Ampicillin / sulbactam (Unasyn) — plans on this site that list it on Tier 3

Align powered by Sanford Health Plan

2 plans on this site

• Align SecureChoice (PPO) — Offered in IA: Lyon, O'Brien, Osceola, Sioux; ND: 17 counties; SD: 19 counties
• Align SecureChoice Gold (PPO) — Offered in IA: Lyon, O'Brien, Osceola, Sioux; ND: 17 counties; SD: 19 counties

AlohaCare

1 plan on this site

• AlohaCare Advantage Plus (HMO D-SNP) — Offered in HI: Hawaii, Honolulu, Kalawao, Kauai, Maui

AmeriHealth Caritas VIP Care (HMO-D-SNP)

1 plan on this site

• AmeriHealth Caritas VIP Care Choice (HMO D-SNP) — Offered in DE: Kent, New Castle, Sussex

Blue Cross Blue Shield of Arizona (AZ Blue)

3 plans on this site

• Blue Best Life Classic (HMO) — Offered in AZ: Maricopa, Pinal
• Blue Best Life Plus (HMO) — Offered in AZ: Maricopa, Pinal
• Blue Best Life Select (HMO) — Offered in AZ: Maricopa, Pinal

Blue Cross Blue Shield of South Carolina

2 plans on this site

• BlueCross Total (PPO) — Offered in SC: 12 counties
• BlueCross Total Value (PPO) — Offered in SC: 15 counties

Blue Cross and Blue Shield of North Carolina

5 plans on this site

• Blue Medicare Enhanced (HMO-POS) — Offered in NC: 42 counties
• Blue Medicare Essential (HMO) — Offered in NC: 80 counties
• Blue Medicare Essential Plus (HMO-POS) — Offered in NC: 42 counties
• Blue Medicare PPO Enhanced (PPO) — Offered in NC: 61 counties
• Healthy Blue + Medicare (HMO-POS D-SNP) — Offered in NC: 100 counties

CarePlus Health Plans, Inc.

17 plans on this site

• CareAccess (HMO) — Offered in FL: 17 counties
• CareBreeze (HMO C-SNP) — Offered in FL: 20 counties
• CareBreeze Platinum (HMO C-SNP) — Offered in FL: Brevard, Clay, Duval, Flagler, Indian River, St. Johns, Volusia
• CareBreeze Platinum (HMO-POS C-SNP) — Offered in FL: Broward, Palm Beach
• CareComplete (HMO C-SNP) — Offered in FL: 20 counties
• CareComplete Local (HMO C-SNP) — Offered in FL: Lake, Marion, Sumter
• CareComplete Platinum (HMO C-SNP) — Offered in FL: Brevard, Clay, Duval, Flagler, Indian River, St. Johns, Volusia
• CareComplete Platinum (HMO-POS C-SNP) — Offered in FL: Broward, Palm Beach
• CareFree Giveback (HMO) — Offered in FL: Lake, Marion, Orange, Osceola, Seminole, Sumter
• CareFree Platinum Giveback (HMO) — Offered in FL: Lake, Marion, Orange, Osceola, Seminole, Sumter
• CareFree Platinum Giveback (HMO-POS) — Offered in FL: Broward, Palm Beach
• CareNeeds Extra (HMO D-SNP) — Offered in FL: Brevard
• CareNeeds Platinum (HMO D-SNP) — Offered in FL: 17 counties
• CareNeeds Plus (HMO D-SNP) — Offered in FL: 17 counties
• CareOne Plus (HMO) — Offered in FL: Clay, Duval, Flagler, St. Johns, Volusia
• CareOne Plus (HMO-POS) — Offered in FL: Lake, Marion, Orange, Osceola, Seminole, Sumter
• CareOne Plus Local (HMO-POS) — Offered in FL: Lake, Marion, Sumter

Clover Health

8 plans on this site

• Clover Health Choice (PPO) — Offered in NJ: 12 counties
• Clover Health Choice Giveback (PPO) — Offered in NJ: 20 counties
• Clover Health Choice Value (PPO) — Offered in NJ: 12 counties
• Clover Health Classic (HMO) — Offered in NJ: Atlantic, Bergen, Essex, Hudson, Passaic, Union
• Clover Health LiveHealthy (PPO) — Offered in GA: 151 counties
• Clover Health LiveHealthy Giveback (PPO) — Offered in GA: 139 counties; SC: 12 counties
• Clover Health LiveHealthy Premier (PPO) — Offered in GA: 151 counties
• Clover Health Value (HMO) — Offered in NJ: Atlantic, Bergen, Essex, Hudson, Middlesex, Passaic, Union

