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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BlueAdvantage Sapphire (PPO) in TN - H7917-004-0 Benefit Details |
Benton | $42.00 | $0 | No Gap Coverage | Tier 1: $2.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $65.00 Tier 5: 33% | n/a Browse Formulary | |||||
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BlueAdvantage Sapphire (PPO) in TN - H7917-004-0 Benefit Details |
Carroll | $42.00 | $0 | No Gap Coverage | Tier 1: $2.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $65.00 Tier 5: 33% | n/a Browse Formulary | |||||
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BlueAdvantage Sapphire (PPO) in TN - H7917-004-0 Benefit Details |
Chester | $42.00 | $0 | No Gap Coverage | Tier 1: $2.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $65.00 Tier 5: 33% | n/a Browse Formulary | |||||
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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 | |||||||||
BlueAdvantage Sapphire (PPO) in TN - H7917-004-0 Benefit Details |
Crockett | $42.00 | $0 | No Gap Coverage | Tier 1: $2.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $65.00 Tier 5: 33% | n/a Browse Formulary | |||||
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BlueAdvantage Sapphire (PPO) in TN - H7917-004-0 Benefit Details |
Dyer | $42.00 | $0 | No Gap Coverage | Tier 1: $2.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $65.00 Tier 5: 33% | n/a Browse Formulary | |||||
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BlueAdvantage Sapphire (PPO) in TN - H7917-004-0 Benefit Details |
Gibson | $42.00 | $0 | No Gap Coverage | Tier 1: $2.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $65.00 Tier 5: 33% | n/a Browse Formulary | |||||
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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 | |||||||||
BlueAdvantage Sapphire (PPO) in TN - H7917-004-0 Benefit Details |
Hardeman | $42.00 | $0 | No Gap Coverage | Tier 1: $2.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $65.00 Tier 5: 33% | n/a Browse Formulary | |||||
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BlueAdvantage Sapphire (PPO) in TN - H7917-004-0 Benefit Details |
Hardin | $42.00 | $0 | No Gap Coverage | Tier 1: $2.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $65.00 Tier 5: 33% | n/a Browse Formulary | |||||
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BlueAdvantage Sapphire (PPO) in TN - H7917-004-0 Benefit Details |
Haywood | $42.00 | $0 | No Gap Coverage | Tier 1: $2.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $65.00 Tier 5: 33% | n/a Browse Formulary | |||||
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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 | |||||||||
BlueAdvantage Sapphire (PPO) in TN - H7917-004-0 Benefit Details |
Henderson | $42.00 | $0 | No Gap Coverage | Tier 1: $2.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $65.00 Tier 5: 33% | n/a Browse Formulary | |||||
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BlueAdvantage Sapphire (PPO) in TN - H7917-004-0 Benefit Details |
Lake | $42.00 | $0 | No Gap Coverage | Tier 1: $2.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $65.00 Tier 5: 33% | n/a Browse Formulary | |||||
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BlueAdvantage Sapphire (PPO) in TN - H7917-004-0 Benefit Details |
Lauderdale | $42.00 | $0 | No Gap Coverage | Tier 1: $2.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $65.00 Tier 5: 33% | n/a Browse Formulary | |||||
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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 | |||||||||
BlueAdvantage Sapphire (PPO) in TN - H7917-004-0 Benefit Details |
Madison | $42.00 | $0 | No Gap Coverage | Tier 1: $2.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $65.00 Tier 5: 33% | n/a Browse Formulary | |||||
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BlueAdvantage Sapphire (PPO) in TN - H7917-004-0 Benefit Details |
McNairy | $42.00 | $0 | No Gap Coverage | Tier 1: $2.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $65.00 Tier 5: 33% | n/a Browse Formulary | |||||
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BlueAdvantage Sapphire (PPO) in TN - H7917-004-0 Benefit Details |
Obion | $42.00 | $0 | No Gap Coverage | Tier 1: $2.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $65.00 Tier 5: 33% | n/a Browse Formulary | |||||
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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 | |||||||||
BlueAdvantage Sapphire (PPO) in TN - H7917-004-0 Benefit Details |
Shelby | $42.00 | $0 | No Gap Coverage | Tier 1: $2.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $65.00 Tier 5: 33% | n/a Browse Formulary | |||||
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BlueAdvantage Sapphire (PPO) in TN - H7917-004-0 Benefit Details |
Tipton | $42.00 | $0 | No Gap Coverage | Tier 1: $2.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $65.00 Tier 5: 33% | n/a Browse Formulary | |||||
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BlueAdvantage Sapphire (PPO) in TN - H7917-004-0 Benefit Details |
Weakley | $42.00 | $0 | No Gap Coverage | Tier 1: $2.00 Tier 2: $10.00 Tier 3: $45.00 Tier 4: $65.00 Tier 5: 33% | n/a Browse Formulary | |||||
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