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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Gundersen Lutheran Senior Pref. Value w/RX (HMO) in WI - H5262-003-0 Benefit Details |
Buffalo | $34.60 | $0 | No Gap Coverage | Tier 1 - Generic Drugs: $9.00 Tier 2 - Formulary Preferred Brand Drugs: $32.00 Tier 3 - Formulary Non-Preferred Brand Drugs: $87.00 Tier 4 - Specialty High Cost Drugs: 33% | n/a Browse Formulary | |||||
Gundersen Lutheran Senior Pref. Value w/RX (HMO) in WI - H5262-003-0 Benefit Details |
Crawford | $34.60 | $0 | No Gap Coverage | Tier 1 - Generic Drugs: $9.00 Tier 2 - Formulary Preferred Brand Drugs: $32.00 Tier 3 - Formulary Non-Preferred Brand Drugs: $87.00 Tier 4 - Specialty High Cost Drugs: 33% | n/a Browse Formulary | |||||
Gundersen Lutheran Senior Pref. Value w/RX (HMO) in WI - H5262-003-0 Benefit Details |
Grant | $34.60 | $0 | No Gap Coverage | Tier 1 - Generic Drugs: $9.00 Tier 2 - Formulary Preferred Brand Drugs: $32.00 Tier 3 - Formulary Non-Preferred Brand Drugs: $87.00 Tier 4 - Specialty High Cost Drugs: 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 | |||||||||
Gundersen Lutheran Senior Pref. Value w/RX (HMO) in WI - H5262-003-0 Benefit Details |
Jackson | $34.60 | $0 | No Gap Coverage | Tier 1 - Generic Drugs: $9.00 Tier 2 - Formulary Preferred Brand Drugs: $32.00 Tier 3 - Formulary Non-Preferred Brand Drugs: $87.00 Tier 4 - Specialty High Cost Drugs: 33% | n/a Browse Formulary | |||||
Gundersen Lutheran Senior Pref. Value w/RX (HMO) in WI - H5262-003-0 Benefit Details |
Juneau | $34.60 | $0 | No Gap Coverage | Tier 1 - Generic Drugs: $9.00 Tier 2 - Formulary Preferred Brand Drugs: $32.00 Tier 3 - Formulary Non-Preferred Brand Drugs: $87.00 Tier 4 - Specialty High Cost Drugs: 33% | n/a Browse Formulary | |||||
Gundersen Lutheran Senior Pref. Value w/RX (HMO) in WI - H5262-003-0 Benefit Details |
La Crosse | $34.60 | $0 | No Gap Coverage | Tier 1 - Generic Drugs: $9.00 Tier 2 - Formulary Preferred Brand Drugs: $32.00 Tier 3 - Formulary Non-Preferred Brand Drugs: $87.00 Tier 4 - Specialty High Cost Drugs: 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 | |||||||||
Gundersen Lutheran Senior Pref. Value w/RX (HMO) in WI - H5262-003-0 Benefit Details |
Monroe | $34.60 | $0 | No Gap Coverage | Tier 1 - Generic Drugs: $9.00 Tier 2 - Formulary Preferred Brand Drugs: $32.00 Tier 3 - Formulary Non-Preferred Brand Drugs: $87.00 Tier 4 - Specialty High Cost Drugs: 33% | n/a Browse Formulary | |||||
Gundersen Lutheran Senior Pref. Value w/RX (HMO) in WI - H5262-003-0 Benefit Details |
Richland | $34.60 | $0 | No Gap Coverage | Tier 1 - Generic Drugs: $9.00 Tier 2 - Formulary Preferred Brand Drugs: $32.00 Tier 3 - Formulary Non-Preferred Brand Drugs: $87.00 Tier 4 - Specialty High Cost Drugs: 33% | n/a Browse Formulary | |||||
Gundersen Lutheran Senior Pref. Value w/RX (HMO) in WI - H5262-003-0 Benefit Details |
Sauk | $34.60 | $0 | No Gap Coverage | Tier 1 - Generic Drugs: $9.00 Tier 2 - Formulary Preferred Brand Drugs: $32.00 Tier 3 - Formulary Non-Preferred Brand Drugs: $87.00 Tier 4 - Specialty High Cost Drugs: 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 | |||||||||
Gundersen Lutheran Senior Pref. Value w/RX (HMO) in WI - H5262-003-0 Benefit Details |
Trempealeau | $34.60 | $0 | No Gap Coverage | Tier 1 - Generic Drugs: $9.00 Tier 2 - Formulary Preferred Brand Drugs: $32.00 Tier 3 - Formulary Non-Preferred Brand Drugs: $87.00 Tier 4 - Specialty High Cost Drugs: 33% | n/a Browse Formulary | |||||
Gundersen Lutheran Senior Pref. Value w/RX (HMO) in WI - H5262-003-0 Benefit Details |
Vernon | $34.60 | $0 | No Gap Coverage | Tier 1 - Generic Drugs: $9.00 Tier 2 - Formulary Preferred Brand Drugs: $32.00 Tier 3 - Formulary Non-Preferred Brand Drugs: $87.00 Tier 4 - Specialty High Cost Drugs: 33% | n/a Browse Formulary | |||||
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