This is archive material for research purposes. Please see
PDPFinder.com or
MAFinder.com for current plans.
2014 Medicare Advantage Plan Prescription Drug Cost-Sharing Details
| 2014 Medicare Advantage Prescription Drug Formulary (Drug List) Cost-Sharing Details | ||||||
|
Windsor Medicare Extra Comp Plus Plan (HMO SNP) (H5698-134-0) Benefit Details 
 | ||||||
| This plan is available in SCOTT County, MS Monthly Premium: $26.30 Rx Deductible: $310 Initial Coverage Limit: $2,850 Click on a letter below to view the Windsor Medicare Extra Comp Plus Plan (HMO SNP) Formulary A B C D E F G H I J K L M N O P Q R S T U V W X Y Z 0-9 | ||||||
| 30-Day Supply Cost-Sharing |
90-Day Supply Cost-Sharing |
|||||
| Preferred Pharmacy | Standard Pharmacy | Mail- Order* | Preferred Pharmacy | Standard Pharmacy | Mail- Order* | |
| Initial Deductible Phase Cost Sharing | ||||||
| All Formulary Drug Tiers: | 100% | 100% | 100% | 100% | 100% | 100% |
| Initial Coverage Phase Cost-Sharing | ||||||
| Tier 1: : | n/a | n/a | n/a | n/a | n/a | n/a |
| Tier 2: : | n/a | n/a | n/a | n/a | n/a | n/a |
| Tier 3: : | n/a | n/a | n/a | n/a | n/a | n/a |
| Tier 4: : | n/a | n/a | n/a | n/a | n/a | n/a |
| Tier 5: : | n/a | n/a | n/a | n/a | n/a | n/a |
| Coverage Gap (Donut Hole) Phase Cost Sharing Plan offers no Gap Coverage -- 28% Generic and 52.5% Brand Donut Hole Discount applies | ||||||
| All Formulary Generic Drugs: | 79% | 79% | 79% | 79% | 79% | 79% |
| All Formulary Brand-Name Drugs: | 47.5% | 47.5% | 47.5% | 47.5% | 47.5% | 47.5% |
| Catastrophic Coverage Phase Cost Sharing | ||||||
| Generic & Preferred Multi-Source Drugs: | The greater of 5% or $2.55 | The greater of 5% or $2.55 | ||||
| Other Drugs (Brand-Name or Non-Preferred Multi-Source Drugs): | The greater of 5% or $6.35 | The greater of 5% or $6.35 | ||||
| Go to the Windsor Medicare Extra Comp Plus Plan (HMO SNP) 2014 Formulary Browser by choosing a letter below: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z 0-9 | ||||||