2010 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
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Plan Name | County | Monthly Prem. (Parts C & D) |
Deduct- ible |
(Donut Hole) Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance 30-Day Supply |
MOOP for Part A & B Benefits | |||||
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
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Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Alcona | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Alger | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-1 Benefit Details |
Allegan | $116.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Alpena | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Antrim | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-5 Benefit Details |
Arenac | $229.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Baraga | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-2 Benefit Details |
Barry | $162.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-5 Benefit Details |
Bay | $229.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Benzie | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-2 Benefit Details |
Berrien | $162.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-4 Benefit Details |
Branch | $191.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-4 Benefit Details |
Calhoun | $191.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-2 Benefit Details |
Cass | $162.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Charlevoix | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Cheboygan | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Chippewa | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-5 Benefit Details |
Clare | $229.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-2 Benefit Details |
Clinton | $162.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Crawford | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Delta | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Dickinson | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-2 Benefit Details |
Eaton | $162.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Emmet | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-5 Benefit Details |
Genesee | $229.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-5 Benefit Details |
Gladwin | $229.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Gogebic | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Grand Traverse | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-5 Benefit Details |
Gratiot | $229.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-4 Benefit Details |
Hillsdale | $191.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Houghton | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-5 Benefit Details |
Huron | $229.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-2 Benefit Details |
Ingham | $162.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-2 Benefit Details |
Ionia | $162.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-5 Benefit Details |
Iosco | $229.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Iron | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-5 Benefit Details |
Isabella | $229.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-4 Benefit Details |
Jackson | $191.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-2 Benefit Details |
Kalamazoo | $162.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Kalkaska | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-1 Benefit Details |
Kent | $116.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Keweenaw | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-5 Benefit Details |
Lake | $229.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-5 Benefit Details |
Lapeer | $229.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Leelanau | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-4 Benefit Details |
Lenawee | $191.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-4 Benefit Details |
Livingston | $191.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Luce | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Mackinac | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-6 Benefit Details |
Macomb | $248.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-5 Benefit Details |
Manistee | $229.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Marquette | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-5 Benefit Details |
Mason | $229.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-5 Benefit Details |
Mecosta | $229.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Menominee | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-5 Benefit Details |
Midland | $229.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-5 Benefit Details |
Missaukee | $229.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-4 Benefit Details |
Monroe | $191.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-5 Benefit Details |
Montcalm | $229.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Montmorency | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-1 Benefit Details |
Muskegon | $116.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-1 Benefit Details |
Newaygo | $116.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-6 Benefit Details |
Oakland | $248.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-5 Benefit Details |
Oceana | $229.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-5 Benefit Details |
Ogemaw | $229.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Ontonagon | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-5 Benefit Details |
Osceola | $229.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Oscoda | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Otsego | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-1 Benefit Details |
Ottawa | $116.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Presque Isle | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-5 Benefit Details |
Roscommon | $229.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-5 Benefit Details |
Saginaw | $229.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-5 Benefit Details |
Sanilac | $229.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-3 Benefit Details |
Schoolcraft | $208.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-5 Benefit Details |
Shiawassee | $229.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-5 Benefit Details |
St. Clair | $229.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-4 Benefit Details |
St. Joseph | $191.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-5 Benefit Details |
Tuscola | $229.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-2 Benefit Details |
Van Buren | $162.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-4 Benefit Details |
Washtenaw | $191.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-6 Benefit Details |
Wayne | $248.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
Medicare Plus Blue Option B (PFFS) in MI - H2319-009-5 Benefit Details |
Wexford | $229.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $30.00 Non Preferred: $70.00 Specialty: 25% Non Self Administered Injectable: 25% | n/a Browse Formulary | |||||
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