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Cottonwood + Rx (HMO-POS)

Plus Row Graphic

Deductible

$0

OOP Max

$4,800

Summit + Rx (HMO-POS)

Plus Row Graphic

Deductible

$0

OOP Max

$5,500

Pine + Rx (HMO)

Plus Row Graphic

Deductible

$0

OOP Max

$5,500

Harbor + Rx (HMO)

Plus Row Graphic

Deductible

$0

OOP Max

$6,700

Bridge 1 + Rx (HMO-POS)

Plus Row Graphic

Deductible

$0

OOP Max

$4,900

Bridge 2 + Rx (HMO-POS)

Plus Row Graphic

Deductible

$0

OOP Max

$4,900

Enrich + Rx (HMO)

Plus Row Graphic

Deductible

$0

OOP Max

$5,000

Compass + Rx (HMO-POS)

Plus Row Graphic

Deductible

$0

OOP Max

$5,900

Prime + Rx (HMO)

Plus Row Graphic

Deductible

$0

OOP Max

$5,900

Timber + Rx (HMO)

Plus Row Graphic

Deductible

$0

OOP Max

$5,500

Latitude + Rx (HMO-POS)

Plus Row Graphic

Deductible

$0

OOP Max

$5,500

Select Medical (HMO-POS)

Plus Row Graphic

Deductible

$0

OOP Max

$4,500

Choice + Rx 001 (HMO-POS)

Plus Row Graphic

Deductible

$0

OOP Max

$4,500

Choice + Rx 002 (HMO-POS)

Plus Row Graphic

Deductible

$0

OOP Max

$4,500

Focus Medical (HMO)

Plus Row Graphic

Deductible

$0

OOP Max

$3,400

Extra + Rx 001 (HMO)

Plus Row Graphic

Deductible

$0

OOP Max

$3,400

Extra + Rx 002 (HMO)

Plus Row Graphic

Deductible

$0

OOP Max

$3,400

Dual Plus (HMO D-SNP)

Plus Row Graphic

Deductible

$0 or $203*

OOP Max

$3,400*

*This plan has special enrollment requirements. To be eligible, you must qualify for full Medicaid benefits and Medicare.

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