2010 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
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 |
|||||||||
Any, Any, Any MA Only (PFFS) in AZ - H5820-028-0 Benefit Details |
Cochise | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in AZ - H5820-028-0 Benefit Details |
Graham | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in AZ - H5820-028-0 Benefit Details |
Greenlee | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in AZ - H5820-028-0 Benefit Details |
Mohave | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in FL - H5820-028-0 Benefit Details |
Baker | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in FL - H5820-028-0 Benefit Details |
Hardee | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in FL - H5820-028-0 Benefit Details |
Indian River | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in FL - H5820-028-0 Benefit Details |
Leon | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in FL - H5820-028-0 Benefit Details |
Polk | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in FL - H5820-028-0 Benefit Details |
Volusia | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in FL - H5820-028-0 Benefit Details |
Wakulla | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in GA - H5820-028-0 Benefit Details |
Baldwin | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in GA - H5820-028-0 Benefit Details |
Bartow | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in GA - H5820-028-0 Benefit Details |
Brooks | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in GA - H5820-028-0 Benefit Details |
Burke | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in GA - H5820-028-0 Benefit Details |
Charlton | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in GA - H5820-028-0 Benefit Details |
Columbia | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in GA - H5820-028-0 Benefit Details |
Decatur | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in GA - H5820-028-0 Benefit Details |
Douglas | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in GA - H5820-028-0 Benefit Details |
Echols | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in GA - H5820-028-0 Benefit Details |
Fannin | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in GA - H5820-028-0 Benefit Details |
Grady | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in GA - H5820-028-0 Benefit Details |
Haralson | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in GA - H5820-028-0 Benefit Details |
Henry | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in GA - H5820-028-0 Benefit Details |
Liberty | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in GA - H5820-028-0 Benefit Details |
Morgan | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in GA - H5820-028-0 Benefit Details |
Peach | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in GA - H5820-028-0 Benefit Details |
Rockdale | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in GA - H5820-028-0 Benefit Details |
Talbot | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in GA - H5820-028-0 Benefit Details |
Towns | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in GA - H5820-028-0 Benefit Details |
Treutlen | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in GA - H5820-028-0 Benefit Details |
Warren | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in GA - H5820-028-0 Benefit Details |
Wilkes | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in LA - H5820-028-0 Benefit Details |
East Baton Rouge | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in LA - H5820-028-0 Benefit Details |
Rapides | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in LA - H5820-028-0 Benefit Details |
Sabine | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in LA - H5820-028-0 Benefit Details |
St. Helena | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in LA - H5820-028-0 Benefit Details |
Vermilion | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in LA - H5820-028-0 Benefit Details |
Webster | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in LA - H5820-028-0 Benefit Details |
West Carroll | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
Attala | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
Benton | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
Claiborne | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
Copiah | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
Franklin | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
George | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
Grenada | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
Hancock | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
Harrison | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
Hinds | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
Holmes | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
Issaquena | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
Jackson | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
Lafayette | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
Leake | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
Madison | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
Marshall | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
Montgomery | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
Neshoba | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
Oktibbeha | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
Pearl River | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
Pike | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
Quitman | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
Rankin | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
Scott | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
Tate | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
Tippah | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
Wilkinson | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in MS - H5820-028-0 Benefit Details |
Yazoo | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in NV - H5820-028-0 Benefit Details |
Lincoln | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in NV - H5820-028-0 Benefit Details |
Mineral | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in PA - H5820-028-0 Benefit Details |
Adams | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in PA - H5820-028-0 Benefit Details |
Allegheny | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in PA - H5820-028-0 Benefit Details |
Armstrong | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in PA - H5820-028-0 Benefit Details |
Butler | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in PA - H5820-028-0 Benefit Details |
Chester | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in PA - H5820-028-0 Benefit Details |
Franklin | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in PA - H5820-028-0 Benefit Details |
Greene | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in PA - H5820-028-0 Benefit Details |
Huntingdon | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in PA - H5820-028-0 Benefit Details |
Juniata | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in PA - H5820-028-0 Benefit Details |
McKean | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in PA - H5820-028-0 Benefit Details |
Montour | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in PA - H5820-028-0 Benefit Details |
Northumberland | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in PA - H5820-028-0 Benefit Details |
Potter | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in PA - H5820-028-0 Benefit Details |
Susquehanna | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in PA - H5820-028-0 Benefit Details |
Warren | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in PA - H5820-028-0 Benefit Details |
Wayne | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in PA - H5820-028-0 Benefit Details |
Westmoreland | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in SC - H5820-028-0 Benefit Details |
Cherokee | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in SC - H5820-028-0 Benefit Details |
McCormick | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in SC - H5820-028-0 Benefit Details |
Saluda | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Borden | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Bowie | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Brewster | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Brown | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Collingsworth | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Comanche | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Culberson | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Dawson | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Deaf Smith | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Edwards | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Goliad | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Hudspeth | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Hunt | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Irion | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Karnes | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Kendall | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Kent | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
King | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
La Salle | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Lynn | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Matagorda | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Midland | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Mills | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Montgomery | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Nueces | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Oldham | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Parmer | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Presidio | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Reeves | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
San Augustine | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Shelby | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Swisher | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Terry | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Tyler | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Val Verde | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Victoria | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Winkler | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Wise | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in TX - H5820-028-0 Benefit Details |
Wood | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in UT - H5820-028-0 Benefit Details |
Iron | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in UT - H5820-028-0 Benefit Details |
Piute | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in UT - H5820-028-0 Benefit Details |
Rich | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in UT - H5820-028-0 Benefit Details |
Salt Lake | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Any, Any, Any MA Only (PFFS) in UT - H5820-028-0 Benefit Details |
Uintah | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Any, Any, Any MA Only (PFFS) in UT - H5820-028-0 Benefit Details |
Weber | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|