First Choice VIP Care (HMO D-SNP)

1 plan on this site

• First Choice VIP Care (HMO D-SNP) — Offered in SC: 46 counties

Great Plains Medicare Advantage

3 plans on this site

• Great Plain Medicare Advantage Gold (HMO I-SNP) — Offered in IA: Fremont, Harrison, Lyon, Mills, Montgomery, Plymouth, Pottawattamie, Shelby; ND: 19 counties; SD: 23 counties
• Great Plains Medicare Advantage (HMO I-SNP) — Offered in NE: 56 counties
• Great Plains Medicare Advantage Gold (HMO I-SNP) — Offered in NE: 56 counties

Humana

35 plans on this site

• Humana Community HMO Diabetes and Heart (HMO C-SNP) — Offered in FL: Lake, Marion, Sumter
• Humana Dual Integrated (PPO D-SNP) — Offered in FL: 36 counties
• Humana Dual Select H1036-077 (HMO D-SNP) — Offered in FL: Broward, Miami-Dade, Palm Beach
• Humana Dual Select H1036-102 (HMO D-SNP) — Offered in FL: Citrus, Hardee, Hernando, Highlands, Hillsborough, Manatee, Pasco, Pinellas, Polk, Sarasota
• Humana Dual Select H1036-209 (HMO D-SNP) — Offered in FL: Flagler, Volusia
• Humana Dual Select H1036-210 (HMO D-SNP) — Offered in FL: Alachua, Baker, Bradford, Clay, Columbia, Duval, Nassau, Putnam, St. Johns
• Humana Dual Select H1036-213 (HMO D-SNP) — Offered in FL: Lake, Marion, Orange, Osceola, Seminole, Sumter
• Humana Dual Select H1036-214 (HMO D-SNP) — Offered in FL: Escambia, Santa Rosa, Walton
• Humana Dual Select H1036-285 (HMO D-SNP) — Offered in FL: Charlotte, Collier, DeSoto, Lee
• Humana Dual Select H1036-304 (HMO D-SNP) — Offered in FL: Broward, Miami-Dade, Palm Beach
• Humana Dual Select H1036-314 (HMO D-SNP) — Offered in FL: 36 counties
• Humana Dual Select H5216-394 (PPO D-SNP) — Offered in FL: 56 counties
• Humana Dual Select H7284-010 (PPO D-SNP) — Offered in FL: Broward, Glades, Indian River, Martin, Miami-Dade, Okeechobee, Palm Beach, St. Lucie
• Humana Fully Integrated H1036-280 (HMO D-SNP) — Offered in FL: 21 counties
• Humana Gold Plus Giveback H1036-157 (HMO) — Offered in FL: Flagler, Volusia
• Humana Gold Plus Giveback H1036-265 (HMO) — Offered in FL: Citrus, Hardee, Hernando, Highlands, Hillsborough, Pasco, Pinellas
• Humana Gold Plus Giveback H1036-266 (HMO) — Offered in FL: Citrus, Hardee, Highlands, Polk
• Humana Gold Plus Giveback H1036-269 (HMO) — Offered in FL: Lake, Marion, Orange, Osceola, Seminole, Sumter
• Humana Gold Plus Giveback H1036-270 (HMO) — Offered in FL: Alachua, Baker, Bradford, Clay, Columbia, Duval, Nassau, Putnam, St. Johns
• Humana Gold Plus Giveback H1036-278 (HMO) — Offered in FL: Charlotte, Collier, DeSoto, Lee
• Humana Gold Plus Giveback H1036-305 (HMO) — Offered in FL: Broward, Miami-Dade, Palm Beach
• Humana Gold Plus H1036-025 (HMO) — Offered in FL: Hernando, Hillsborough, Pasco, Pinellas
• Humana Gold Plus H1036-044 (HMO) — Offered in FL: Flagler, Volusia
• Humana Gold Plus H1036-054C (HMO) — Offered in FL: Miami-Dade
• Humana Gold Plus H1036-062C (HMO) — Offered in FL: Palm Beach
• Humana Gold Plus H1036-065C (HMO) — Offered in FL: Broward
• Humana Gold Plus H1036-068 (HMO) — Offered in FL: Alachua, Baker, Bradford, Clay, Columbia, Duval, Nassau, Putnam, St. Johns
• Humana Gold Plus H1036-074 (HMO) — Offered in FL: Citrus, Manatee, Sarasota
• Humana Gold Plus H1036-143 (HMO) — Offered in FL: Bay, Escambia, Okaloosa, Santa Rosa, Walton
• Humana Gold Plus H1036-146 (HMO) — Offered in FL: Lake, Marion, Orange, Osceola, Seminole, Sumter
• Humana Gold Plus H1036-217 (HMO) — Offered in FL: Charlotte, Collier, DeSoto, Lee
• Humana Gold Plus H1036-230 (HMO) — Offered in FL: Hardee, Highlands, Polk
• Humana Gold Plus Lung (HMO C-SNP) — Offered in FL: Citrus, Hardee, Hernando, Highlands, Hillsborough, Manatee, Pasco, Pinellas, Polk, Sarasota
• Humana PathWays Dual Care (HMO-POS D-SNP) — Offered in IN: 92 counties
• Humana PathWays Dual Care NFLOC (HMO-POS D-SNP) — Offered in IN: 92 counties

