2010 Medicare Part D Contract ID/Plan ID Search

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2010 Medicare Part D Contract ID/Plan ID Search

This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

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**There are 239 2010 Medicare Advantage plans (MAPD) meeting your criteria.**
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	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
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Alamance	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Alexander	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Alleghany	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Anson	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Ashe	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Avery	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Beaufort	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Bertie	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Bladen	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Brunswick	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Buncombe	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Burke	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Cabarrus	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Caldwell	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Camden	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Carteret	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Caswell	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Catawba	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Chatham	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Cherokee	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Chowan	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Clay	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Cleveland	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Columbus	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Craven	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Cumberland	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Currituck	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Dare	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Davidson	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Davie	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Duplin	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Durham	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Edgecombe	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Forsyth	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Franklin	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Gaston	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Gates	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Graham	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Granville	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Greene	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Guilford	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Halifax	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Harnett	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Haywood	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Henderson	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Hertford	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Hoke	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Hyde	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Iredell	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Jackson	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Johnston	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Jones	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Lee	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Lenoir	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Lincoln	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Macon	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Madison	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Martin	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			McDowell	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Mecklenburg	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Mitchell	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Montgomery	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Moore	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Nash	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			New Hanover	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Northampton	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Onslow	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Orange	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Pamlico	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Pasquotank	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Pender	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Perquimans	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Person	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Pitt	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Polk	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Randolph	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Richmond	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Robeson	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Rockingham	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Rowan	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Rutherford	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Sampson	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Scotland	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Stanly	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Statewide	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Stokes	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Surry	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Swain	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Transylvania	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Tyrrell	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Union	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Vance	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Wake	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Warren	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Washington	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Watauga	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Wayne	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Wilkes	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Wilson	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Yadkin	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in NC - R5826-079-0 Benefit Details			Yancey	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Accomack	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Albemarle	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Alexandria City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Alleghany	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Amelia	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Amherst	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Appomattox	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Arlington	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Augusta	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Bath	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Bedford	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Bedford City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Bland	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Botetourt	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Bristol City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Brunswick	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Buchanan	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Buckingham	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Buena Vista City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Campbell	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Caroline	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Carroll	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Charles City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Charlotte	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Charlottesville City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Chesapeake City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Chesterfield	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Clarke	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Clifton Forge City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Colonial Heights City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Covington City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Craig	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Culpeper	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Cumberland	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Danville City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Dickenson	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Dinwiddie	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Emporia City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Essex	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Fairfax	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Fairfax City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Falls Church City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Fauquier	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Floyd	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Fluvanna	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Franklin	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Franklin City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Frederick	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Fredericksburg City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Galax City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Giles	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Gloucester	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Goochland	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Grayson	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Greene	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Greensville	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Halifax	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Hampton City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Hanover	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Harrisonburg City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Henrico	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Henry	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Highland	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Hopewell City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Isle of Wight	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			James City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			King and Queen	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			King George	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			King William	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Lancaster	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Lee	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Lexington City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Loudoun	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Louisa	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Lunenburg	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Lynchburg City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Madison	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Manassas City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Manassas Park City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Martinsville City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Mathews	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Mecklenburg	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Middlesex	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Montgomery	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Nansemond City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Nelson	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			New Kent	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Newport News City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Norfolk City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Northampton	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Northumberland	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Norton City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Nottoway	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Orange	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Page	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Patrick	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Petersburg City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Pittsylvania	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Poquoson City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Portsmouth City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Powhatan	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Prince Edward	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Prince George	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Prince William	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Pulaski	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Radford City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Rappahannock	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Richmond	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Richmond City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Roanoke	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Roanoke City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Rockbridge	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Rockingham	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Russell	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Salem City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Scott	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Shenandoah	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Smyth	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			South Boston City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Southampton	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Spotsylvania	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Stafford	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Statewide	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Staunton City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Suffolk City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Surry	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Sussex	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Tazewell	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Virginia Beach City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Warren	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Washington	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Waynesboro City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Westmoreland	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Williamsburg City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Winchester City	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Wise	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 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	County	Monthly Prem.	Deduct- ible	Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			Wythe	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

HumanaChoice R5826-079 (Regional PPO) in VA - R5826-079-0 Benefit Details			York	$56.00	$310	No Gap Coverage	Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25%	n/a Browse Formulary

Chart Legend:

Below are a few notes to help with the understanding of the 2010 Medicare Part D Prescription Drug Plan chart above and Search Tips to help you narrow down your list of plans to those that best meet your needs.

