2011 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) Additional 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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Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Adams | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Benson | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Billings | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Bottineau | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Bowman | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Burke | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Burleigh | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Cavalier | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Divide | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Dunn | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Eddy | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Emmons | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Foster | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Golden Valley | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Grant | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Hettinger | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Kidder | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Logan | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
McHenry | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
McIntosh | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
McKenzie | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
McLean | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Mercer | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Morton | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Mountrail | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Nelson | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Oliver | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Pembina | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Pierce | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Ramsey | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Renville | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Rolette | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Sheridan | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Sioux | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Slope | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Stark | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Towner | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Walsh | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Ward | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Wells | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in ND - H2410-018-0 Benefit Details |
Williams | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Aurora | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Beadle | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Bennett | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Bon Homme | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Brule | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Buffalo | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Butte | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Campbell | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Charles Mix | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Clark | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Clay | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Codington | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Corson | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Custer | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Davison | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Dewey | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Douglas | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Edmunds | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Fall River | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Faulk | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Gregory | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Haakon | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Hand | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Hanson | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Harding | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Hughes | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Hutchinson | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Hyde | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Jackson | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Jerauld | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Jones | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Kingsbury | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Lake | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Lawrence | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Lyman | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
McCook | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
McPherson | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Meade | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Mellette | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Miner | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Pennington | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Perkins | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Potter | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Sanborn | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Shannon | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Spink | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Stanley | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Sully | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Todd | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Tripp | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Turner | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Union | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Walworth | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Yankton | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Advantage Sol. Standard with Enhanced Rx (PFFS) in SD - H2410-018-0 Benefit Details |
Ziebach | $25.20 | $0 | Many Generics | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
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