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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Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Aitkin | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Anoka | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Becker | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 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 | |||||||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Beltrami | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Benton | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Big Stone | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 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 | |||||||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Blue Earth | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Brown | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Carlton | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 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 | |||||||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Carver | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Cass | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Chippewa | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 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 | |||||||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Chisago | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Clay | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Clearwater | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 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 | |||||||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Cook | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Cottonwood | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Crow Wing | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 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 | |||||||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Dakota | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Dodge | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Douglas | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 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 | |||||||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Faribault | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Fillmore | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Freeborn | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 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 | |||||||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Goodhue | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Grant | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Hennepin | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 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 | |||||||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Houston | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Hubbard | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Isanti | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 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 | |||||||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Itasca | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Jackson | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Kanabec | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 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 | |||||||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Kandiyohi | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Kittson | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Koochiching | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 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 | |||||||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Lac qui Parle | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Lake | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Lake of the Woods | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 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 | |||||||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Le Sueur | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Lincoln | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Lyon | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 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 | |||||||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Mahnomen | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Marshall | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Martin | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 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 | |||||||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
McLeod | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Meeker | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Mille Lacs | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 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 | |||||||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Morrison | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Mower | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Murray | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 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 | |||||||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Nicollet | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Nobles | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Norman | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 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 | |||||||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Olmsted | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Otter Tail | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Pennington | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 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 | |||||||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Pine | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Pipestone | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Polk | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 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 | |||||||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Pope | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Ramsey | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Red Lake | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 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 | |||||||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Redwood | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Renville | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Rice | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 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 | |||||||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Rock | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Roseau | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Scott | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 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 | |||||||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Sherburne | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Sibley | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
St. Louis | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 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 | |||||||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Stearns | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Steele | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Stevens | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 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 | |||||||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Swift | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Todd | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Traverse | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 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 | |||||||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Wabasha | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Wadena | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Waseca | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 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 | |||||||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Washington | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Watonwan | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Wilkin | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 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 | |||||||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Winona | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Wright | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
Medica Prime Solution Enhanced w/Std. Rx - MN (Cost) in MN - H2450-002-0 Benefit Details |
Yellow Medicine | $158.90 | $0 | No Gap Coverage | Generic: $10.00 Preferred Brand: $34.00 Non-Preferred Brand: $74.00 Specialty: 25% | n/a Browse Formulary | |||||
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