A few notes to help with the understanding of the 2010 Medicare Part D Prescription Drug Plan chart above and Search Tips to help you narrow down your list of plans to those that best meet your needs.

Plan Name: This is the official plan name from the Centers for Medicare and Medicaid Services (CMS). The same plan name generally has a different plan id in each state. (Search Tip: If you would like to reduce the plans shown to just plans for one or two specific carriers, you can select the carrier name in the "Plan Family" fields 1 and 2. Select the empty (blank) option at the top of the list to remove the criteria. You can also click the "National Plans" checkbox to limit your search to just national plans.)

CMS Plan Ratings: these are found under the Plan Name at the left side of the chart.

This is a 1 to 5 star rating system with five (5) stars as excellent, four (4) stars as very good, three (3) stars as good, two (2) stars as fair and one (1) star as poor. (updated: November 2009)

Cust. Service Rating - Drug Plan Customer Service - Medicare and members rate the drug plan and how well a drug plan provides customer service.

This category includes measures of how drug plans rate on the following areas:
- Time on Hold When Customer and Pharmacist Calls Drug Plan.
- Calls Disconnected When Customer and Pharmacist Calls Drug Plan.
- Drug Plan’s Timeliness in Giving a Decision for Members Who Make an Appeal.
- Fairness of Drug Plan’s Denials to a Member’s Appeal, Based on an Independent Reviewer.

Member Plan Exper. - Member Experience with Drug Plan - This category shows how well drug plans make prescription drugs available to their members.

This category includes measures of how drug plans rate on the following areas:
- Drug Plan Provides Information or Help When Members Need It.
- Members’ Overall Rating of Drug Plan.
- Members’ Ability to Get Prescriptions Filled Easily When Using the Drug Plan.

RxCost Info Rating - This category shows how well drug plans are doing with pricing prescriptions and providing information on the Medicare website.

This category includes measures of how drug plans rate on the following areas:
- Completeness of the Drug Plan’s Information on Members Who Need Extra Help.
- Drug Plan Provides Current Information on Costs and Coverage for Medicare’s Website (the same data is used on this Q1Medicare.com).
- Drug Plan’s Prices that Did Not Increase More Than Expected During the Year.
- Drug Plan’s Prices on Medicare’s Website (and this website) Are Similar to the Prices Members Pay at the Pharmacy.
- Drug Plan’s Members 65 and Older Who Received Prescriptions for Certain Drugs with a High Risk of Side Effects, when There May Be Safer Drug Choices.