KelseyCare Advantage

2 plans on this site

• KelseyCare Advantage Freedom (HMO-POS) — Offered in TX: 13 counties
• KelseyCare Advantage Signature (HMO) — Offered in TX: Brazoria, Fort Bend, Galveston, Harris, Montgomery

Mass General Brigham Health Plan

3 plans on this site

• Mass General Brigham Advantage Core (HMO-POS) — Offered in MA: Bristol, Dukes, Essex, Middlesex, Nantucket, Norfolk, Plymouth, Suffolk, Worcester
• Mass General Brigham Advantage Plus (HMO-POS) — Offered in MA: Bristol, Dukes, Essex, Middlesex, Nantucket, Norfolk, Plymouth, Suffolk, Worcester
• Mass General Brigham Advantage Secure (HMO-POS) — Offered in MA: Bristol, Dukes, Essex, Middlesex, Nantucket, Norfolk, Plymouth, Suffolk, Worcester

MyAdvocate Medicare Advantage

2 plans on this site

• MyAdvocate Medicare Advantage GOLD (HMO-POS) — Offered in NE: 21 counties
• MyAdvocate Medicare Advantage SILVER (HMO-POS) — Offered in NE: 21 counties

Prominence Health Plan

11 plans on this site

• Prominence Beyond (HMO-POS) — Offered in TX: Cooke, Deaf Smith, Fannin, Gray, Grayson, Moore, Potter, Randall
• Prominence Bridge (HMO D-SNP) — Offered in TX: Brooks, Cameron, Hidalgo, Jim Hogg, Starr, Webb, Willacy, Zapata
• Prominence Diabetes and Heart (HMO C-SNP) — Offered in NV: Washoe
• Prominence Diabetes and Heart Care Plus (HMO C-SNP) — Offered in TX: Brooks, Cameron, Hidalgo, Jim Hogg, Starr, Webb, Willacy, Zapata
• Prominence Diabetes and Heart Giveback (HMO C-SNP) — Offered in TX: Cooke, Deaf Smith, Fannin, Gray, Grayson, Moore, Potter, Randall
• Prominence Dual (HMO D-SNP) — Offered in TX: Brooks, Cameron, Hidalgo, Jim Hogg, Starr, Webb, Willacy, Zapata
• Prominence Extra Help (HMO) — Offered in TX: Brooks, Cameron, Hidalgo, Jim Hogg, Starr, Webb, Willacy, Zapata
• Prominence Giveback (HMO) — Offered in TX: Cooke, Deaf Smith, Fannin, Gray, Grayson, Moore, Potter, Randall
• Prominence Meridian (HMO-POS) — Offered in NV: Washoe
• Prominence Plus (HMO) — Offered in TX: Cooke, Deaf Smith, Fannin, Gray, Grayson, Moore, Potter, Randall
• Prominence Silver Peak (HMO) — Offered in NV: Carson City, Churchill, Douglas, Lyon, Storey

Quartz Medicare Advantage (HMO)

