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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CIGNA Medicare Access Plus RX Plan Four (PFFS) in AL - H2762-038-0 Benefit Details |
Chambers | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in AL - H2762-038-0 Benefit Details |
Fayette | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in AL - H2762-038-0 Benefit Details |
Mobile | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in AR - H2762-038-0 Benefit Details |
Boone | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in AR - H2762-038-0 Benefit Details |
Conway | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in AR - H2762-038-0 Benefit Details |
Crittenden | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in AR - H2762-038-0 Benefit Details |
Faulkner | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in AR - H2762-038-0 Benefit Details |
Grant | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in AR - H2762-038-0 Benefit Details |
Johnson | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in AR - H2762-038-0 Benefit Details |
Lincoln | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in AR - H2762-038-0 Benefit Details |
Lonoke | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in AR - H2762-038-0 Benefit Details |
Miller | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in AR - H2762-038-0 Benefit Details |
Nevada | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in AR - H2762-038-0 Benefit Details |
Perry | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in AR - H2762-038-0 Benefit Details |
Pulaski | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in AR - H2762-038-0 Benefit Details |
Saline | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in CO - H2762-038-0 Benefit Details |
Crowley | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in CO - H2762-038-0 Benefit Details |
El Paso | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in CO - H2762-038-0 Benefit Details |
Hinsdale | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in CO - H2762-038-0 Benefit Details |
Montezuma | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in CO - H2762-038-0 Benefit Details |
Otero | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in CO - H2762-038-0 Benefit Details |
Teller | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in FL - H2762-038-0 Benefit Details |
Gadsden | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in FL - H2762-038-0 Benefit Details |
Jefferson | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in FL - H2762-038-0 Benefit Details |
Taylor | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Baldwin | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Barrow | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Bartow | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Bibb | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Butts | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Carroll | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Clayton | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Crawford | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Dawson | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Decatur | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Douglas | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Fayette | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Forsyth | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Grady | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Haralson | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Heard | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Henry | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Houston | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Jasper | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Johnson | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Jones | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Lamar | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Macon | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Monroe | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Morgan | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Newton | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Paulding | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Peach | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Pickens | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Pike | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Rockdale | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Schley | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Spalding | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Sumter | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Talbot | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Troup | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Turner | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Twiggs | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in GA - H2762-038-0 Benefit Details |
Walton | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in IL - H2762-038-0 Benefit Details |
Adams | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in IL - H2762-038-0 Benefit Details |
Carroll | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in IL - H2762-038-0 Benefit Details |
Coles | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in IL - H2762-038-0 Benefit Details |
Macoupin | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in IL - H2762-038-0 Benefit Details |
Marshall | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in IL - H2762-038-0 Benefit Details |
Menard | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in IL - H2762-038-0 Benefit Details |
Morgan | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in IL - H2762-038-0 Benefit Details |
Sangamon | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in IL - H2762-038-0 Benefit Details |
Schuyler | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in IN - H2762-038-0 Benefit Details |
Boone | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in IN - H2762-038-0 Benefit Details |
Dearborn | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in IN - H2762-038-0 Benefit Details |
Fayette | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in IN - H2762-038-0 Benefit Details |
Hamilton | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in IN - H2762-038-0 Benefit Details |
Hancock | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in IN - H2762-038-0 Benefit Details |
Hendricks | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in IN - H2762-038-0 Benefit Details |
Johnson | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in IN - H2762-038-0 Benefit Details |
Madison | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in IN - H2762-038-0 Benefit Details |
Marion | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in IN - H2762-038-0 Benefit Details |
Morgan | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in IN - H2762-038-0 Benefit Details |
Putnam | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in IN - H2762-038-0 Benefit Details |
Scott | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in IN - H2762-038-0 Benefit Details |
Shelby | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in MA - H2762-038-0 Benefit Details |
Norfolk | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in MO - H2762-038-0 Benefit Details |
Audrain | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in MO - H2762-038-0 Benefit Details |
Callaway | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in MO - H2762-038-0 Benefit Details |
