Estimate drug costs Estimate drug costs Estimate drug costs
Varies4
Varies4 Varies4 Varies4
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