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Monthly Premium: This is the amount you must pay each month to use the plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase. (Search Tip: If you would like to reduce the plans shown to just plans under a certain premium, enter this value in the "Maximum Premium" field.)
Deductible: This is the $310 deductible that was presented in the CMS Standard Plan. Many provider’s plans do not have a deductible, however the premium may be higher. (Search Tip: If you would like to reduce the plans shown to just plans with a deductible under a certain value, enter this value in the "Maximum Deductible field" field.)
Gap Coverage: the Donut Hole: In the CMS Standard Plan, the beneficiary must pay the next $3610 in drug costs (the Donut Hole). Many provider’s plans cover the costs that fall into this category for an additional premium. In our chart, you will see one of the following:
- No Gap Coverage: you must pay the $3610;
- Some Generics: 10% to 65% of formulary generics are covered, but you must pay for Brand Drugs up to $3610;
- Many Generics: 65% to 100% of formulary generics are covered, but you must pay for Brand Drugs up to $3610;
- All Generics : All formulary Generics are covered, but you must pay for Brand Drugs up to $3610;
- All Generics & Few Brands: One regional plan (Alliance Medicare RX), only available in Michigan covers all Generics and a few (less than 10%) of Brand drugs on the plan’s formulary.
- Many Generics & Few Brands: two regional plans, only available in Florida (Quality Rx Plus) and Wisconsin (DeanCare Rx Enhanced) cover many Generics (65%-100% of formulary generics) and a few (less than 10%) of formulary Brands. (Search Tip: If you would like to reduce the plans shown to just plans with a certain type of gap coverage, select this type of coverage in the "Type of Gap Coverage" field.)
$0 Premium with Full LIS - Does the plan Qualify for $0 Premium with Full Low-Income Subsidy?: If Yes is in the field, then you would pay a $0 premium if you have a Full Low-Income Subsidy (LIS). If No is in the field, then you would be responsible for the difference between what the state provides as the Full Low-Income Subsidy and the actual cost of the plan even if you have a Full Low-Income Subsidy. (Search Tip: If you would like to reduce the plans shown to just plans that qualify for the $0 premium (Benchmark plans), select "Yes..." in the "Full Low-Income Subsidy?" field.)
Plan ID: This is the unique id for this particular plan.

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Copay / Coinsurance - Cost Sharing - These figures apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in "tiers". Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on the drug’s tier. Plans can form their own tiers, so you should contact the plan or reference their summary of benefits to find out what copays and limitations are associated with each tier. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. (Search Tip: If you would like to reduce the plans shown to just plans that have a tier 1 (Generics) co-pay of up to a certain value (ex: $0 co-pay), enter the value (ex: 0) in the "Max. Co-pay Tier 1 (Generics)" field.)

Additional Information Fields:
You can select one of the following additional pieces of plan information to display (Search Tip: to change the type of information shown in the last column of the chart, select the data to be shown in the "Additional Info" field.)

Total Formulary Drugs (default) - This is the total number of medications on the plans formulary or drug list. For 2009 Medicare Part D plans, the smallest formulary is the Geisinger Gold Rx 1 plan formulary in PA and WV with 1,994 total medications and the largest formulary is the AARP Enhanced and Preferred plans’ formulary (all states) with 5,218 total formulary drugs. This total drug count does not include "Bonus Drugs". These are non-Medicare Part D drugs which are covered by the plan, however they do not count toward your plan deductible, retail drug cost, or TrOOP.
Offers Mail Order - "Yes" is displayed if this plan offers mail order on any medications. It does NOT mean that ALL medications are available through mail order.
Members in This State (updated: September 2010 figures) - This is the total number of members in this plan for this CMS Region. For regions which contain more than one state, this is the total for all of those states combined. We are showing the latest Medicare Part D plan enrollment figures. We update this figure as new enrollment statistics are released by Medicare.
Members Nation Wide (updated: September 20109 figures) - This is the total number of member for this plan in all CMS Regions (States) combined. We are showing the latest Medicare Part D plan enrollment figures. We update this figure as new enrollment statistics are released by Medicare.

Initial Coverage Limit (ICL) - The initial coverage limit phase of a Medicare Part D plan is the phase AFTER the initial deductible is met (if the plan has an initial deductible) and BEFORE the coverage gap (or donut hole) begins. The ICL is the phase of the prescription drug plan during which you and your plan share your prescription costs. During this phase you will pay either a co-payment (a flat fee per prescription) or co-insurance (a percentage of the drug cost). The details of the cost-sharing for the plan are shown in the Cost-Sharing column directly to the left of this column. The CMS standard Initial Coverage Limit for 2010 is $2830 and increases each year.
National or Regional Plans - This column simply displays the word "National" if the plan is sponsored by a national carrier or "Regional" if the plan sponsor is a regional carrier.

(Chart Source: various files provided by the Centers for Medicare and Medicaid Services along with data from the Medicare.gov website plan finder.)

Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, we cannot guarantee the accuracy of this information.

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