Cole | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in MO - H2762-038-0 Benefit Details |
Dade | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in MO - H2762-038-0 Benefit Details |
Iron | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in MO - H2762-038-0 Benefit Details |
Johnson | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in MO - H2762-038-0 Benefit Details |
Laclede | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in MO - H2762-038-0 Benefit Details |
Moniteau | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in MO - H2762-038-0 Benefit Details |
Osage | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in MO - H2762-038-0 Benefit Details |
Ozark | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in MO - H2762-038-0 Benefit Details |
Vernon | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in OH - H2762-038-0 Benefit Details |
Brown | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in OH - H2762-038-0 Benefit Details |
Butler | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in OH - H2762-038-0 Benefit Details |
Carroll | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in OH - H2762-038-0 Benefit Details |
Clark | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in OH - H2762-038-0 Benefit Details |
Clermont | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in OH - H2762-038-0 Benefit Details |
Columbiana | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in OH - H2762-038-0 Benefit Details |
Delaware | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in OH - H2762-038-0 Benefit Details |
Fairfield | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in OH - H2762-038-0 Benefit Details |
Franklin | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in OH - H2762-038-0 Benefit Details |
Greene | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in OH - H2762-038-0 Benefit Details |
Hamilton | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in OH - H2762-038-0 Benefit Details |
Jefferson | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in OH - H2762-038-0 Benefit Details |
Licking | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in OH - H2762-038-0 Benefit Details |
Madison | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in OH - H2762-038-0 Benefit Details |
Mahoning | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in OH - H2762-038-0 Benefit Details |
Miami | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in OH - H2762-038-0 Benefit Details |
Montgomery | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in OH - H2762-038-0 Benefit Details |
Muskingum | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in OH - H2762-038-0 Benefit Details |
Pickaway | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in OH - H2762-038-0 Benefit Details |
Preble | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in OH - H2762-038-0 Benefit Details |
Seneca | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in OH - H2762-038-0 Benefit Details |
Stark | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in OH - H2762-038-0 Benefit Details |
Trumbull | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in OH - H2762-038-0 Benefit Details |
Union | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in OH - H2762-038-0 Benefit Details |
Warren | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in SC - H2762-038-0 Benefit Details |
Berkeley | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in SC - H2762-038-0 Benefit Details |
Charleston | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in SC - H2762-038-0 Benefit Details |
Colleton | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in SC - H2762-038-0 Benefit Details |
Dorchester | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in SC - H2762-038-0 Benefit Details |
Hampton | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in SC - H2762-038-0 Benefit Details |
McCormick | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in SC - H2762-038-0 Benefit Details |
Newberry | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in TN - H2762-038-0 Benefit Details |
Maury | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in TN - H2762-038-0 Benefit Details |
Monroe | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in TN - H2762-038-0 Benefit Details |
Morgan | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in TN - H2762-038-0 Benefit Details |
Warren | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in TX - H2762-038-0 Benefit Details |
El Paso | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in TX - H2762-038-0 Benefit Details |
Maverick | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in TX - H2762-038-0 Benefit Details |
Nueces | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in TX - H2762-038-0 Benefit Details |
Presidio | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in TX - H2762-038-0 Benefit Details |
Wood | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in VT - H2762-038-0 Benefit Details |
Addison | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in VT - H2762-038-0 Benefit Details |
Bennington | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in VT - H2762-038-0 Benefit Details |
Caledonia | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in VT - H2762-038-0 Benefit Details |
Chittenden | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in VT - H2762-038-0 Benefit Details |
Essex | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in VT - H2762-038-0 Benefit Details |
Franklin | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in VT - H2762-038-0 Benefit Details |
Grand Isle | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in VT - H2762-038-0 Benefit Details |
Lamoille | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in VT - H2762-038-0 Benefit Details |
Orange | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in VT - H2762-038-0 Benefit Details |
Orleans | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in VT - H2762-038-0 Benefit Details |
Rutland | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in VT - H2762-038-0 Benefit Details |
Washington | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in VT - H2762-038-0 Benefit Details |
Windham | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in VT - H2762-038-0 Benefit Details |
Windsor | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in WA - H2762-038-0 Benefit Details |
Wahkiakum | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in WV - H2762-038-0 Benefit Details |
Cabell | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in WV - H2762-038-0 Benefit Details |
Calhoun | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in WV - H2762-038-0 Benefit Details |
Gilmer | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in WV - H2762-038-0 Benefit Details |
Hampshire | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in WV - H2762-038-0 Benefit Details |
Pleasants | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in WV - H2762-038-0 Benefit Details |
Ritchie | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in WV - H2762-038-0 Benefit Details |
Roane | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in WV - H2762-038-0 Benefit Details |
Tyler | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 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 | |||||||||
CIGNA Medicare Access Plus RX Plan Four (PFFS) in WV - H2762-038-0 Benefit Details |
Wetzel | $135.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | n/a Browse Formulary | |||||
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