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 - H7917-007-0 Benefit Details |
Anderson | $0.00 | $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 - H7917-007-0 Benefit Details |
Blount | $0.00 | $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 - H7917-007-0 Benefit Details |
Campbell | $0.00 | $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 - H7917-007-0 Benefit Details |
Carter | $0.00 | $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 - H7917-007-0 Benefit Details |
Claiborne | $0.00 | $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 - H7917-007-0 Benefit Details |
Cocke | $0.00 | $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 - H7917-007-0 Benefit Details |
Grainger | $0.00 | $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 - H7917-007-0 Benefit Details |
Greene | $0.00 | $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 - H7917-007-0 Benefit Details |
Hamblen | $0.00 | $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 - H7917-007-0 Benefit Details |
Hancock | $0.00 | $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 - H7917-007-0 Benefit Details |
Hawkins | $0.00 | $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 - H7917-007-0 Benefit Details |
Jefferson | $0.00 | $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 - H7917-007-0 Benefit Details |
Johnson | $0.00 | $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 - H7917-007-0 Benefit Details |
Knox | $0.00 | $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 - H7917-007-0 Benefit Details |
Loudon | $0.00 | $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 - H7917-007-0 Benefit Details |
Morgan | $0.00 | $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 - H7917-007-0 Benefit Details |
Overton | $0.00 | $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 - H7917-007-0 Benefit Details |
Roane | $0.00 | $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 - H7917-007-0 Benefit Details |
Scott | $0.00 | $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 - H7917-007-0 Benefit Details |
Sevier | $0.00 | $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 - H7917-007-0 Benefit Details |
Sullivan | $0.00 | $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 - H7917-007-0 Benefit Details |
Unicoi | $0.00 | $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 - H7917-007-0 Benefit Details |
Union | $0.00 | $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 - H7917-007-0 Benefit Details |
Warren | $0.00 | $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 - H7917-007-0 Benefit Details |
Washington | $0.00 | $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 - H7917-007-0 Benefit Details |
White | $0.00 | $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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