14 plans on this site

• Gundersen MN Quartz Med Advantage Basic D (w/Rx) (HMO) — Offered in MN: Fillmore, Houston, Wabasha
• Gundersen MN Quartz Med Advantage Core D (w/Rx) (HMO) — Offered in MN: Fillmore, Houston, Wabasha
• Gundersen MN Quartz Med Advantage Elite D (w/Rx) (HMO) — Offered in MN: Fillmore, Houston, Wabasha
• Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) — Offered in MN: Fillmore, Houston, Wabasha
• Gundersen Quartz Med Advantage Basic D (w/Rx) (HMO) — Offered in IA: Allamakee, Fayette, Winneshiek; WI: Buffalo, La Crosse, Monroe, Pepin, Trempealeau
• Gundersen Quartz Med Advantage Core D (w/Rx) (HMO) — Offered in IA: Allamakee, Fayette, Winneshiek; WI: Buffalo, La Crosse, Monroe, Pepin, Trempealeau
• Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP) — Offered in WI: La Crosse
• Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO) — Offered in IA: Allamakee, Fayette, Winneshiek; WI: Buffalo, La Crosse, Monroe, Pepin, Trempealeau
• Gundersen Quartz Med Advantage Value D (w/Rx) (HMO) — Offered in IA: Allamakee, Fayette, Winneshiek; WI: Buffalo, La Crosse, Monroe, Pepin, Trempealeau
• UW Health Quartz Med Advantage Basic D (w/Rx) (HMO) — Offered in WI: Columbia, Dane, Green
• UW Health Quartz Med Advantage Core D (w/Rx) (HMO) — Offered in WI: Columbia, Dane, Green
• UW Health Quartz Med Advantage Dual Eligible (HMO D-SNP) — Offered in WI: Dane
• UW Health Quartz Med Advantage Elite D (w/Rx) (HMO) — Offered in WI: Columbia, Dane, Green
• UW Health Quartz Med Advantage Value D (w/Rx) (HMO) — Offered in WI: Columbia, Dane, Green

Samaritan Advantage Health Plans

1 plan on this site

• Samaritan Dual Advantage (HMO D-SNP) — Offered in OR: Benton, Lincoln, Linn

Security Health Plan of Wisconsin, Inc.

4 plans on this site

• Esteem Rx (HMO) — Offered in WI: 33 counties
• Esteem Rx Gold (HMO-POS) — Offered in WI: 33 counties
• Esteem Rx Silver (HMO-POS) — Offered in WI: 33 counties
• Legacy Rx (HMO-POS) — Offered in WI: 33 counties

South Country Health Alliance

2 plans on this site

• AbilityCare (HMO D-SNP) — Offered in MN: Brown, Dodge, Goodhue, Sibley, Steele, Wabasha, Waseca
• SeniorCare Complete (HMO D-SNP) — Offered in MN: Brown, Dodge, Goodhue, Sibley, Steele, Wabasha, Waseca

Ultimate Health Plans

5 plans on this site

• Advantage Care COPD by Ultimate (HMO C-SNP) — Offered in FL: 12 counties
• Advantage Care by Ultimate (HMO C-SNP) — Offered in FL: Citrus, Hernando, Pasco
• Advantage Plus by Ultimate (Full) (HMO D-SNP) — Offered in FL: 16 counties
• Advantage Plus by Ultimate (Partial) (HMO D-SNP) — Offered in FL: 16 counties
• Premier by Ultimate (HMO) — Offered in FL: Citrus, Hernando, Indian River, Pasco, St. Lucie

VISTA Health Plan Inc.

2 plans on this site

• Amerihealth Caritas VIP Care (HMO D-SNP) — Offered in PA: 62 counties
• Keystone First VIP Choice (HMO D-SNP) — Offered in PA: Bucks, Chester, Delaware, Montgomery, Philadelphia

VillageCareMAX

3 plans on this site

• VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) — Offered in NY: Bronx, Kings, New York, Putnam, Queens, Richmond, Westchester
• VillageCareMAX Medicare Select Advantage Plan (HMO) — Offered in NY: Bronx, Kings, Nassau, New York, Putnam, Queens, Richmond, Westchester
• VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) — Offered in NY: Bronx, Kings, Nassau, New York, Putnam, Queens, Richmond, Westchester

eternalHealth

6 plans on this site

• eternalHealth Catalina (HMO) — Offered in AZ: Pima
• eternalHealth Forever (HMO) — Offered in MA: Bristol, Middlesex, Norfolk, Plymouth, Suffolk, Worcester
• eternalHealth Freedom (PPO) — Offered in MA: Bristol, Middlesex, Norfolk, Plymouth, Suffolk, Worcester
• eternalHealth Give Back (PPO) — Offered in MA: Bristol, Middlesex, Norfolk, Plymouth, Suffolk, Worcester
• eternalHealth Harmony (HMO) — Offered in AZ: Graham, Maricopa, Pinal
• eternalHealth Horizon (HMO) — Offered in AZ: Graham, Maricopa, Pima, Pinal