LIS Eligibility & Premium No LIS: $24.3025% Subsidy: $18.2050% Subsidy: $12.1075% Subsidy: $6.10100% Subsidy: $0 MOOP $5,200 PCP $0 copay Specialist $40 copay Inpatient Hospital $300 continue reading
2021
July 6, 2020
Premium $0 MOOP $7,550 PCP $0 copay Specialist $0 copay Inpatient Hospital $0 copay RX Deductible $0 RX Preferred Cost Share T1/T2/T3/T4/T5/T6 $0 / $0-$3.70 / continue reading
July 6, 2020
Premium $0 MOOP $7,550 PCP $0 copay Specialist $0 copay Inpatient Hospital $0 copay RX Deductible $0 RX Preferred Cost Share T1/T2/T3/T4/T5/T6 $0 / $0-$3.70 / continue reading
July 6, 2020
Premium $0 MOOP $4,900 applies to in-network Medicare-covered benefits PCP $0 copay Specialist $0 copay Inpatient Hospital $295 (days 1-6) ; $0 (days 7-90) Ambulatory Surgery Center continue reading
July 6, 2020
Premium $0 MOOP $7,550 PCP $0 copay Specialist $35 copay Inpatient Hospital $275 copay (days 1-6) RX Deductible N/A RX Preferred Cost Share T1/T2/T3/T4/T5/T6 N/A Key continue reading
July 6, 2020
Premium $0 MOOP $7,550 PCP $0 copay Specialist $0 copay Inpatient Hospital $0 copay RX Deductible $0 RX Preferred Cost Share T1/T2/T3/T4/T5/T6 $0 / $0- $3.70 continue reading
July 6, 2020
Premium $58 MOOP $5,900 PCP $5 copay Specialist $35 copay Inpatient Hospital $295 copay (days 1-6) RX Deductible $95 (T3-5) RX Preferred Cost Share T1/T2/T3/T4/T5/T6 $4 continue reading
July 6, 2020
Premium $24 MOOP $6,700 PCP $10 copay Specialist $40 copay Inpatient Hospital $393 copay (days 1-5) RX Deductible $150 (T3-5) RX Preferred Cost Share T1/T2/T3/T4/T5/T6 $4 continue reading
July 6, 2020
Premium $0 MOOP $3,450 PCP $0 copay Specialist $0 - $35 copay Inpatient Hospital $325 copay (days 1-5) RX Deductible $0 RX Preferred Cost Share T1/T2/T3/T4/T5/T6 continue reading
July 6, 2020
Premium $0 MOOP $3,450 PCP $10 copay Specialist $0 - $40 copay Inpatient Hospital $345 copay (days 1-5) RX Deductible $0 RX Preferred Cost Share T1/T2/T3/T4/T5/T6 continue reading
July 6, 2020
Premium $0 MOOP $4,900 PCP $5 copay Specialist $45 copay Inpatient Hospital $300 copay (days 1-5) RX Deductible $325 (T3-T5) RX Preferred Cost Share T1/T2/T3/T4/T5/T6 $4 continue reading
July 6, 2020
Premium $0 MOOP $5,900 PCP $0 copay Specialist $40 copay Inpatient Hospital $325 copay (days 1-5) RX Deductible $325 (T3-T5) RX Preferred Cost Share T1/T2/T3/T4/T5/T6 $4 continue reading
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