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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Aetna Medicare Open Value Plan w/Rx (PFFS) in IL - H5736-025-0 Benefit Details |
Henry | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in IL - H5736-025-0 Benefit Details |
Rock Island | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Allen | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - 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 | |||||||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Ashland | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Ashtabula | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Athens | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - 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 | |||||||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Auglaize | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Carroll | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Clinton | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - 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 | |||||||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Coshocton | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Crawford | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Cuyahoga | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - 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 | |||||||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Defiance | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Erie | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Franklin | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - 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 | |||||||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Fulton | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Gallia | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Hancock | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - 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 | |||||||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Hardin | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Harrison | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Henry | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - 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 | |||||||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Highland | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Huron | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Jackson | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - 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 | |||||||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Jefferson | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Knox | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Lake | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - 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 | |||||||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Logan | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Lorain | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Lucas | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - 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 | |||||||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Mahoning | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Medina | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Meigs | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - 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 | |||||||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Mercer | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Ottawa | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Paulding | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - 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 | |||||||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Pike | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Portage | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Putnam | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - 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 | |||||||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Richland | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Ross | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Sandusky | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - 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 | |||||||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Scioto | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Seneca | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Shelby | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - 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 | |||||||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Stark | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Summit | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Trumbull | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - 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 | |||||||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Tuscarawas | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Van Wert | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Vinton | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - 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 | |||||||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Wayne | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Williams | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Wood | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - 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 | |||||||||
Aetna Medicare Open Value Plan w/Rx (PFFS) in OH - H5736-025-0 Benefit Details |
Wyandot | $78.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
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